Lung cancer

Lung cancer is a malignant tumour that originates in the bronchial epithelium.

• Leading cause of cancer deaths worldwide.
• Strong association with tobacco smoking.

• Smoking: primary risk factor.
• Asbestos exposure.
• Radon gas.
• Family history.
• Chronic obstructive pulmonary disease (COPD).

• Non-small cell lung cancer (NSCLC): 85% of cases
  • Adenocarcinoma: Most common subtype, often peripherally located.
  • Squamous cell carcinoma: Central, linked to smoking, may produce parathyroid hormone-related peptide.
  • Large cell carcinoma: Poor prognosis, can appear anywhere in the lung.
• Small cell lung cancer (SCLC): 15% of cases, aggressive, associated with paraneoplastic syndromes.

• New or changing cough.
• Haemoptysis.
• Weight loss, anorexia.
• Dyspnoea.
• Chest pain.
• Recurrent chest infections.

• Chest X-ray: May show mass or hilar lymphadenopathy.
• CT scan: Assess tumour size, nodal involvement, metastasis.
• Biopsy: Diagnostic; either bronchoscopic or CT-guided.
• PET scan: Staging and looking for metastasis.
• Blood tests: FBC, U&Es, liver function tests, calcium.

• Surgery: Curative intent, mainly for NSCLC.
• Radiation: Can be curative or palliative.
• Chemotherapy: Main treatment for SCLC, also used for advanced NSCLC.
• Targeted therapies: Specific to mutations in tumour DNA.
• Supportive care: Pain management, oxygen for dyspnoea.
• Multidisciplinary team involvement including respiratory physicians, radiologists, thoracic surgeons, clinical and medical oncologists, etc.

• Metastasis.
• Paraneoplastic syndromes.
• Superior vena cava obstruction.
• Horner’s syndrome.
• Pancoast tumour.

• Generally poor, especially for SCLC.
• 5-year survival varies: NSCLC (10-20%), SCLC (2-8%).

• Smoking cessation.
• Avoidance of known carcinogens.
• Regular health screenings for high-risk populations.

• Lung cancer is a malignant tumour, with a generally poor prognosis that originates in the bronchial epithelium.
• Its is classified as either NSCLC (most common) or SCLC, which dictates management.
• Smoking cessation is a key prevention factor.
• Management includes surgery, radiation, chemotherapy, targeted therapies and supportive care.
• Involvement of a multidisciplinary team is crucial for both diagnosis and management.