Clinical Features and Staging of Lung Cancer

Question 1

What is the leading cause of cancer death in men and women

Answer 1

Lung cancer

Question 2

How many cancer deaths in the UK are due to lung cancer

Answer 2

1 in 5

22%

Question 3

How many lung cancers are due to smoking

Answer 3

Over 85%

Question 4

Which cancer is most preventable

Answer 4

Lung

Question 5

What are the risk factors for lung cancer

Answer 5

Smoking
Passive smoking
Exposure to asbestos, radon, air pollution and diesel exhaust

Question 6

What are 10 signs and symptoms of lung cancer

Answer 6

Chronic coughing
Coughing up blood
Wheezing
Chest and bone pain
Chest infections
Difficulty swallowing
Raspy, hoarse voice
Shortness of breath
Unexplained weight loss
Nail clubbing

Question 7

Name 4 symptoms of advanced metastatic disease

Answer 7

Bone pain
Spinal cord compression
Cerebral metastases
Thrombosis

Question 8

What are the signs of spinal cord compression

Answer 8

Limb weakness
Paraesthesia
Bladder/bowel dysfunction

Question 9

What are the signs of cerebral metastases

Answer 9

Headache
Vomiting
Dizziness
Ataxia
Focal weakness

Question 10

Name 7 symptoms of advanced paraneoplastic disease

Answer 10

Hyponatraemia
Anaemia
Hypercalcaemia
Dermatomyositis/polymositis
Eaton-lambert syndrome
Cerebella ataxia
Sensorimotor neuropathy

Question 11

What are the signs of hyponatraemia

Answer 11

SIADH

Question 12

What are the signs of hypercalcaemia

Answer 12

Parathyroid hormone related protein

Bone metastases

Question 13

What are the signs of dermatomyositis/polymositis

Answer 13

Proximal muscle weakness

Question 14

What are the signs of Eaton-lambert syndrome

Answer 14

Upper limb weakness

Question 15

What are the clinical signs of lung cancer

Answer 15

Chest signs
Clubbing
Lymphadenopathy
Horner’s syndrome 
Pancoast tumour
Superior vena cava
obstruction
Lymphadenopathy
Hepatomegaly
Skin nodules (metastases)

Question 16

What are the initial investigations conducted through the GP

Answer 16

Chest X-Ray
Full blood count
Renal, liver functions and calcium
Clotting screen
Spirometry

Question 17

What type of imaging is used for staging

Answer 17

CT of thorax and abdomen

Question 18

What investigations can be done for tissue diagnosis

Answer 18

Bronchoscopy
EBUS
Image guided lung biopsy
Image guided liver biopsy
FNA of neck node or skin metastasis
Excision of cerebral metastasis!
Bone biopsy
Mediastinoscopy/otomy 
Surgical excision biopsy

Question 19

How is bronchoscopy conducted

Answer 19

A bronchoscope is used to view the airways and check for any abnormalities

Question 20

How of lung cancer does small cell carcinoma account for by histology

Answer 20

15%

Question 21

How of lung cancer does adenocarcinoma account for by histology

Answer 21

40%

Question 22

How of lung cancer does squamous cell carcinoma account for by histology

Answer 22

30%

Question 23

How of lung cancer does large cell carcinoma account for by histology

Answer 23

10%

Question 24

What is the diameter of a T1 tumour

Answer 24

T1a is under 2cm

T1b is between 2-3cm

Question 25

What is the diameter of a T2 tumour

Answer 25

T2a is between 3-5cm | T2b is between 5-7cm

Question 26

What is the diameter of a T3 tumour

Answer 26

Over 7cm

Question 27

What will the scopy of a T1 tumour show

Answer 27

No invasion | Lobar bronchus

Question 28

What will the scopy of a T2 tumour show

Answer 28

Over 2cm to the carina

Question 29

What will the scopy of a T3 tumour show

Answer 29

Under 2cm to the carina

Question 30

What will the scopy of a T4 tumour show

Answer 30

Tumour in carina

Question 31

What type of atelectasis will a T2 tumour show

Answer 31

Lobar atelectasis or obstructive pneumonia to hilus

Question 32

What type of atelectasis will a T3 tumour show

Answer 32

Whole lung

Question 33

State 5 things that should be considered when deciding on treatment

Answer 33

``` Performance status Patient wishes Histological type and stage Multidisciplinary team Aims of treatment (e.g. radical or palliative) ```

Question 34

State the different performance status types

Answer 34

``` 0 = fully active 1 = symptoms but ambulatory 2 = “up and about” over 50%, unable to work 3 = “up and about” under 50%, limited self-care 4 = bed or chair bound ```

Question 35

What treatments are available for patients

Answer 35

``` Surgery (18% of patients) Radiotherapy Chemotherapy Best supportive care Co-ordination (lung cancer specialist nurse) ```

Question 36

What type of surgery could be preformed

Answer 36

Wedge resection Lobectomy Pneumonectomy

Question 37

What type of radiotherapy is available

Answer 37

Radical Palliative Stereotactic

Question 38

What type of chemotherapy is available

Answer 38

Part of radical or palliative treatment Alone, combined with radiotherapy or adjuvant (after surgery) Targeted agents (e.g. Tyrosine Kinase Inhibitors and monoclonal antibodies) Small cell e.g. cisplatin/etoposide Adenocarcinoma e.g. cisplatin/pemetrexed Squamous e.g. cisplatin/gemcitabine

Question 39

What are the 5 aspects of palliative management

Answer 39

Symptom control Quality of life Community support Decisions and planning, resuscitation status, end of life care Multidisciplinary team including lung cancer nurse and hospice

Question 40

What are the methods of symptom control

Answer 40

Chemotherapy Radiotherapy (e.g. pain, haemoptysis) Opiates, bisphosphonates, benzodiazepines Treatment of hypercalcaemia, dehydration and hyponatraemia