Lung Cancers

Question 1

Classification of lung cancer

Answer 1

Small cell carcinoma: contain a homegenous population of cells. Highly malignant

Non-small cell carcinoma: squamous cell carcinoma, adenocarcinoma, large cell carcinoma
Slower growing

Question 2

Symptoms of primary lung cancer

Answer 2

Unproductive cough > 3 weeks - irritation of lung parenchyma

Haemoptysis - tumour invading and bleeding into an airway

Breathlessness - central tumours occlude airway

Pain - invasion of the chest wall/pleura

Poorly resolving chest infection - bronchial obstruction

Question 3

Symptoms of metastatic lung cancer (nodes)

Answer 3

Hoarse voice - compression of RLN
Dysphagia - tumour causes obstruction
Central chest ache - mediastinal node disease
Stridor - obstruction

Question 4

Name 4 non-metastatic manifesations of lung cancer

Answer 4

Cachexia
Clubbing
Extopic PTH/ACTH production
SIADH (more common in small cell)
Dermatomyositis

Question 5

Risk factors for lung cancer

Answer 5

SMOKING

Environmental: aesbestos, polycyclin aromatic hydrocarbons, radiation

Host: infection, genetics, lung disease

Question 6

Staging and investigations in lung cancer

Answer 6

CXR - detect any obvious abnormalities

CT - indicates extent of disease

PET/CT - indicates extent of mediastinal node involvement and metastasis

Question 7

Lung cancer presentations on CXR

Answer 7

Mass lesion
Pleural effusion
Hilar lymphadenopathy
Collapse
Consolidation

Question 8

Methods used to sample suspected lung cancer

Answer 8

Bronchoscopy
Needle biopsy of the lung
Pleural tap (sample of pleural fluid taken from behind)

Question 9

Routes of lung cancer spread

Answer 9

Local invasion - pleura and chest wall, mediastinum, SVC

Lymphatic: hilar, mediastinal and supraclavicular nodes

Blood: Liver, bone, brain

Question 10

Treatments for lung cancer

Answer 10

Small cell: chemotherapy and radiotherapy due to high turnover rate

Non-small cell: surgery, slower to spread and metastasise. In patients where surgery is not possible - palliative chemo and radiotherapy

Question 11

What test could you perform on a biopsy of a NSC lung cancer to aid treatment

Answer 11

Test for EGFR mutation. Over expressed in non-small cell cancers. Giving tyrosine kinase inhibitor improves prognosis.