Week 4 - Clinical Features of Lung Cancer and Staging

Question 1

What are 9 symptoms of lung cancer?

Answer 1

• chronic cough w/wo blood
• wheeze
• Chest + bone pain
• chest infections
• difficulty swallowing
• raspy hoarse voice
• SoB
• Unexplained weight loss
• Nail clubbing

Question 2

What are some metastatic advanced disease symptoms? (3)

Answer 2

• metastatic bone pain,
• spinal cord compression effects,
• cerebral metastasis,

Question 3

What are some paraneoplastic advanced disease symptoms? (7)

Answer 3

hyponatraemia, hypercalcaemia, anaemia, dermatomyositis/polymyositis, eaton-lambert syndrome, cerebellar ataxia, sensorimotor neuropathy

Question 4

What is a paraneoplastic effect?

Answer 4

substances released from cancer disrupt normal function of tissues and cells

Question 5

What is lambert-eaton syndrome?

Answer 5

paraneoplastic effect. nerve and muscle connection attacked by immune system - upper limb weakness

Question 6

What are 8 clinical signs?

Answer 6

• chest signs,
• clubbing,
• lymphadenopathy,
• horners,
• pancoast tumour,
• superior vena cava obstruction (swelling of upper body),
• hepatomegaly (enlarged liver)
• skin nodules

Question 7

What initial investigations are taken? (8)

Answer 7

CXR, FBC, renal function, liver function, calcium and alkaline phosphatase (bone metastasis), clotting screen, spirometry

Question 8

Which ways can a biopsy be taken for investigation?

Answer 8

• bronchoscopy,
• EBUS,
• image guided lung.
• liver biopsy,
• fine needle aspiration,
• cerebral metastasis excision,
• surgical excision biopsy
• bone biopsy,
• mediastinotomy/oscopy

Question 9

How is cancer staged?

Answer 9

TNM system - tumour size, lymph nodes and metastasis

Question 10

What stage is a metastasised tumour in?

Answer 10

any metastasis - stage 4

Question 11

What influences our treatment decision?

Answer 11

stage, histological type, patient performance, patient wishes

Question 12

How is patient performance status assessed?

Answer 12

0-4. 0-fully active, 2 is up and about >50% time, 3 is up and about<50% time, 4 is bed/chair bound

Question 13

Which 3 types of surgical treatments are offered to remove lung cancer?

Answer 13

pneumonectomy, lobectomy, wedge resection

Question 14

What type of radiotherapy is offered?

Answer 14

radical, palliative or stereotactic (high intensity to small area)

Question 15

What kind of chemotherapy is offered? (3)

Answer 15

• radical/palliative treatment,
• alone/combination with radiotherapy,
• targetted agents (tyrosine kinase inhibitors or monoclonal antibodies),

Question 16

what does palliative management aim to achieve?

Answer 16

control sympyoms, improve QoL

Question 17

What type of palliative treatment may be offered?

Answer 17

• chemo,
• radiotherapy for pain and to stop haemoptysis,
• opiates,
• bisphosphonates (reduce bone loss),
• benzodiazepines (slow brain and body function)