Lung Cancer

Question 1

Lung cancer is the most frequent…

Answer 1

cause of cancer death in both males and females in North America.

Question 2

What is the most common cancer in men and women? What is the most common cause of cancer death in men and women?

Answer 2

Most common cancer (women): breast cancer
Most common cancer (men): prostate cancer
Most common cause of cancer death: lung cancer (both men and women)

Question 3

How has the huge decrease in smoking since the 1980s impacted lung cancer death rates in women?

Answer 3

Lung cancer death rates in women were increasing until 2008, but are now decreasing. This reflects the effect of stopping smoking in the 1980s.

Question 4

Which is more deadly for women?
a) breast cancer
b) lung cancer

Answer 4

b) lung cancer (even though breast cancer is more common)

Question 5

For never-smoking patients, is lung cancer more common in women or men?

Answer 5

The proportion of never-smoking patients with lung cancer is twice as high in women than in men

Question 6

How do lung cancer survival rates compare between Indigenous and non-Indigenous patients?

Answer 6

5-year survival rates of Indigenous patients are 35% lower than non-Indigenous patients.

Question 7

Compared to other circumpolar populations, which Arctic State has a significantly higher number of lung cancer cases per year?

Answer 7

Nunavut

Question 8

Why do patients with lung cancer have such high death rates? (3)

Answer 8

• 75% of patients present with locally advanced or metastatic disease
• There is frequently and absence of symptoms in early stages
• Survival rates are low even in early stages of the disease

Question 9

What is the overall 5 year survival rate for lung cancer?

Answer 9

20%

much lower than the 5-year survival rates of other cancers

Question 10

How is lung cancer mortality rate currently changing (2023)?

Answer 10

In 2023, it was reported as decreasing by ~ 4% per year in males and in females. This is the fastest decline in lung cancer mortality reported to date in Canada, and largest decline in cancer mortality across all cancer types.

Question 11

In recent years, the percentage of lung cancer patients living at least 3 years after diagnosis…
a) rose
b) fell

Answer 11

a) rose (from 19% to 31%)

Question 12

What are the main causes of improving trends in terms of lung cancer mortality rates? (3)

Answer 12

• Decrease in tobacco use over the last 40 years
• Improvements in diagnostic and surgical procedures
• Improvements in therapies for stage 4 patients (driver mutations & immunotherapy)

Question 13

Which cancer type has shown greater improvement in terms of survival rates?
a) small cell lung carcinoma (SCLC)
b) non-small cell lung carcinoma (NSCLC)

Answer 13

b) NSCLC

Question 14

Name some risk factors for lung cancer (5)

Answer 14

1. Cigarette smoking
2. Prior lung radiation (breast cancer survivors)
3. Scarring (from old TB, pulmonary fibrosis)
4. Environmental exposures (work-related, second-hand smoke, air pollution)
5. Genetic factors

Question 15

Which lung cancer type is most strongly associated with cigarette smoking?

Answer 15

Small cell lung cancer

Question 16

Globally, cigarette smoking by itself is responsible for … of all lung cancer cases

Answer 16

80%

Question 17

What aspects of cigarette smoking affect risk of lung cancer? (6)

Answer 17

• number of cigarettes smoked
• duration
• age of starting
• degree of inhalation
• tar and nicotine content of cigarettes
• use of unfiltered cigarettes

Question 18

What is a pack-year?

Answer 18

Number of packs of cigarettes smoked per day multiplied by the number of years smoked.

Example: Someone who has smoked 10 cigarettes per day (0.5 packs) for 40 years is. a 20 pack-year smoker.

Question 19

How does the risk of lung cancer compare in patients who continue to smoke vs patients who have quit smoking?

Answer 19

The risk is greatly reduced after 10 years of quitting (the earlier you quit, the better)! However, it will never reach that of non-smokers.

Question 20

Is second-hand smoke an important risk factor for lung cancer?

Answer 20

Yes! Living with a smoker is associated with a 20-30% increase in the risk of lung cancer.

Question 21

Lung cancers in non-smokers are currently on the rise. What are some risk factors that may be responsible for this phenomenon? (6)

Answer 21

• Second-hand smoke
• Air pollution
• Occupation
• Exposure to radon
• Lung diseases (esp. parenchymal scarring due to lung fibrosis or old TB)
• Genetic factors

Question 22

What are some occupational lung cancer exposures?

Answer 22

• Asbestos (pipe insulation, brakes, construction)
• Arsenic (batteries, paint, fertilizers)
• Radon (mining)
• Nickel

Question 23

What cancer type is most commonly linked to asbestos exposure?

Answer 23

Mesothelioma

Question 24

How does a combined exposure to asbestos and cigarette smoking alter the risk of developing lung cancer?

Answer 24

Cigarette smoking and asbestos exposure have a multiplicative effect.
Together, they increase the risk of lung cancer 20-50 times compared to a non-smoking, non-exposed individual.

Note: Smoking alone does not put you at risk of mesothelioma, but it has a compound effect in the case of asbestos exposure

Question 25

What is the lag period between asbestos exposure and development of lung cancer?

Answer 25

Long: 20-30 years

Question 26

What type of early screening can help reduce lung cancer mortality?

Answer 26

CT scanning (more sensitive than CXR and sputum cytology).

Question 27

Which type of lung cancer can develop in old scars?

Answer 27

Adenocarcinoma

Question 28

What type of lung cancer can be associated with hypercalcemia? *Hint: It carries the best relative prognosis*

Answer 28

Squamous cell carcinoma

Question 29

What is typical of lung cancer presentation?

Answer 29

Lung cancer tends to present late Even a small primary tumour can result in wide-spread metastasis

Question 30

What are some signs and symptoms of lung cancer? (9)

Answer 30

* Cough * Bronchorrhoea (large production of watery sputum) * Hemoptysis * Obstructive pneumonia * Chest pain (from chest wall invasion) * Neck nodes * Hoarseness (invasion of recurrent laryngeal nerve) * Swallowing problems * Dyspnea from pleural or pericardial effusions

Question 31

What about a smoker's cough is indicative of cancer? (2 sounds and what they suggest)

Answer 31

CHANGE in character of a smoker's cough: Inspiratory sound: Stridor may indicate compression of trachea or large tumour in trachea Expiratory sound: Wheeze (unilateral) may indicate an airway obstructed by an endobronchial tumor

Question 32

What is SVCO syndrome? What are some symptoms (4)

Answer 32

An important sign of lung cancer. It is an obstruction of the superior vena cava that leads to: * headaches * edema of upper limbs * facial congestion * distention of jugular vein and veins of the chest

Question 33

What is Pancoast syndrome?

Answer 33

An important sign of lung cancer. It is caused by the presence of a tumour at the apex of the lung that leads to: * hand or arm pain (from brachial plexus involvement) * Horner's syndrome (from sympathetic chain involvement)

Question 34

What is Horner's syndrome? What is its classic triad of symptoms?

Answer 34

Condition characterized by damage to the sympathetic nerves supplying the eye and face (often results from Pancoast syndrome). 1. Ptosis: drooping of the upper eyelid 2. Miosis: pupil constriction 3. Anhydrosis: decreased sweating on the affected side of the face

Question 35

Name two symptoms that a physician can immediately notice during a physical examination of the patient that may be signs of lung cancer.

Answer 35

1. Clubbing (hypertrophic pulmonary osteoarthropathy) 2. Heliotrope signs (dermatomyositis)

Question 36

What are PET scans used for?

Answer 36

PET scans measure metabolic activity and help diagnose and stage lung cancer (combined with a CT scan).