Lung Cancer


Overview Lung cancer is the leading cause of cancer deaths in men and women. Lung cancer can be divided into small cell and non-small cell carcinoma. Small cell lung carcinoma presents late stage and has poorer prognosis.  A solitary pulmonary nodule measuring 8 mm or less can be followed radiographically. For larger lesions, a biopsy, whether bronchoscopic, percutaneous, or surgical, should be considered. Steps in management of a patient with suspected lung cancer include tissue diagnosis, staging, preoperative evaluation, and treatment with surgery, radiotherapy, or chemotherapy.

Massive haemoptysis: More than 500 mL of blood loss that is coughed up within a 24-hour period
Horner Syndrome: Symptoms are ptosis, loss of pupillary dilation (miosis), and loss of sweating on the ipsilateral side (anhidrosis) caused by compression of the superior cervical ganglion and resultant loss of sympathetic innervation.
Superior Vena Cava syndrome: Obstruction of venous drainage, usually by external compression of the SVC, leading to edema of the face, neck, and upper part of the torso often with formation of collateral veins on the upper chest.


Risk Factors


There are many risk factors for lung cancer. Smoking, underlying lung disease and exposure to certain chemical are the most common

Signs and Symptoms


Small proportion of patients with lung cancer are asymptomatic when diagnosed. In these cases, a lung nodule usually is found incidentally on chest x-ray or CT. Common signs and symptoms include cough, dyspnea, chest pain, fatigue, weight loss and haemoptysis

Think Most patients with hemoptysis require evaluation with bronchoscopy. Massive hemoptysis may result in death by asphyxiation.

Differential Diagnosis

  • Bronchitis
  • Pneumonia
  • Sarcoidosis
  • Lymphoma
  • Bronchiectasis



  • Chest X-Ray - opacity
  • Spirometry - if thinking of obstructive or restrictive lung disease
  • CT

Investigation Chest x-ray findings can vary in patients with lung cancer and can include pulmonary opacity, hilar enlargement, pleural effusion and collapsed lung.

Investigations for staging

  • CT
  • CT- Biopsy
  • PET scan
  • Pleural fluid aspiration
  • Lung biopsy with bronchoscopy
  • Endobronchial ultrasound
  • Sputum MCS

Lung Carcinoma classification



Lung cancer can be broadly divided into either small cell lung carcinoma or non-small cell carcinoma. Non small cell lung carcinoma making up the majority 80%

Small cell lung carcinoma (SCLC - 20%)

Non-small cell lung carcinoma ( NSCLC - 80%)

  • Adenocarcinoma
  • Squamous cell carcinoma
  • Large cell
Remember Staging of SCLC is limited or extensive. NSCLC uses the TNM classification for staging

Lung cancer characteristics    
SCLC Adenocarcinoma Squamous cell Large cell
Location Central Peripheral Central Peripheral
Cavitation Never Most likely
Metastases Early Early Late Late
Neoplastic Syndrome and Extrapulmonary manifestation  ADH, ACTH Thrombophlebitis  PTH Superior vena cava syndromes + hoarseness

Management and staging

Once a patient presents with symptoms or radiographic findings suggestive of lung cancer, the next steps are as follows:

  1. Tissue diagnosis to establish malignant diagnosis and histologic type
  2. Staging to determine resectability or curative potential
  3. Cancer treatment: surgery, radiotherapy, or chemotherapy
Management overview

Summary Epidemiology, Staging and Management of Lung Cancer

Video: Lung Cancer Management and Staging

Prognosis and Prevention



  • Post-obstructive pneumonia/hypoxia
  • Superior vena vaca syndrome
  • Paraneoplastic syndromes


  • Post-obstructive pneumonia/hypoxia
  • Superior vena vaca syndrome
  • Paraneoplastic syndromes
  • Chemothreapy induced hematological toxicity
  • Radiation induced esophageal/lung injury


  • SCLC mean survival is 3 months if untreated, 1-1.5 year if treated
  • NSCLC 50% 2 year survival without spread, 10% with spread.

Paraneoplastic syndrome


Paraneoplastic syndrome are a group of syndromes where cancer cells produce peptides that mimic certain hormones. This occurs through genetic mutations within cancer cells allow them to develop new abilities and become "neuroendocrine cells". In lung cancer common hormone like substances produced include: PTH, ACTH and ADH

More info on Paraneoplastic Syndrome

Lung Cancer

Summary of Lung Cancer Lung Cancer is the leading cause of cancer related deaths. Fever, nights sweats and sudden weight loss +/- hemoptysis rings alarm bells especially in the presence of strong risk factors such as smoking, exposure to certain chemicals and family history. Chest X-ray is a helpful technique in ruling in/out diseases. Treatment includes chemotherapy and lung tissue resection

Video: Lung Cancer Overview