Lung Cancer (2nd edition)

• What is the third most common cancer in the UK?

  Lung cancer
• What is the most significant cause of lung cancer?

  Smoking
• What percentage of lung cancers are thought to be preventable?

  Around 80%
• What are the histological types of lung cancer?

  • Small-cell lung cancer (SCLC) - around 20%
  • Non-small-cell lung cancer (NSCLC) - around 80%
  • Adenocarcinoma - around 40%
  • Squamous cell carcinoma - around 20%
  • Large-cell carcinoma - around 10%
  • Other types - around 10%
• What type of granules do small-cell lung cancer cells contain?

  Neurosecretory granules
• What is mesothelioma and what is it linked to?

  Mesothelioma is a lung malignancy affecting mesothelial cells and is strongly linked to asbestos inhalation.
• What is the prognosis for mesothelioma?

  The prognosis is very poor.
• What can improve survival in mesothelioma patients?

  Chemotherapy can improve survival but is essentially palliative.
• What are the presenting features of lung cancer?

  • Shortness of breath
  • Cough
  • Haemoptysis (coughing up blood)
  • Finger clubbing
  • Recurrent pneumonia
  • Weight loss
  • Lymphadenopathy (often supraclavicular nodes)
• What is a common first sign of lung cancer in asymptomatic patients?

  Paraneoplastic syndromes can be the first evidence of lung cancer.
• What does recurrent laryngeal nerve palsy present with?

  It presents with a hoarse voice.
• What causes phrenic nerve palsy in lung cancer?

  It is caused by nerve compression leading to diaphragm weakness.
• What is superior vena cava obstruction and how does it present?

  It is caused by direct tumor compression and presents with facial swelling, difficulty breathing, and distended neck veins.
• What is Pemberton’s sign?

  Pemberton’s sign is facial congestion and cyanosis when raising the hands over the head.
• What is Horner’s syndrome and what can cause it?

  Horner’s syndrome is a triad of partial ptosis, anhidrosis, and miosis, and can be caused by a Pancoast tumor.
• What is SIADH and what can cause it in lung cancer?

  SIADH is caused by ectopic ADH secreted by small-cell lung cancer and presents with hyponatraemia.
• What can cause Cushing’s syndrome in lung cancer?

  Cushing’s syndrome can be caused by ectopic ACTH secretion by small-cell lung cancer.
• What can cause hypercalcaemia in lung cancer?

  Hypercalcaemia can be caused by ectopic parathyroid hormone secreted by squamous cell carcinoma.
• What is limbic encephalitis and how is it associated with lung cancer?

  Limbic encephalitis is a paraneoplastic syndrome caused by small-cell lung cancer leading to inflammation in the limbic system.
• What antibodies are associated with limbic encephalitis?

  It is associated with anti-Hu antibodies.
• What is Lambert-Eaton myasthenic syndrome and how is it related to lung cancer?

  It is caused by antibodies against small-cell lung cancer cells that damage voltage-gated calcium channels in motor neurons.
• What symptoms can Lambert-Eaton myasthenic syndrome cause?

  It can cause weakness in proximal muscles, diplopia, ptosis, slurred speech, and dysphagia.
• What autonomic dysfunction symptoms can occur with Lambert-Eaton myasthenic syndrome?

  Patients may experience dry mouth, blurred vision, impotence, and dizziness.
• What are the NICE guidelines for offering a chest x-ray in suspected lung cancer?

  • Patients over 40 with:
  • Clubbing
  • Lymphadenopathy (supraclavicular or persistent abnormal cervical nodes)
  • Recurrent or persistent chest infections
  • Raised platelet count (thrombocytosis)
  • Chest signs of lung cancer
  • Patients over 40 with:
  • Two or more unexplained symptoms (never smoked)
  • One or more unexplained symptoms (ever smoked or had asbestos exposure)
• What are the two key examination findings that indicate an urgent chest x-ray?

  Finger clubbing and supraclavicular lymphadenopathy.
• What are the unexplained symptoms listed in the NICE guidelines for lung cancer?

  Cough, shortness of breath, chest pain, fatigue, weight loss, and loss of appetite.
• What is the first-line investigation in suspected lung cancer?

  Chest x-ray
• What findings on a chest x-ray suggest lung cancer?

  Hilar enlargement, peripheral opacity, pleural effusion, and collapse.
• What is the purpose of a staging CT scan in lung cancer?

  To assess the stage, lymph node involvement, and presence of metastases.
• What is a PET-CT scan used for in lung cancer diagnosis?

  To visualize how metabolically active various tissues are and identify metastases.
• What does bronchoscopy with endobronchial ultrasound allow for?

  It allows detailed assessment of the tumor and ultrasound-guided biopsy.
• What is required for a histological diagnosis of lung cancer?

  A biopsy to check the type of cells in the tumor.
• What are the treatment options for lung cancer?

  • Surgery (first-line for non-small-cell lung cancer)
  • Radiotherapy (curative in early-stage non-small-cell lung cancer)
  • Chemotherapy (adjuvant or palliative)
  • Small-cell lung cancer treatment usually involves chemotherapy and radiotherapy
  • Endobronchial treatment (stents or debulking for palliative care)
• What is the intention of surgery in non-small-cell lung cancer?

  To remove the entire tumor and cure the cancer.
• When can radiotherapy be curative in lung cancer?

  When diagnosed early in non-small-cell lung cancer.
• What is adjuvant chemotherapy?

  Adjuvant chemotherapy is given in addition to surgery or radiotherapy to improve outcomes.
• What is palliative chemotherapy?

  Palliative chemotherapy is used to improve survival and quality of life in later stages of non-small-cell lung cancer.
• What is the prognosis for small-cell lung cancer compared to non-small-cell lung cancer?

  The prognosis is generally worse for small-cell lung cancer.