🎯 Pathology

• tumours originating from the lung parenchyma or within the bronchi

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💡 Types of lung cancer

• small-cell lung cancer (SCLC)

• non-small-cell lung cancer (NSCLC)

  • adenocarcinoma (most common type of lung cancer)

  • squamous cell carcinoma

  • large-cell carcinoma

  • bronchial carcinoid tumour

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🩺 Clinical features

• the signs and symptoms are non-specific

• symptoms​

  • dyspnoea

  • chest pain

• signs

  • cough

  • haemoptysis

  • constitutional: fever, night sweats, weight loss, cachexia

  • clubbing

  • lymphadenopathy of the supraclavicular and/or axillary lymph nodes

  • Pancoast tumour signs

    • superior vena cava syndrome: pulseless jugular venous distension, swelling of the face, neck and upper extremities, positive Pemberton sign (elevation of arms over the head causes facial plethora)

    • Horner’s syndrome: compression of the stellate ganglion leading to miosis, ptosis, anhydrosis

    • hoarseness (due to recurrent laryngeal nerve palsy)

    • shoulder pain (due to compression of the brachial plexus)

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📌 Small-cell lung cancer

• location

  • central

• risk factors

  • smoking

• paraneoplastic syndromes

  • Cushing’s syndrome (due to ectopic ACTH secretion)

  • syndrome of inappropriate ADH (due to ectopic ADH secretion) --> increased water retention and low sodium levels 

  • Lambert-Eaton myasthenic syndrome (antibodies against pre-synaptic voltage-gated calcium channels)

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📌 Adenocarcinoma

• location

  • peripheral

• risk factors

  • most common in non-smokers

• paraneoplastic syndromes

  • hypertrophic pulmonary osteoarthropathy

  • gynaecomastia

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📌 Large cell carcinoma

• location

  • peripheral

• paraneoplastic syndromes

  • gynaecomastia

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📌 Squamous cell carcinoma

• location

  • central

• risk factors

  • smoking

• paraneoplastic syndromes

  • hypercalcaemia due to release of parathyroid hormone-related peptide (PTH-rP)

  • hypertrophic pulmonary osteoarthropathy

• extra features

  • associated with cavitating lesions

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📌 Bronchial carcinoid tumour

• releases serotonin (5-HT) leading to

  • flushing

  • wheeze

  • diarrhoea

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🕵️‍♂️ Investigations

• bloods

  • thrombocytosis

• imaging

  • initial: chest x-ray

  • best: CT chest, abdomen and pelvis for staging (contrast-enhanced)

• invasive

  • central lesions: bronchoscopy

  • peripheral lesions: fine-needle aspiration (CT guided)

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💆‍♂️ Management

• SCLC

  • chemotherapy and radiotherapy

• NSCLC

  • 1st line = surgery

  • 2nd line = chemotherapy and radiotherapy

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🧲 High-yield tips 

• location of Squamous cell carcinoma and Small cell lung cancer = Sentral

• lung cancers most associated with Smoking = Small cell lung cancer = Sentral

• lung cancers usually metastasise to the brain, liver, adrenals and bones