Lung cancer: clinical features and staging

Question 1

specific symptoms of metastatic lung cancer (4)

Answer 1

Bone pain
Spinal cord compression
Cerebral metastases
Thrombosis

Question 2

spinal cord compression can cause what

Answer 2

Limb weakness
Paraesthesia (abnormal sensation, typically tingling or pricking)
Bladder/bowel dysfunction

Question 3

what is paraesthesia

Answer 3

abnormal sensation, typically tingling or pricking- nerve damage

Question 4

6 red flags indicating lung cancer in smokers

Answer 4

Cough for 2 to 3 weeks
Coughing blood
Repeated chest infection 
Shoulder pain 
Change in voice 
Unexplained weight loss

Question 5

clinical signs of lung cancer (8) N.B think whole body!

Answer 5

Chest signs
Clubbing
Lymphadenopathy
Horner’s syndrome
Pancoast tumour - tumour at apex of lung so at the top - typically spreads to nearby tissues such as the ribs and vertebrae

Superior vena cava obstruction
Lymphadenopathy
Hepatomegaly
Skin nodules - tumour invading chest wall

Question 6

bad signs in examination of chest

Answer 6

Increase in air in one side of the lung

Fluid collection around the lung or obstruction of airways

Question 7

what can facial swelling be caused by

Answer 7

obstruction of superior vena cava

Question 8

what initial investigations are undergone for suspected lung cancer

Answer 8

Chest xray (CXR)
FBC full blood count
Renal, Liver functions
and Calcium
Clotting screen
Spirometry

Question 9

when is a patient referred for a CT scan to examine their chest?

Answer 9

once the x-ray comes back as looking abnormal

Question 10

investigations done for lung cancer (7)

Answer 10

Bronchoscopy (camera to look at airways

Image guided lung biopsy - either by CT, fluoroscopy, ultrasound (Endobronchial-EBUS) or MRI - obtain tissue or fluid samples from the lungs and surrounding lymph nodes without conventional surgery

Image guided liver biopsy

Fine needle aspiration of neck node or skin metastasis

Bone biopsy

Mediastinoscopy/otomy

Surgical excision biopsy - cerebral metastasis (whole tumour is removed in excision)

Question 11

which main 3 tests/investigations do 85% of patients undergo

Answer 11

bronchoscopy
Endobronchial ultrasound EBUS
image guided lung biopsy CT, fluoroscopy or ultrasound

Question 12

palliative treatment means?

Answer 12

usually stage 3 or 4
know you can’t cure
it is to prolong life and control symptoms