Lung Cancer

Question 1

How common is lung cancer in the UK?

Answer 1

Lung cancer is the third most common cancer in the UK behind breast and prostate.

Question 2

One of the biggest cause of lung cancer is

Answer 2

Cigarette smoking

Question 3

Non-small cell lung cancer accounts for about

Answer 3

80% of all lung cancers

Question 4

Non-small cell lung cancer types include

Answer 4

Adenocarcinoma (around 40%)
Squamous cell carcinoma (around 20%)
Large-cell carcinoma (around 10%)
Other types (around 10%)

Question 5

Small Cell Lung Cancer (SCLC) accounts for about

Answer 5

20% of all lung cancers

Question 6

Small cell lung cancer cells contain ________ that can release _________ hormones. This makes SCLC responsible for multiple paraneoplastic syndromes.

Answer 6

neurosecretory granules; neuroendocrine

Question 7

Signs and Symptoms of lung cancer include

Answer 7

• Shortness of breath
• Cough
• Haemoptysis
• Finger clubbing
• Recurrent pneumonia
• Weight loss
• Lymphadenopathy – often supraclavicular nodes are the first to be found on examination

Question 8

Lung cancer investigations include:

Answer 8

• Chest x-ray
• Staging CT scan
• PET-CT (positron emission tomography)
• Bronchoscopy with endobronchial ultrasound (EBUS)
• Histological diagnosis

Question 9

Chest x-ray is the first-line investigation in suspected lung cancer. Findings suggesting cancer include:

Answer 9

• Hilar enlargement
• “Peripheral opacity” – a visible lesion in the lung field
• Pleural effusion – usually unilateral in cancer
• Collapse

Question 10

How should the Staging CT scan of chest, abdomen and pelvis be carried out?

Answer 10

This should be contrast enhanced using an injected contrast to give more detailed information about different tissues.

Question 11

PET-CT (positron emission tomography) scans involve

Answer 11

injecting a radioactive tracer (usually attached to glucose molecules) and taking images using a combination of a CT scanner and a gamma ray detector to visualise how metabolically active various tissues are. They are useful in identifying areas that the cancer has spread to by showing areas of increased metabolic activity suggestive of cancer.

Question 12

What does a Bronchoscopy with endobronchial ultrasound (EBUS) provide?

Answer 12

This allows for detailed assessment of the tumour and ultrasound guided biopsy.

Question 13

What are some available treatment options for lung cancer?

Answer 13

• Surgery
• Radiotherapy
• Chemotherapy
• Endobronchial treatment

Question 14

When is surgery for lung cancer offered?

Answer 14

Surgery is offered first line in non-small cell lung cancer to patients that have disease isolated to a single area with intention to cure the cancer.

Question 15

What are the 2 types of lung cancer surgeries available?

Answer 15

• Lobectomy (removing the lung lobe containing the tumour) is first line.
• Segmentectomy or wedge resection (taking a segment or wedge of lung to remove the tumour).

Question 16

When can radiotherapy be used?

Answer 16

Radiotherapy can also be curative in non-small cell lung cancer when early enough.

Question 17

When can chemotherapy be used?

Answer 17

• Can be offered in addition to surgery or radiotherapy in certain patients to improve outcomes (“adjuvant chemotherapy”)
• As palliative treatment to improve survival and quality of life in later stages of non-small cell lung cancer.

Question 18

Treatment for small cell lung cancer is usually

Answer 18

chemotherapy and radiotherapy

Question 19

Prognosis is generally worse for

Answer 19

small cell lung cancer than non-small cell lung cancer

Question 20

When can endobronchial treatment be used?

Answer 20

Endobronchial treatment with stents or debulking can be used as part of palliative treatment to relieve bronchial obstruction caused by lung cancer.

Question 21

Lung cancer is associated with a lot of

Answer 21

extrapulmonary manifestations and paraneoplastic syndromes

Question 22

Extrapulmonary Manifestations associated with lung cancer include

Answer 22

• Recurrent laryngeal nerve palsy
• Phrenic nerve palsy
• Superior vena cava obstruction
• Horner’s syndrome
• Syndrome of inappropriate ADH (SIADH)
• Cushing’s syndrome
• Hypercalcaemia
• Limbic encephalitis
• Lambert-Eaton myasthenic syndrome

Question 23

What is Recurrent laryngeal nerve palsy?

Answer 23

Recurrent laryngeal nerve palsy presents with a hoarse voice. It is caused by the cancer pressing on or affecting the recurrent laryngeal nerve as it passes through the mediastinum.

Question 24

Why does Phrenic nerve palsy occur?

Answer 24

Phrenic nerve palsy due to nerve compression causes diaphragm weakness and presents as shortness of breath.

Question 25

What is Superior vena cava obstruction?

Answer 25

Superior vena cava obstruction is a complication of lung cancer. It is caused by direct compression of the tumour on the superior vena cava. It presents with facial swelling, difficulty breathing and distended veins in the neck and upper chest.

Question 26

What is Pemberton’s sign?

Answer 26

“Pemberton’s sign” is where raising the hands over the head causes facial congestion and cyanosis. This is a medical emergency.

Question 27

What is Horner’s syndrome?

Answer 27

Horner’s syndrome is a triad of partial ptosis, anhidrosis and miosis. It is caused by a Pancoast’s tumour (tumour in the pulmonary apex) pressing on the sympathetic ganglion.

Question 28

Syndrome of inappropriate ADH (SIADH) is caused by

Answer 28

ectopic ADH secretion by a small cell lung cancer and presents with hyponatraemia

Question 29

Cushing’s syndrome can be caused by

Answer 29

ectopic ACTH secretion by a small cell lung cancer

Question 30

Hypercalcaemia is caused by

Answer 30

ectopic parathyroid hormone from a squamous cell carcinoma

Question 31

What is Limbic encephalitis?

Answer 31

This is a paraneoplastic syndrome where the small cell lung cancer causes the immune system to make antibodies to tissues in the brain, specifically the limbic system, causing inflammation in these areas. This causes symptoms such as short-term memory impairment, hallucinations, confusion and seizures. It is associated with anti-Hu antibodies.

Question 32

Lambert-Eaton myasthenic syndrome is a result of

Answer 32

antibodies produced by the immune system against small cell lung cancer cells

Question 33

Lambert-Eaton myasthenic syndrome antibodies target and damage

Answer 33

voltage-gated calcium channels sited on the presynaptic terminals in motor neurones

Question 34

Lambert-Eaton myasthenic syndrome antibodies target and damage voltage-gated calcium channels sited on the presynaptic terminals in motor neurones leading to

Answer 34

weakness, particularly in the proximal muscles but can also affect intraocular muscles causing diplopia (double vision), levator muscles in the eyelid causing ptosis and pharyngeal muscles causing slurred speech and dysphagia (difficulty swallowing). Patients may also experience dry mouth, blurred vision, impotence and dizziness due to autonomic dysfunction.

Question 35

Patients with Lambert-Eaton have reduced

Answer 35

tendon reflexes

Question 36

In older smokers with symptoms of Lambert-Eaton syndrome consider

Answer 36

Small cell lung cancer

Question 37

What is mesothelioma?

Answer 37

Mesothelioma is a lung malignancy affecting the mesothelial cells of the pleura. It is strongly linked to asbestos inhalation. There is a huge latent period between exposure to asbestos and the development of mesothelioma of up to 45 years. The prognosis is very poor. Chemotherapy can improve survival but it is essentially palliative.