Lung Cancer Overview and Symptoms

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Questions and Answers

What type of lung cancer is most commonly associated with smoking?

Non-small cell lung cancer (NSCLC) (correct)

Small cell lung cancer (SCLC)

Carcinoid tumor

Adenocarcinoma

Which type of non-small cell lung cancer is more commonly found peripherally?

Large cell carcinoma

Squamous cell carcinoma

Adenocarcinoma (correct)

Mixed cell carcinoma

Which symptom is NOT specific to lung cancer?

Shortness of breath

Haemoptysis

Chest pain

Fatigue (correct)

What is a characteristic that distinguishes small cell lung cancer from non-small cell lung cancer?

SCLC is often associated with paraneoplastic effects Signup and view all the answers

In which scenario should a patient be referred for a suspected cancer pathway referral?

If they present with chest X-ray findings suggesting lung cancer Signup and view all the answers

Which of the following is NOT a generalized cancer symptom?

Pancoast symptoms Signup and view all the answers

What is the most common sign associated with lung cancer?

Palpable lymph nodes Signup and view all the answers

What is required for the histological categorization of lung cancer grading?

Imaging to guide the biopsy Signup and view all the answers

What does the N in TNM classification stand for?

Node spread Signup and view all the answers

Which treatment is primarily used for localized tumors with limited spread?

Surgery Signup and view all the answers

What is the purpose of radiotherapy with respect to tumor treatment?

It applies a high dose to the tumor while minimizing exposure to surrounding tissue. Signup and view all the answers

Why might immunotherapy require specific testing such as PD-L1 evaluation?

To identify the presence of cancer cell defenses against immune attack. Signup and view all the answers

What distinguishes a lower respiratory tract infection (LRTI) from an upper respiratory tract infection (URTI)?

LRTIs involve the alveoli and airways, while URTIs involve the nasal cavity and larynx. Signup and view all the answers

What is the classification of pneumonia in terms of respiratory infection types?

Lower Respiratory Tract Infection Signup and view all the answers

What is a common screening recommendation for individuals at high risk of lung cancer?

Low-dose CT scan of the lungs Signup and view all the answers

What is a key feature of the grading process in tumor evaluation?

It relies on histological evaluation. Signup and view all the answers

Study Notes

Lung Cancer

Non-small cell lung cancer (NSCLC): Most common, higher association with smoking. Subdivided into adenocarcinoma, squamous cell carcinoma, large cell, and mixed types. Adenocarcinoma is more common peripherally, while squamous cell carcinoma is more common in airways. Carcinoid tumors (rare) secrete chemicals causing various symptoms.
Small cell lung cancer (SCLC): Less common, not amenable to surgery. Often associated with paraneoplastic effects, meaning unusual symptoms in other parts of the body due to substances released into the bloodstream.

Lung Cancer Symptoms (Specific)

Cough
Shortness of breath
Haemoptysis (coughing up blood)
Non-resolving pneumonia
Chest pain (direct invasion)
Mass effect (hoarse voice)
Pancoast symptoms (rare)

Lung Cancer Symptoms (Generalised)

Fatigue
Unexplained weight loss
Pain/symptoms from metastases
Paraneoplastic phenomena
Hypocalcaemia

Lung Cancer Signs

Palpable lymph nodes
Signs of SVC obstruction (swelling of face, neck, arms, upper body)
Monophonic wheeze
Signs of nerve damage (mass effect)
Effusion (unilateral), dull to percussion
General cancer signs (cachexia, emaciation)

Lung Cancer Investigation

People referred with suspected lung cancer pathway referral within 2 weeks if they have chest X-ray findings suggestive of lung cancer or are over 40 and have unexplained haemoptysis.
Urgent chest X-rays are offered to people over 40 who exhibit two or more unexplained symptoms or a history of smoking with one or more symptoms (cough, fatigue, shortness of breath, chest pain, weight loss, appetite loss, recurrent chest infection, finger clubbing, thrombocytosis, supraclavicular or persistent cervical lymphadenopathy, chest signs consistent with lung cancer)

Lung Cancer Evaluation

Grading: A histological categorization needing a biopsy, possibly needing imaging for guidance.
Staging: Anatomical categorization requiring imaging, considering tumor size, location, and presence/position of metastases, using the TNM classification. T1-4 (based on size/structures invaded), N0-3 (based on lymph node spread), M0-1 (based on metastases).

Lung Cancer Treatment

Surgery: Suitable for localized tumors with limited spread
Radiotherapy: Used for tumors or regions unsuitable for surgery, with concentrated radiation beams over tumor site to lower surrounding tissue damage.
Chemotherapy: To control or sometimes cure certain cancers (toxic, affecting rapidly dividing cells, reduces a patient's immune system), immunotherapy (specific to tumor subtype, needs testing) blocks receptors to allow T-cell immune attack.

Lung Cancer Screening

Individuals between 55-75 who smoke or have smoked will get an invite for a lung cancer assessment (low-dose CT scan if high risk).

Respiratory Infections

URTI (Upper Respiratory Tract Infection): Larynx, pharynx, tonsils, nasal cavity (less likely severe)
LRTI (Lower Respiratory Tract Infection): Below larynx, airways, alveoli (more likely severe)
Pneumonia: Infection of lung parenchyma, inflamed alveoli walls filled with pus and fluid containing bacteria/blood cells. Can be lobar or bronchopneumonia. Community- or hospital-acquired (CAP/HAP); Antibiotics are used for treatment for bacterial pneumonia, potentially causing sepsis.
Epiglottitis: Inflammation of upper airway tissues (life-threatening, usually bacterial); characterized by pyrexia, painful swallowing, and drooling.
Bronchitis: Inflammation of bronchial mucosa, mainly viral (self-limiting); causing cough and sputum. May have URTI symptoms.
Bronchiolitis: Inflammation of small airways (<2mm), often infective (RSV) in children; causing wheezing, fever, and cough.
Mycobacterium TB: Slow-growing bacteria; requiring several antibiotics for months to work. It is hard to isolate and culture via sputum samples.

Asthma

Obstructive ventilatory disorder, characterized by hyper-responsiveness of the bronchi leading to episodic spasm and inflammation.
Diagnosed based on FENO (fraction of exhaled nitric oxide) not imaging.
Symptoms: increased risk of contrast hypersensitivity, inflammatory mucosa, smooth muscle contraction, and airway mucous secretions, all lead to airway obstruction.
Triggers: Allergens, medications, environment (smoke), occupational, and complications (secondary infections like pneumothorax), loss of lung function if left untreated.
Treatment: Bronchodilators and corticosteroids (e.g., salbutamol), beta2 agonists, leukotriene receptor antagonists.

COPD (Chronic Obstructive Pulmonary Disease)

Airflow limitation from chronic inflammatory response in airways, leading to lung tissue destruction.
Primarily linked with smoking.
Components: Chronic bronchitis (inflammation of bronchi) and emphysema (breakdown of alveolar walls; affects upper lobes more).

Interstitial Lung Disease

Characterized by inflammation and scarring, making breathing difficult.
Scarring: called pulmonary fibrosis, affecting the interstitium/interlobular septum.
Stiffens and loses compliance of the lungs, causing restrictive ventilatory defect.
Causes: Autoimmune diseases, occupation lung disease, drugs, idiopathic (no known cause), post-infectious, or radiation.

Pneumothorax

Air in the pleural space (between parietal and visceral pleura).
Can be spontaneous (not due to trauma) or secondary (from lung disease).
Symptoms: Difficulty breathing, chest pain.
Diagnosis via chest X-ray.
Treatment depends on size and underlying lung disease.

Pleural Effusion

Excess fluid in the pleural cavity.
Exudate: Fluid leakage from blood vessels (e.g., cancer, infection, injury)
Transudate: Fluid passing through membranes (e.g., heart/liver/kidney failure).
Left pleural effusion: Progressive breathlessness as effusion progresses. Treatment depends on the cause: aspirating fluid, chest drain insertion.

Pulmonary Embolism (PE)

Venous clot lodged in pulmonary vessels.
Deep vein thrombosis (DVT): Clots formed in deep veins.
Symptoms: Pleuritic chest pain, SOB, hypoxemia, hypotension, cardiac arrest.
Diagnosis often uses CXR to check for other cause before definitive PE blood tests like D-dimer.
Treatment: Anticoagulation, thrombolytic therapy.

Other Lung Infections

Tracheitis: Inflammation of the trachea; more severe if bacterial (mostly affecting children).
Empyema: Pus in pleural fluid.
Lung Abscess: Localized collection of pus in the lung.

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Description

This quiz explores the key aspects of lung cancer, including its types such as non-small cell lung cancer and small cell lung cancer, along with their distinct symptoms. Participants will learn about specific and generalized symptoms associated with lung cancer, aiding in better understanding and awareness of the disease.