Session 9: Lung Cancer

Question 1

Describe the incidence of lung cancer.

Answer 1

Most common cancer to cause death in the UK.

Slightly more common in males than females.

35000 per year in UK

Question 2

Risk factors of lung cancer.

Answer 2

Smoking (80-90%)

Environment such as asbestos, radon, chromium, nickel and arsenic.

Genetics

Question 3

Prevention of lung cancer.

Answer 3

Stop smoking (education and negative advertisement etc…)

Screening

Question 4

Pros and cons of screening for lung cancer.

Answer 4

It is becoming more and more common to screen for lung cancer.

Pros:

Can detect disease before the critical point and improve prognosis for patients

Can start treatment earlier and is more effective when applied before symptoms arise.

Cons:

Overdiagnosis

Exposure to radiation

Question 5

Explain why staging is important in lung cancer.

Answer 5

It gives a prognosis for the patient.

Staging is also done to know which treatment is appropriate for the patient.

Question 6

What staging is used for lung cancer?

Answer 6

TNM

Question 7

Explain TNM briefly.

Answer 7

T - Size of tumour, number of nodules, location of nodules.

N - Spread to local lymph nodes

M - Metastasis into systemic circulation.

Question 8

How can staging be assessed?

Answer 8

Either by imaging or tissue sampling.

Question 9

Give imaging methods for staging of lung cancer.

Answer 9

CXR

CT scan

PET scan

MRI

USS

Bone scan

ECHO

Question 10

Why might a ct scan be more useful than CXR in staging?

Answer 10

The CT scan is called a staging CT and scan both thorax and abdomen and not only thorax.

Question 11

Why might a PET scan be more useful than a CT scan to assess staging in lung cancer?

Answer 11

PET scan more or less covers the whole body.

The PET scan can detect smaller nodules as well that hasn’t been detected on the CT.

Question 12

Why might it be useful for a USS as well in assessment of staging?

Answer 12

USS can differ between hemangioma and metastases.

(Hemangioma looks like metastases on CT)

Question 13

Give examples of tissue sampling done in assessment of staging.

Answer 13

Bronchoscopy

USS

CT biopsy

Thorocoscopy

Surgical

Question 14

How might tissue sampling have other uses than staging?

Answer 14

It can be used to check for the histological type of lung cancer.

Question 15

What are the main histological types of lung cancer?

Answer 15

Non-small cell carcinoma (80%)

Small cell carcinoma (12%)

Carcinoid (5%)

Question 16

Give types of non-small cell carcinoma.

Answer 16

Squamous cell carcinoma (40%)

Adenocarcinoma (35%)

Large cell carcinoma (5%)

Question 17

Why is it important to know what histological type of lung cancer a patient has?

Answer 17

Because they behave differently. Different types of lung cancer can exhibit different symptoms.

Also it is important to be aware of the histological cancer in order to know which treatment to use.

Small cell is much more aggressive than non-small cell lung carcinoma.

Question 18

Give common location of metastases in lung cancer.

Answer 18

Brain

Draining lymph nodes

Pericardium

Liver

Adrenals

Bones

Question 19

How might symptoms differ in lung cancer?

Answer 19

Primary tumour will exhibit certain symptoms

Regional metastases will exhibit different.

Distant metastases will act in their own way.

However most commonly patient have no symptoms.

Question 20

Common symptoms of lung cancer.

Answer 20

Cough

Dyspnoea

Wheezing

Haemoptysis

Lung infection

Chest/shoulder pain

Weight loss

Lethargy/malaise

Question 21

Give less common symptoms experienced in later staging.

Answer 21

Bloated face

Hoarseness

Dyspnoea

Dysphagia

Bone pain/fractures

CNS symptoms

Question 22

Give signs of lung cancer

Answer 22

Cachexia

Pale conjunctiva

Lymphadenopathy

Horner’s syndrome

Finger clubbing

etc…

Question 23

What are other symptoms that might be experienced (endocrine) and what is this syndrome called?

Answer 23

Paraneoplastic syndrome

Cushing’s (ACTH)

Hypercalcaemia (PTHrP)

SIADH (ADH)

Hypertrophic osteoarthropathy

Question 24

Explain the behaviour of small-cell carcinoma.

Answer 24

It is an aggressive cancer which grow and metastasise rapidly.

It can have endocrine features where it produces ACTH or ADH.

Question 25

Explain the behaviour of non-small cell carcinoma.

Answer 25

Slower growing and doesn’t metastasise as quickly.

Can have endocrine features such as production of PTHrP.

Question 26

What are molecular markers in lung cancer?

Answer 26

Genetic signatures that which helps to characterise which type of cancer it is and how to treat it.

Question 27

Why is it important to acknowledge molecular markers?

Answer 27

Because different mutations such as EGFR, ALK, KRAS etc… will respond to different treatment.

Question 28

What is performance status?

Answer 28

An assessment of the patients status and wellbeing.

It is done to assess how appropriate a treatment is.

E.g. surgery is not suitable for a completely bedridden person, as they might be too sick already.

Question 29

Treatment of small cell carcinoma.

Answer 29

Generally combination chemotherapy or combination therapy.

Sugery is usually not possible.

Question 30

Treatment of non-small cell carcinoma.

Answer 30

Surgery

If that doesn’t help or is not possible the chemotherapy/combination therapy.

Question 31

Give a cutting edge treatment that is emerging in treatment of cancer.

Answer 31

Biologic and immunotherapies that are based on mutational analysis and the molecular markers.