Bronchial Carcinoma

Question 1

What are the early signs to detect lung cancer?

Answer 1

A cough you've had for 3 weeks or more.
Feeling breathless for no reason.
A chest infection that doesn't clear up.
Coughing blood.
Unexplained weight loss.
Chest or shoulder pains.
Unexplained tiredness or lack of energy.
A hoarse voice
Haemoptysis – coughing up blood
Recurrent pneumonia
Stridor - usually accompanied by a coarse audible wheeze during inspiration
Shortness of breath

Question 2

What effect can tumours have on the structures surrounding the lungs?

Answer 2

Recurrent laryngeal nerve – hoarse voice
Pericardium – breathless, pericardial effusion, atrial fibrillation
Oesophagus – dysphagia (cannot swallow)
Brachial plexus – Pancoast tumour
Pleural cavity – pleural effusion
Superior vena cava – blood cannot drain back into heart so big dilated veins across the head and neck, patient feels like their head is swelling

Question 3

Name some common sites for metastases?

Answer 3

liver, brain, bone, adrenal, skin, lung

Question 4

What are the clinical signs of lung cancer?

Answer 4

Finger clubbing
Breathless
Cough
Weight loss
Bloated face
Hoarse voice
Lymphadenopathy
Tracheal deviation
Dull percussion
Stridor
Enlarged liver

Question 5

What investigations can you do to diagnose lung cancer?

Answer 5

Full blood count
Coagulation screen
Na, K, Ca, Alk Phos
Spirometry, FEV1
Chest X-ray
CT scan of thorax
PET scan
Bronchoscopy
Endobronchial Ultrasound (EBUS)
CT guided biopsy
Lymph node aspirate
Aspiration of pleural fluid
Thoracoscopy

Question 6

Describe small cell lung cancer?

Answer 6

Rapidly progressive disease
Early metastases
Rarely suitable for surgery
Good initial response to chemotherapy

Question 7

Describe non small cell lung cancer?

Answer 7

Includes Squamous and adeno carcinomas
Curative options are surgery or radical radiotherapy
Palliative chemotherapy and new targeted treatment
Accounts for the majority of lung cancers

Question 8

What are the two surgery options for lung cancer?

Answer 8

Pneumonectomy or lobectomy

Question 9

What type of lung cancer does cytotoxic chemotherapy work best on?

Answer 9

Small cell

Rarely curative but longer survival

Question 10

What are the advantages of radiotherapy?

Answer 10

can be curative
useful for metastases
good palliative care