lung cancer lms

Question 1

other risk factors for lung cancer

Answer 1

pulmonary fibrosis
exposure to environmental tobacco smoke
HIV infection
genetic factors: arsenic, radon gas

Question 2

non small cell lung cancer

Answer 2

85% of cases
- adenocarcinoma (50%)
- squamous cell (30%)
- large cell (undifferentiated)

Question 3

small cell carcinoma

Answer 3

15% of cases

Question 4

adenocarcinoma.

Answer 4

further subdivided into moldecular phenotypes
drugs targeted to specific phenotypes being developed
EGFR is the mot common and can be treated with tyrosine kinase inhibitors

Question 5

common presentations

Answer 5

• new perisstant cough +/- haemoptysis
  most patients with haemoptysis have something other than lung cancer, but the presence is still a red flag
  breathlessness - cancer may be causing pleural effusion, obstruction or lobar collapse
  weight loss, fatigue, non specific symptoms
  bone pain

Question 6

incidental CXR

Answer 6

increasingly patients are picked upp on incidental CXR or CT
follow up incidental lung nodules

Question 7

classical presenting syndromes

Answer 7

pancoasts tumour - tumour in the apex of the lung erodes into the brachial plexus and patient presents with horner syndrome due to loss of sympathetic innervation, pain and muscle wasting in the arm or hand
superior vena cava obstruction - central tumour in the mediastinum eroding into venous return from the head and neck
left recurrent leryngeal nerve palsy - tumour at left hilum causes hoarseness of the voice
bone mets - causes hypercalcaemia, poor prognostic faeture

Question 8

pancoasts tumour

Answer 8

tumour in the apex of the lung erodes into the brachial plexus and patient presents with horner syndrome due to loss of sympathetic innervation, pain and muscle wasting in the arm or hand

Question 9

SIADH

Answer 9

syndrome of innappropriate ADH
leads to hyponatraemia

Question 10

tumour in the apex of the lung

Answer 10

might cause pancoasts syndrome

Question 11

at left hilum

Answer 11

lobal collapse of left upper or lower lobe
or
left laryngeal nerve palsy causing hoarse voice

Question 12

at right hilum

Answer 12

lobar collapse

Question 13

superior mediastinum

Answer 13

super vena cava obstruction

Question 14

a peripheral tumour might cause

Answer 14

chest wall pain if it erodes into the pleura

Question 15

a tumour in the middle of the lung may be

Answer 15

completely asymptomatic because there are no pain receptors in the lung

Question 16

investigation

Answer 16

FBC, calcium, renal function (because youre going to need to use contrast), LFTs
CXR
CT chest and abdomen - with contrast for anatomical localisation and staging
lung function tests
involve respiratory physician for histology and staging
biopsy required for histology

Question 17

PET scan

Answer 17

assess involvement of regional lymph nodes/presence of mets
PET and CT simultaneous scan used to find mets - shows areas of increased metabolic uptake likely to be due to cancer activity

Question 18

how to stage the tumour

Answer 18

biopsy required for histology
bronchoscopy for central tumours - combine with endobronchial USS for mediastinal lymph node sampling

Question 19

sputum cytology

Answer 19

not first line
only recommended in extremely frail patients with central tumours in whom any other type of investigation would be innapprpriate

Question 20

staging for non small cell lung cancer

Answer 20

stages 1-4 depending on size, site, LN involevment
metastasses (distant mets = automatic staage 4 cancer)

Question 21

staging for small cell lung cancer

Answer 21

‘limited stage’ = within thorax
‘extensive stage’ = outside the thorax

surgery not offered as treatment for small cell lung cancer

Question 22

common sites of. mets

Answer 22

liver, adrenal glands, bones, spine, brain
can also metastasis to other lobes of the same lung or to the other lung

Question 23

treatment for non small cell lung cancer

Answer 23

surgery is the only chance for cure (only 11-12% of cases are operable)
for everyone else care is applaitive: chemotherapy and radiotherapy

Question 24

chemotherapy for non small cell lung cancer

Answer 24

palliative
tyrosine kinase inhibitors for EGFR positive
drugs are expensive and improve quality of life but not length of life

Question 25

radiotherapy for non small cell cancer

Answer 25

high dose is localised and innoperable (attempt for cure)
palliative for symptom control

Question 26

treatment for small cell lung cancer

Answer 26

chemotherapy is first line
most therapy will have a good remission
when the tumour recurs further treatment is available but treatment is not curative

Question 27

prognosis

Answer 27

poor
5 year survival overall is 15%

Question 28

screening for lung cancer

Answer 28

numerous trials for cancer screening
for high risk groups
annual low dose non contrast CT scans
major implications for resources due to follow up of numerous nodules/abnormalities