Lung Cancer

Question 1

How common is lung cancer?

Answer 1

3rd most common

Question 2

Who is often affected by lung cancer?

Answer 2

M>F

People over 75 years

Question 3

What are the types of lung cancer?

Answer 3

Non small cell
Small cell
Mesothelioma
Neuroendocrine tumours
(Mets)

Question 4

What are the risk factors for lung cancer?

Answer 4

SMOKING!
Other lung disease
Radiotherapy
Toxins
Pulmonary fibrosis
HIV
FHx

Question 5

What toxins are associated with lung cancer?

Answer 5

Asbestos
Radon gas
Arsenic

Question 6

What is the problem with small cell lung cancer?

Answer 6

It is fast onset so treatment needs to be initiated immediately

Question 7

What are the non small cell lung cancers?

Answer 7

Squamous cell

Adenocarcinoma

Question 8

What kind of lung tumours make up the majority?

Answer 8

Non small cell

Question 9

What are the issues associated with mesothelioma?

Answer 9

It isn’t chemo sensitive

Surgery is very difficult as disease affects pleura

Question 10

What is a bit different about neuroendocrine tumours?

Answer 10

They are not related to smoking.

More common in women.

Question 11

If someone has lung disease anyway, what is the issue?

Answer 11

Symptoms can be masked e.g. by COPD

Question 12

Tell me about Horner’s syndrome/triad.

Answer 12

Triad of miosis, partial ptosis, and anhidrosis.

In context of lung cancer, it is caused by Pancoast’s tumour

Question 13

What is a Pancoast’s tumour?

Answer 13

A tumour located in the apex of the lung

Question 14

Which type of lung cancer can develop Pancoast tumours?

Answer 14

Non small cell

Question 15

What are the common paraneoplastic syndromes associated with small cell lung cancer?

Answer 15

• SIADH
• ACTH excess
• Lamberton-Eaton Syndrome

Question 16

What is Lamberton-Eaton syndrome?

Answer 16

Rare, autoimmune paraneoplastic syndrome associated with small cell lung cancer that causes weakness of the muscles in the proximal arms and legs. Weakness improves slowly with exertion.

Question 17

What are the paraneoplastic syndromes associated with squamous cell lung cancer?

Answer 17

• PTH-rp secretion -> hypercalcaemia
• Clubbing
• Hypertrophic pulmonary osteoarthropathy
• Hyperthyroidism (ectopic TSH)

Question 18

What are the paraneoplastic syndromes associated with adenocarcinoma of the lung?

Answer 18

• Gynaecomastic

- Hypertrophic pulmonary osteoarthropathy

Question 19

What are the guidelines for an unexplained cough?

Answer 19

Send for a chest x-ray after 3 weeks of an unexplained cough

Question 20

Why is the prognosis poor for small cell lung cancers?

Answer 20

They grow rapidly and are highly malignant, spreading early.

Question 21

A pt with a 40yr pack history of smoking presents to the GP with a chronic cough, weight loss, and haemoptysis.

What other symptoms/signs might this pt have?

Answer 21

SoB
Chest pain
Bone pain
Finger clubbing
Fever
Weakness
Hoarse voice
SVCO
Dysphagia
Headache
N+V
Wheezing and stridor

Question 22

A pt with a 40yr pack history of smoking presents to the GP with a chronic cough, weight loss, and haemoptysis.

What is your list of differentials?

Answer 22

Lung cancer
Lung mets
TB
Benign lung disease

Question 23

A pt with a 40yr pack history of smoking presents to the GP with a chronic cough, weight loss, and haemoptysis.

On a CXR there is a solitary round shadow in the lung. What are th differentials?

Answer 23

Cancer - primary or secondary
AV malformation
Pulmonary harmatoma
Bronchial adenoma
Abscess
Cyst
TB/Granuloma
Foreign body

Question 24

What are the 2ww guidelines for referral of suspected lung cancer?

Answer 24

• CXR suggesting lung cancer or mesothelioma

- Pt over 40 with unexplained haemoptysis

Question 25

What might a lung cancer pts CXR look like?

Answer 25

There may be: - Peripheral circular opacity - Hilar enlargement - Consolidation - Pleural effusion - Bony secondaries

Question 26

How is lung cancer staged?

Answer 26

Contrast enhanced CT chest

Question 27

When should a lung cancer pt be offered a PET can?

Answer 27

If they are potentially curable. Offer it before treatment for precise location of pathology.

Question 28

What procedures can we do for histological samples of lung cancer?

Answer 28

``` Bronchoscopy Needle biopsy Surgical biopsy Thoracentesis Sputum cytology ```

Question 29

Where does lung cancer metastasise to commonly?

Answer 29

``` Brain Bone Liver Other areas of the lung Adrenal glands ```

Question 30

What system is used to stage lung cancer?

Answer 30

TNM

Question 31

What are the general steps to management of lung cancer?

Answer 31

``` Lifestyle changes Lung function tests for monitoring Surgical resection Radiotherapy Chemotherapy Immunotherapy ```

Question 32

What lifestyle changes should a lung cancer pt be advised to make?

Answer 32

Stop smoking Nicotine replacement Nutritional support

Question 33

What surgical option is first line for early stage disease?

Answer 33

Lobectomy

Question 34

What should happen to all pts who undergo surgical resection for lung cancer?

Answer 34

Hilar and mediastinal lymph node sampling for accurate staging.

Question 35

If a pt is not suitable for surgery, what can we offer to treat lung cancer?

Answer 35

Radiotherapy

Question 36

When is chemotherapy offered for lung cancer?

Answer 36

Stage III and IV disease

Question 37

What blood tests are done to help stage small-cell lung cancer?

Answer 37

Lactate dehydrogensase LFTs Na

Question 38

A pt with terminal lung cancer says they have some symptoms that are bothering them. What symptoms might they need treating?

Answer 38

``` Breathlessness Haemopytsis Cough Chest pain Hoarse voice Face/upper limb swelling Confusion/headache Lower neurological symptoms Bone pain ```

Question 39

A pt with terminal lung cancer says they have some symptoms that are bothering them. What conditions might they need treating?

Answer 39

``` SVCO Spinal cord compression Bone mets Cerebral mets Bronchial obstruction Pleural effusion ```

Question 40

What complications can arise from the local presence of lung cancer?

Answer 40

- Recurrent laryngeal palsy - Phrenic nerve palsy - SVCO - Pericarditis - AF - Rib erosion

Question 41

A pt with lung cancer comes into A+E having had a fit. What are we worried about most here?

Answer 41

Brain mets

Question 42

What consequences can arise from lung cancer metastasising to the adrenal glands?

Answer 42

Addison's (adrenal insufficiency)

Question 43

What non-metastatic endocrine consequences are there of lung cancer?

Answer 43

``` SIADH Hypercalcaemia Cushing's Gynaecomastia Hypoglycaemia Hyperthyroidism ```

Question 44

What is the prognosis like for lung cancer?

Answer 44

Getting gradually better, but ten year survival is about 6%. Prognosis is worse for small cell lung cancer.

Question 45

How can we help prevent lung cancer?

Answer 45

Actively discourage smoking and encourage smoking cessation.

Question 46

What is malignant mesothelioma?

Answer 46

Aggressive tumour of mesothelial cells of the lung that usually occurs in the pleura usually related to asbestos exposure.

Question 47

What are the symptoms of malignant mesothelioma?

Answer 47

SoB Chest pain Weight loss Hx of asbestos exposure

Question 48

How do pts with mesothelioma describe their chest pain?

Answer 48

Dull Diffuse Progressive Sometimes pleuritic

Question 49

Why does clubbing occur in mesothelioma?

Answer 49

Due to underlying asbestosis

Question 50

How should suspected malignant mesothelioma be investigated?

Answer 50

CXR and CT chest Pleural fluid = straw-coloured/bloodstained

Question 51

How is malignant mesothelioma managed?

Answer 51

- Symptom control | - Surgery only effective in extremely early disease

Question 52

What is the prognosis associated with mesothelioma?

Answer 52

Poor, typically survival is only one year. It is almost always fatal.