Lung Cancer - Clinical Features

Question 1

What exposures increase your risk of lung canceR?

Answer 1

• Smoking
• Asbestos
• Radon
• Air pollution
• Diesel Exhaust

Question 2

What are the top 10 signs/symptoms of lung cancer?

Answer 2

• Chronic Cough
• Wheeze
• Chest & Bone Pain
• Repeated chest infections
• Swallowing problems
• Raspy hoarse voice
• SOB
• Weight Loss
• Nail Clubbing

Question 3

What other symptoms arise in advanced lung canceR?

Answer 3

Metastatic & paraneoplastic symptoms

Question 4

What would horners syndrome, SVC obstruction, hepatomegaly or skin nodules indicate in lung canceR?

Answer 4

It has invaded/metastasised to other tissues

Question 5

What is Horners Syndrome?

Answer 5

Lung cancer invades the cervical sympathetic ganglion.

Nerve damage causes small pupil, drooping eyelid and loss of sweat in one side of the face

Question 6

What is a pancoast tumour?

Answer 6

A tumour of lung cancer found at the very apex of the lung.

Question 7

How do we rank a patients performance?

Answer 7

0-4
0 = fully active
1 = Symptoms but ambulatory
2 = ‘up & about’ for >50% of the day but unable to work
3 = ‘up & about’ <50% and limited in caring for themselves
4 = Bed or chair bound

Question 8

What initial investigations would be done if lung cancer was suspected?

Answer 8

• CXR
• Full Blood Count (FBC)
• Renal/Liver function
• Calcium level
• Clotting screen
• Spirometry

Question 9

Why do a calcium test in suspected lung canceR?

Answer 9

Some lung cancers can affect calcium levels hwich in turn affects liver function

Question 10

Once cancer is confirmed what test would we use to locate it prior to tissue diagnosis?

Answer 10

CTs of the thorax and abdomen

Question 11

What method of tissue dianosis would we use for a central tumour?

Answer 11

Bronchoscopy

Allows visual and biopsy info

Question 12

What method of tissue diagnosis would we use for tumour spread to mediastinal nodes?

Answer 12

An EBUS guided procedure (endobronchial ultrasound).

Using a -ve pressure syringe to aspirate cells form the tumour for study

Question 13

How would we diagnose a peripheral lung tumour?

Answer 13

With an image guided lung biopsy

Question 14

What would we do if the CT showed a liver tumour?

Answer 14

An image guided liver biopsy

Question 15

What are the parts of staging?

Answer 15

Staing of a tumour is made up of ‘T’, ‘N’ & ‘M’.
T = Size & evidence of invasion
N = Level of nodal involvement (& which nodes)
M = Presence of metastasis

Question 16

If there is metastasis what stage of cancer is it?

Answer 16

Always a stage 4 when theres metastasis

Question 17

If considering surgical treatment what further staging must be done first?

Answer 17

A full body PET scan to map other tumours

Question 18

Why do we remove a large margin (or even whole lobe/lung) when doing surgery on a lung tumour?

Answer 18

To ensure the entire tumour and nearby micrometastases have been removed

Question 19

What factors come into lung cancer treatment descisions?

Answer 19

• Performance Status
• Patient Wishes
• Histological type
• Stage
• Aims e.g. radical or palliative

Question 20

What treatments are available for lung cancer?

Answer 20

• Surgery (18% of patients)
• Radiotherapy
• Chemotherapy
• Best supportive care

Question 21

What is ‘best supportive care’?

Answer 21

Care designed to treat symptoms, calm any fears and generally improve the patients quality of life.

But not treat the cancer

Question 22

What are the aspects of pallaiative management?

Answer 22

• Symptom control
• Quality of Life care
• Community support
• Planning for the End