Lung cancer: clinical features and staging

Question 1

What is the risk factors for lung cancers

Answer 1

• Smoking (more than 85%)
• Passive smoking
• Exposure to Asbestos, Radon, air pollution,
and diesel exhaust

Question 2

What is the leading cause of cancer death in men and women

Answer 2

Lung cancer

Question 3

What is the clinical signs of lung cancer

Answer 3

• Chest signs
• Clubbing
• Horner’s syndrome
• Pancoast tumour
• Superior vena cava
obstruction
• Lymphadenopathy
• Hepatomegaly
• Skin nodules (metastases)


Question 4

What is the symptoms of lung cancer

Answer 4

Chronic cough 
coughing up blood 
wheezing 
Chest and bone pain 
Chest infection
Difficulty swalloing 
Raspy horse voice 
Shortness of breath
Unexplained weight loss

Question 5

What is advanced metastatic lung cancer symptoms - when the lung cancer spreads

Answer 5

Bone pain
Spinal chord compression
Cerebral metastases
Thrombosis

Question 6

What symptoms can a cerebral metastases cause

Answer 6

– Headache
– Vomiting
– Dizziness
– Ataxia
– Focal weakness

Question 7

What is the initial investigations for lung cancer

Answer 7

Chest ray - most common 
CT scan - thorax + abdomen 
Kidney function test 
Full blood count - 
Check calcium 
Spirometry - asses lung function 
Clotting screen - abnormal/normal

Question 8

What is the best screening tool for lung cancer

Answer 8

chest X ray

Question 9

What is examples of tissue diagnnosis

Answer 9

• Bronchoscopy - 
• Fine needle aspiration/biopsy 
• FNA of neck node or skin metastasis
• Mediastinoscopy/otomy
- EBUS

Question 10

How does a bronchoscopy work

Answer 10

Tube passed into airway while patient is under anesthetic

Question 11

When do we do bronchoscopy

Answer 11

Tumour on the CT scan

Question 12

What is the different histological types of lung cancerr

Answer 12

Small cell carcinoma
adenocarcinoma - non smoker
Squamous cell carcinoma
Large cell carcinoma

Question 13

What type of cell type is non smokers and has a good prognosis

Answer 13

adenocaricinoma

Question 14

How many stages of lung cancer is there

Answer 14

4

Question 15

What is staging categories based on

Answer 15

Nodes and metastasis

Question 16

What does the prognosis depend on

Answer 16

staging and cell type

Question 17

Curative treatment can only be offered to what staging

Answer 17

1 + 2

Question 18

What cell type has the worst prognosis

Answer 18

small cell carcinoma

Question 19

What is mandatory to determine if there is further staging (or patients going for surgery)

Answer 19

CT

PET scan

Question 20

What is treatment decisions based on?

Answer 20

• Performance status
• Patient wishes
• Histological type and stage
• Multi disciplinary team
• Aims of treatment e.g. radical or palliative

Question 21

What is the performance statement ranking?

Answer 21

• 0 = fully active
• 1 = symptoms but ambulatory
• 2 = “up and about” > 50%, unable to work
• 3 = “up and about” < 50%, limited self care
• 4 = bed or chair bound

Question 22

What is the treatment for lung cancer

Answer 22

Surgery
radio therapy
chemotherapy
best supportive care - just treat symptoms
Co-ordination - lung cancer specialist nurse
palliative care

Question 23

What is palliative management

Answer 23

symptom control - chemotherapy/radiotherapy, opiates
improve quality of life
offer community support

Question 24

If the X-ray is abnormal where do you refer

Answer 24

respiratory clinical for CT scan

Question 25

What is the different surgical treatments of lung cancer

Answer 25

Wedge resection
Lobectomy
Pneumonectomy