Lung cancer

Question 1

List some associations of lung cancer

Answer 1

• Smoking and passive smoking
• COPD, fibrosis, alveolitis, TB, chronic inflammation
• Environmental carcinogens: silica, chromium, iron oxide, nickel, asbestos (mesothelioma), radon gas, diesel engine exhaust fumes, air pollution
• Poor diet, lack of exercise
• Family history

Question 2

List the local symptoms of lung cancer

Answer 2

• Cough
• SOB
• Coughing blood
• Pain
• Recurrent pneumonia

Question 3

List the systemic symptoms of lung cancer

Answer 3

• Weight loss, anorexia
• Voice changes
• Paraneoplastic syndromes
• Metastases – brain and bone
• Dysphagia

Question 4

Describe the examination for lung cancer

Answer 4

Colour
Clubbing
RR
SpO2
Pleural fluid
Collapse/consolidation
SVCO

Question 5

What investigations

Answer 5

CXR
Bloods 
SaO2
EBUS
CT
PET CT
MRI, pleural fluid cytology

Question 6

What is radical treatment

Answer 6

Curative intent

Question 7

What is palliative treatment

Answer 7

palliate symptoms and possibly prolong survival

Question 8

What is neoadjuvant treatment

Answer 8

post surgery when no cancer present aiming to improve chance of cure

Question 9

What is adjuvant treatment

Answer 9

chemo/radiotherapy before surgery aiming to downstage

Question 10

What are the two main types of lung cancer

Answer 10

Small cell (15-20%) and non-small cell (75-85%)

Question 11

What is EBUS

Answer 11

Endobronchial ultrasound

Question 12

What are the treatment modalities for lung cancer

Answer 12

Chemo/radio/immunotherapy
Surgical resection
Palliative treatments - TK inhibitors, chemo, radiotherapy

Question 13

What is the management for stage 1 lung cancer?

Answer 13

Surgery or SABR

Question 14

What is the management for stage 2 lung cancer?

Answer 14

surgery +/- chemo or radical RT

Question 15

What is the management for stage 3 lung cancer?

Answer 15

multimodality treatment

Question 16

What is the 5 year survival for lung cancer?

Answer 16

50%

Question 17

What is the management for stage 4 lung cancer?

Answer 17

palliative chemotherapy (+/- RT)

Question 18

Name 3 oncological emergencies which may present to other specialities

Answer 18

Superior vena cava obstruction
Metastatic spinal cord compression
Bony metastasis - pathological fracture

Question 19

What scan would you order for someone presenting with suspected metastatic spinal cord compression?

Answer 19

MRI of whole spine

Question 20

How may orthopaedics help patients with bony metastasis

Answer 20

Prophylactic nailing

Or fixing/replacement of broken joints

Question 21

How do you nurse patients with SVCO?

Answer 21

Upright with O2

Question 22

How do patients with SVOC present?

Answer 22

Dyspnoea
Dilated neck veins
Sitting upright and forward - tripod position

Question 23

List the types of non-small cell cancer?

Answer 23

o Adenocarcinoma
o Squamous cell
o Large cell, adenosquamous, carcinoma, carcinoid

Question 24

Which type of non-small cell cancer presents with gyanecomastia?

Answer 24

Adenocarcinoma

Question 25

Which type of non-small cell cancer presents with gynaecomastia?

Answer 25

Adenocarcinoma

Question 26

What are some toxicities of chemo

Answer 26

``` Fatigue Nausea and vomiting Mouth ulcers/stomatitis Hair loss Myelosuppression Renal impairment Neuropathy Thromboembolic ```

Question 27

What mutations do we test for in lung cancers

Answer 27

EGFR, ALK, ROS-1, KRAS

Question 28

Which patients may be at increased risk of mutation

Answer 28

Females Non-smokers Asian/Indian people

Question 29

Which type of cancer is more associated with genetic mutations?

Answer 29

Adenocarcinoma

Question 30

Which lung cancer has strongest association with smoking?

Answer 30

Squamous cell carcinoma

Question 31

What scale is used to measure a patients fitness?

Answer 31

Performance status - from PS0(asymptomatic) to PS4 (Bedridden)