Lung Cancer: Non Small Cell Lung Cancer

Question 1

Defintion

Answer 1

Primary bronchial carcinoma
Three different types:
- squamous cell
- adenocarcinoma
- bronchoalveolar cell tumours

Question 2

Adenocarcinoma

Answer 2

Location: peripheral lesion
- arises from MUCUS SECRETING GLANDULAR EPITHELIUM
- mets common = bone, brain, adrenals, lymph nodes, liver
Epidemiology + RF: Not related to smoking and occurs in younger individuals
- commonly ASBESTOS
Paraneoplastic syndromes:
- Hypertrophic pulmonary osteoarthropathy,
- Gynaecomastia
Tx:
- Surgery
- Chemoradiotherapy for metastatic disease

Question 3

Squamous cell carcinoma

Answer 3

Location: central lesion, lesions with central necrosis
- arises from LUNG EPITHELIUM
- late mets, locally spread mostly
RF: strong association with smoking
Paraneoplastic syndromes:
- Hypertrophic pulmonary osteoarthropathy
PTHrP → hypercalcaemia
= Clubbing, Arthritis, Periostitis
Tx:
- Surgery
- Chemoradiotherapy for metastatic disease

Question 4

Large cell carcinoma

Answer 4

Location: Peripheral lesion
RF: Strong link with smoking
Paraneoplastic syndromes:
- Hypertrophic pulmonary osteoarthropathy
- Ectopic β-HCG secretion
Tx:
- Surgery
- Chemoradiotherapy for metastatic disease

Question 5

Carcinoid tumour

Answer 5

Neuroendocrine tumour (secretes serotonin), arise in GIT (mostly) and sometimes lung
- Sx only appear when LIVER METS present
Associated with genetic
- MEN 1 mutation
- Neurofibromatosis 1

Question 6

Signs

Answer 6

Reduced breath sounds and a fixed monophonic wheeze may be present
Stony dull percussion: suggests a malignant pleural effusion
Supraclavicular or persistent cervical lymphadenopathy
Extrapulmonary manifestations:
- Clubbing: strongly associated with squamous cell carcinoma
- Facial plethora and swelling: due to SVCO
- Hoarseness: due to recurrent laryngeal

Question 7

Symptoms

Answer 7

Persistent cough +/- haemoptysis
Dyspnoea
Pleuritic chest pain
Constitutional symptoms:
- Fever
- Weight loss and anorexia
- Night sweats
- Lethargy

Question 8

Diagnosis

Answer 8

FIRST LINE = CXR
- hilar enlargement,
- consolidation,
- pleural effusion,
- circular opacity
GOLD STANDARD = high contrast CT
+ Biopsy = peripheral lesions are biopsies under image guidance (percutaneously)
MRI = staging TNM

Question 9

Management

Answer 9

Smoking cessation

Non-metastatic disease (stage I-IIIa):
- Surgery, usually with adjuvant chemotherapy
- Curative radical radiotherapy can be used as an alternative to surgery
Metastatic disease (stage IIIb and above):
- Palliative treatment with immunotherapy, chemotherapy, and radiotherapy
Remember, NSCLC generally has a poor response to chemotherapy