clinical features of lung cancer

Question 1

what type of cancer is the leading cause of cancer death in both men and women

Answer 1

lung

Question 2

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

Answer 2

1/5

Question 3

what % of lung cancers does smoking account for

Answer 3

85%

Question 4

risk factors for lung cancer

Answer 4

smoking (>85%)
passive smoking
exposure to asbestos, radon, air pollution and diesel exhaust
chemicals have a synergistic effect with smoking

Question 5

symptoms of lung cancer

Answer 5

chronic coughing
haemoptysis 
wheezing sound 
chest and bone pain 
chest infections 
dysphagia 
raspy, hoarse voice
SOB
unexplained weight loss
nail clubbing

Question 6

symptoms of metastatic disease

Answer 6

bone pain
spinal cord compression
cerebral metastases
thrombosis

Question 7

spinal cord compression symptoms

Answer 7

limb weakness
paraesthesia
bladder/bowel dysfunction

Question 8

cerebral mets symptoms

Answer 8

headache
vomiting
dizziness
ataxia
focal weakness

Question 9

paraneoplastic symptoms

Answer 9

causes systemic problems w/o mets
hyponatraemia
ANAEMIA
HYPERCALCAEMIA 
dermatomyositis/polymyositis
eaton-lambert syndrome
cerebellar ataxia
sensorimotor neuropathy

Question 10

clinical signs of lung disease

Answer 10

chest signs 
clubbing 
lymphadenopathy 
Horner's syndrome
Pancoast tumour 
SVC obstruction - facial oedema and dilated neck veins
hepatomegaly 
skin nodules (mets)

Question 11

1y care investigations

Answer 11

CXR 
FBC
renal, LFTs, Ca
clotting screen 
spirometry

Question 12

how is lung cancer staged

Answer 12

CT thorax and abdo
look for signs of lung cancer
central or peripheral
look for mets

Question 13

tissue diagnosis

Answer 13

bronchoscopy - biopsy central tumours
EBUS - sample lymph nodes around airway
imaged guided lung/liver biopsy
FNA of neck node/skin mets

Question 14

types of lung cancer by histology

Answer 14

adenocarcinoma 40% - more common in non-smokers and women 
squamous cell carcinoma 30% 
small cell carcinoma 15%
large cell carcinoma 10%
other 3%

Question 15

tumour staging - imaging

Answer 15

based on CT scan

PET scan if CT shows localised tumour

Question 16

TX

Answer 16

1y tumour can’t be assessed

presence of malignant cells

Question 17

T0

Answer 17

no evidence of 1y tumour

Question 18

T1

Answer 18

T1a <2CM
T1b 2-3cm
no invasion
lobar bronchus

Question 19

T2

Answer 19

T2a 3-5cm
T2b 5-7cm
>2cm to carina
lobar atelectasis or obstructive pneumonia to hilus

Question 20

Atelectasis

Answer 20

is the collapse or closure of a lung resulting in reduced or absent gas exchange

Question 21

T3

Answer 21

>7cm
<2cm to carina
whole lung atelectasis 
invasion: chest wall, diaphragm, mediastinum, pleura, pericardium
nodules in same lobe

Question 22

T4

Answer 22

tumour in carina
invasion: heart, great vessels, trachea, oesophagus, spine
nodules in other ipsilateral lobes

Question 23

NO

Answer 23

no regional node involvement

Question 24

N1

Answer 24

involvement of ipsilateral hilar or peribronchial nodes

Question 25

N2

Answer 25

involvement of ipsilateral mediastinal or subcarinal nodes

Question 26

N3

Answer 26

involvement of contralateral mediastinal or hilar nodes OR ipsilateral or contralateral scalene or supraclavicular nodes

Question 27

M0

Answer 27

distant mets absent

Question 28

M1

Answer 28

distant mets present

Question 29

prognosis for stage 4 lung cancer vs stage 1

Answer 29

stage 1 - 10% die within 1yr | stage 4 - 80% die within 1yr

Question 30

what influences treatment decisions

Answer 30

``` performance status patient wishes histological subtype and stage MDT aims of treatment e.g. radical or palliative ```

Question 31

performance status stages

Answer 31

0 = fully active, no symptoms 1 = functional w/ some symptoms 2 = symptoms and debilitated but >50% up and about, unable to work 3 = <50% up and about, limited self care 4 = chair or bed bound 0-1 offered radical treatment

Question 32

surgical treatment options

Answer 32

``` around 18% of pts stage I and II pts wedge resection lobectomy pneumonectomy ```

Question 33

radiotherapy

Answer 33

radical - localised disease but not fit enough for surgery, high dose, curative intention palliative stereotactic - reduces normal tissue damage

Question 34

chemotherapy

Answer 34

part of radical or palliative treatment alone, combined w/ radiotherapy or adjuvant targeted agents

Question 35

chemotherapy for small cell

Answer 35

cisplatin | eteposide

Question 36

targeted agents in chemotherapy

Answer 36

tyrosine kinase inhibitors monoclonal antibodies e.g. erlotnib, gefitibin, crizotinib

Question 37

chemotherapy for adenocarcinoma

Answer 37

cisplatin | pemetrexed

Question 38

chemotherapy for squamous cell carcinoma

Answer 38

cisplatin | gemcitabine

Question 39

when is best supportive care offered

Answer 39

when treatment is not in their best interest | symptom control and support

Question 40

palliative care components

Answer 40

``` symptom control QOL community support decisions and planning end of life care and resuscitation status MDT ```

Question 41

symptom control in palliative management

Answer 41

may include chemotherapy may include radiotherapy (pain, haemoptysis) opiates, bisphosphonates, benzodiazepines treatment of hypercalcaemia, dehydration, hyponatraemia