Lung Cancer

Exam Cram

• Lung Cancers describes cancers of the lung- classified by histology, severity and location

• Presentation: insidious weight loss, cough, haemoptysis in smoker

• Diagnosis: histological biopsy

• Management: surgery has the best outcomes if lack of metastasis

Outline

Background 

• 80% of lung cancer attributable to smoking

Assessment

History:

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

• Male elderly smoker

• BG- COPD

Examination:

• Cachexic

• Focal consolidation/ crackles

Investigations

• Anaemia, thrombocytosis

• CXR- circular opacification

• Neuroendocrine features

  • Ca2+: hypercalcaemia

  • SIADH: hyponatraemia

  • ACTH- Hypertensive, hypokalaemia

Diagnosis

Diagnostic criteria: histological diagnosis

Differentials: Tuberculosis, Sarcoidosis 

Classifications by:

• Aetiology- tissue type

• Severity- TMN & stage 1-4

• Site

By Aetiology

Metastatic: commonest cause

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

• Diagnose type with biopsy

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

Squamous cell lung cancer:

• Hypercalcaemia (excess PTH related peptide)

Small cell lung cancer:

• Hyponatraemia (ectopic SIADH )

• Cushing's Syndrome (ectopic ACTH)

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

• Responsive to chemotherapy

• Only surgical candidate if nil spread even to lymph nodes

Adenoma lung cancer

• Commonest cause of lung cancer in the non-smoker

Bronchial carcinoid

• Slow growing neuroendocrine tumour

• 'Flushing' key symptom

• Produce serotonin

• Diagnosis: urinary 5HIAA increased, 

• Mx- octreotide + surgical resection

Management

Dictated by classification: histology, TMN/ staging & location. 

Options: watch & wait, surgery, chemotherapy, radiotherapy and immunotherapy. 

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

Med Reg Notes

References and Resources

Written in 2025