The Management of Lung Cancer

Question 1

What are the risk factors for developing lung cancer

Answer 1

• Smoking
• Air pollution
• Radon gas
• Asbestos (especially if also a smoker)
• Family history

Question 2

Why are such low numbers of patients with lung cancer offered treatment with curative intent

Answer 2

Because lung cancer tends to present late in the progression of the disease.

Question 3

What is thought to possibly detect lung cancer at an early stage in development

Answer 3

CT scans however there is a risk of false positive result which can lead to unnecessary operation. There are also new clinical trials with blood biomarkers for the detection of lung cancer.

Question 4

What are some of the symptoms of lung cancer

Answer 4

• Haemoptysis

- Dyspnoea

Question 5

Why are symptoms not diagnostic of lung cancer

Answer 5

Because none of the symptoms are specific to lung cancer and may be due to other conditions such as COPD or bronchiectasis.

Question 6

What technique is used to try and determine the type of tissue in a tumour

Answer 6

Biopsy

Question 7

Which cancers are included under the term “non small cell lung cancer”

Answer 7

Adenocarcinoma and squamous cell carcinoma

Question 8

What is the rate of progress of small cell carcinomas

Answer 8

Small cell carcinomas progress very quickly

Question 9

What is needed for a definitive diagnosis of small cell lung cancer

Answer 9

Radiology and biopsy - a definitive diagnosis is never given following radiology alone.

Question 10

What does squamous cell carcinoma show up with on radiology

Answer 10

A mass with a cavity inside. This is specific to this type of cancer only.

Question 11

In which group does squamous cell carcinoma tend to arise in

Answer 11

Older people.

Question 12

Which type of lung cancer is more common in younger people

Answer 12

Adenocarcinoma

Question 13

What tends to cause adenocarcinoma

Answer 13

Smoking - particularly of long cigarettes 9the ones which are supposed to contain less nicotine). Those who smoke cannabis also are more likely to develop adenocarcinoma.

Question 14

What forms in adenocarcinoma

Answer 14

A glandular growth pattern and scar tissue.

Question 15

What is the staging method used for lung cancer

Answer 15

TNM staging (tumour, node, metastasis)

Question 16

How many “T” stages are there in the TNM classification of lung cancer

Answer 16

Four

Question 17

What is the T1 stage of lung cancer

Answer 17

The tumour is less than 3cm in size.

Question 18

What is the T2 stage of lung cancer

Answer 18

The tumour is 3-7cm in size. Features include -

• Atelectasis (part of the lung)
• Invasion (visceral pleura, main bronchus more than 2cm from the carina)

Question 19

What is the T3 stage of lung cancer

Answer 19

The tumour is more than 7cm in size. Features include -

• Atelectasis (whole lung)
• Invasion (phrenic nerve, diaphragm, chest wall, mediastinal pleura, main bronchus less than 2cm from the carina)

Question 20

What is the T4 stage of lung cancer

Answer 20

Invasion

Question 21

How many stages are there in the “N” category of the classification of lung cancer

Answer 21

Four

Question 22

What is the N0 stage of lung cancer

Answer 22

No lymph node involvement

Question 23

What is the N1 stage of lung cancer

Answer 23

Involvement of the ipsilateral, bronchopulmonary and hilar nodes

Question 24

What is the N2 stage of lung cancer

Answer 24

Involvement of the ipsilateral, mediastinal and subcarinal nodes

Question 25

What is the N3 stage of lung cancer

Answer 25

Involvement of the contralateral hilar, contralateral mediastinal and supraventricular nodes.

Question 26

How many stages are there in the "M" category of lung cancer

Answer 26

Two

Question 27

What is the M0 stage of lung cancer

Answer 27

No metastasis

Question 28

What is the M1 stage of lung cancer

Answer 28

Metastasis to distant sites.

Question 29

What are the three best methods used for lymph node evaluation

Answer 29

Mediatinoscopy, Endobronchial ultrasound and PET. CTs are also sometimes used and can be effective.

Question 30

What is the new diagnostic and staging algorithm for lung cancer

Answer 30

Chest x-ray followed by CT/PET to exclude T4/M1 disease. Then tissue diagnosis and evaluation of the mediastinum. This is followed by bronchoscopy/CT biopsy/endobronchial ultrasound and treatment.

Question 31

How is a PET performed

Answer 31

PET scans identify more metabolically active areas of which tumours are. The patient is injected with radioactive glucose and the metabolically active parts show up bright.

Question 32

What are the treatment options for non small cell lung cancer

Answer 32

- Resection - this is only suitable in very few patients but has a high 5 year survival rate (70%) - Chemo and radiotherapy - this has a poorer 5 year survival (30%) - Palliative chemotherapy to increase survival by a few months - Palliative radiotherapy for symptom control - Supporting care for symptom control.

Question 33

How long do patients with lung cancer tend to live following diagnosis

Answer 33

More than 90% of lung cancer patients die 2 years after diagnosis.

Question 34

What is one benefit of chemotherapy

Answer 34

There is less detrimental effect on the patients quality of life compared to the uncontrolled progression of the cancer spread

Question 35

Which mutation could present a new approach to treatment of lung cancer

Answer 35

The EGFR mutation

Question 36

Which cancer has a particularly high rate of EGFR mutation

Answer 36

Adenocarcinomas

Question 37

Which groups of patients tend to respond well to EGFR blocking therapy

Answer 37

East Asian people, people with adenocarcinoma, females, non-smokers.

Question 38

What leads to the particularly poor prognosis of small cell lung cancer

Answer 38

It is very aggressive and has rapid dissemination so many patients present with distant metastasis.

Question 39

What is considered to be limited disease in small cell lung cancer

Answer 39

The cancer is restricted to one hemithorax with or without involvement of ipsilateral nodes.

Question 40

What is considered to be extensive disease in small cell lung cancer

Answer 40

The cancer has spread beyond one hemithorax.

Question 41

Which treatments are small cell lung cancers particularly sensitive to

Answer 41

Chemotherapy and radiotherapy.

Question 42

What is the median survival of limited small cell lung cancer

Answer 42

10-15 months.

Question 43

What is the median survival of extensive small cell lung cancer

Answer 43

7-10 months.