Lung Cancer

Outline

Background 

• 80% of lung cancer attributable to smoking, adenocarcinoma most common non-smoker lung cancer

• Lung cancer accounts for 20% of cancer deaths, poor prognosis due to its late presentation and difficulty of removing or replacing the lung

Assessment

Presentation:

• Insidious weight loss, dry cough, night sweats, haemoptysis

• Male elderly smoker

• BG- COPD

Examination:

• Cachexic

• Focal consolidation/ crackles/ reduce air entry, dull percussion

• No finger clubbing

Investigations

• CXR- circular opacification

• Anaemia, thrombocytosis

• Neuroendocrine features

  • Ca2+: hypercalcaemia

  • SIADH: hyponatraemia

  • ACTH- Hypertensive, hypokalaemia

Diagnosis

Diagnostic criteria: histological diagnosis

1. CXR: screening

2. CTCAP: stage and lesion for biopsy

3. Biopsy: bronchoscopy, EBUS, CT guided biopsy

4. Discussion lung cancer MDT for mangement

Differentials: Tuberculosis, Sarcoidosis 

Classifications by:

• Aetiology- tissue type

  • Metastatic (commonest)

  • Primary Lung

    • Small Cell Lung Cancer

    • Non Small Cell Lung Cancer

• Severity- TMN & stage 1-4

• Site

Metastatic Lung Cancer

• Colorectal cancer (most common source), also breast & renal

• Diagnose type with biopsy

• Longer interval between primary resection and metastatic re-occurrence the better

Small Cell Lung Cancer

• 20% lung cancers

• Aggressive, late presentation

• Management: usually chemo-radiotherapy or palliative radiotherapy

• Paraneoplastic associations

  • Hyponatraemia (ectopic SIADH )

  • Cushing's Syndrome (ectopic ACTH)

  • Paraneoplastic cerebellar degeneration: Lamberton Eaton Syndrome (LES), cerebellar signs

Non Small Cell Lung Cancers

Majority: 

• Squamous cell lung cancer:

  • • Hypercalcaemia (excess PTH related peptide)

• Adenoma lung cancer

  • • Commonest cause of lung cancer in the non-smoker

Rarer: 

• Large Cell Carcinoma

• Neuroendocrine tumours

Bronchial carcinoid

• Slow growing neuroendocrine tumour

• 'Flushing' key symptom

• Produce serotonin

• Diagnosis: urinary 5HIAA increased, 

• Mx- octreotide + surgical resection

Management

MDT Discussion

• Assessment: staging imgaging- CTCAP +- PETCT, biopsy

  • Fitness: pulmonary function tests, cardiopulmonary exercise testing, frailty score

• Ideally surgery- if nil signs of metastatic spread

• Chemotherapy depending upon stage + fitness

• Palliative radiotherapy & palliative referral

Pneumonectomy

Work up

• PET CT is required to look for metastasis

• Cardiopulmonary exercise testing

• Ventilation/ perfusion isotope lung scan

Indications - lung Cancer

Contraindications

Absolute

• Vocal cord palsy- implies local invasion

• Superior vena cava obstruction- also implied local invasion

Relative

• Age

• Reduced FEV1 < 2.0

• N2: contralateral lymphadenopathy

References and Resources

Written in 2025