Respiratory - Lung Cancer

Question 1

What are the 3 most common cancers in the UK?

Answer 1

1. Breast cancer
2. Prostate cancer
3. Lung cancer

Question 2

What are the risk factors for lung cancer?

Answer 2

• cigarette smoking
• increasing age
• family history of lung cancer
• exposure to carcinogens (e.g. asbestos)

Question 3

Presentation of lung cancer.

Answer 3

• SOB
• cough / haemoptysis
• recurrent pneumonia
• weight loss
• finger clubbing
• supraclavicular lympadenopathy

Question 4

What is the first line investigation in suspected lung cancer?

Answer 4

CXR - results may show:
- hilar enlargement
- peripheral opacity
- pleural effusion (unilateral)
- collapse

Question 5

What are the diagnostic tests for suspected lung cancer?

Answer 5

• CXR (first line)
• bronchoscopy with endobronchial ultrasound (GOLD STANDARD)
• staging CT CAB with contrast
• PET-CT for staging

Question 6

What is the WHO performance status?

Answer 6

Gives an indication of the patient’s level of fitness:

Grade 0 - normal

Grade 1 - restricted in physically strenuous activity

Grade 2 - capable of all self-care, but unable to carry out work activities

Grade 3 - capable of limited self care; confined to bed or chair >50% of the time

Grade 4 - completes disabled and unable to self-care

Grade 5 - dead

Question 7

What are the histological classifications of lung cancer?

Answer 7

Small cell lung cancer.

Non-small cell lung cancer:
- adenocarcinoma
- squamous cell carcinoma
- large cell carcinoma

Question 8

How is lung cancer managed?

Answer 8

Managed via MDT. Options include:

• curative surgery if stage 1/2
• chemoradiotherapy
• palliative care
• watch and wait

Question 9

What are the surgical options for lung cancer treatment?

Answer 9

Lobectomy - removing the lung lobe containing the tumour.

Segmentectomy - removing the segment of lung to remove the tumour.

Question 10

Why may a patient with lung cancer present with hoarseness of voice?

Answer 10

The cancer compresses the recurrent laryngeal nerve as it passes through the mediastinum, causing paralysis of the vocal cords.

This causes the voice to become hoarse.

Question 11

Why may a patient with lung cancer present with facial swelling, difficulty breathing and distended JVP?

Answer 11

A medical emergency whereby the lung cancer is causing superior vena cava obstruction.

Question 12

What is small cell lung cancer?

Answer 12

A type of lung cancer that histologically contains neurosecretory granules, which can release neuroendocrine hormones.

SCLC is responsible for multiple paraneoplastic syndromes.

Question 13

Give some paraneoplastic syndromes that may be present in small cell lung carcinoma.

Answer 13

• SIADH (ectopic ADH secretion, presents with dilutional hyponatraemia)
• Cushing’s syndrome (ectopic ACTH secretion)
• hypercalcaemia (PTHrP secretion)
• limbic encephalitis

Question 14

What is Lambert-Eaton myasthenic syndrome?

Answer 14

A syndrome that results from antibodies produced by the immune system against small cell lung cancer cells, which then target and damage voltage-gated calcium channels in the presynaptic terminals of motor neurones.

This leads to weakness in the proximal muscles, intraocular muscles (diplopia), levator muscles (ptosis), and pharyngeal muscles (slurred speech and dysphagia).

Question 15

What is mesothelioma?

Answer 15

A lung malignancy affecting the mesothelial cells of the pleura, strongly linked to asbestos inhalation.

There is a large latent period between exposure to asbestos and the development of mesothelioma, up to 45 years.