Lung cancer Classification
Small cell Lung cancer	Non Small cell Lung cancer (NSCLC)
	Squamous cell lung cancer (radiosensitive) (SRS) Non squamous cell lung cancer Adenocarcinoma (chemosensitive) Large cell carcinoma

 

Investigation:

Aims of investigation are 

• • to confirm the diagnosis, 
  • to establish the histological cell type 
  • to define the extent of the disease. 
  • to see paraneoplastic manifestation 
  • to see comorbidities

 

Investigation	Finding
CBC, PBF	anemia,  pancytopenia → bone marrow infiltration
Sputum microscopy for malignant cell	may be positive
Chest X Ray	lobar collapse, mass lesions,  effusion, malignant rib destruction elevated diaphragm
CT chest	mediastinal or metastatic spread  helpful for planning biopsy procedures: bronchoscopy or P/C CT-guided biopsy
Biopsy and histopathology
Flexible bronchoscopy with BAL with biopsy bronchoscopy with EBUS-guided node sampling (upper ediastial) Endoscopic (esophageal) USG guided node sampling (lower mediastinal) P/C needle biopsy under CT/USG	histological diagnosis PCNB: iatrogenic pneumothorax, eg. COPD
Pleural fluid aspiration with pleural biopsy (thoracoscopy)
FNAC or biopsy from LN, liver, skin nodule
For staging
Combined CT and whole-body FDG-PET	to detect metastases.
Head CT,  radionuclide bone scanning,  Abdominal USG bone marrow biopsy	liver mets, lymphadenopathy, adrenal enlargement
molecular testing: next-generation sequencing (NGS) for gene mutation	Mutations, fusions, and deletions  EGFR, ROS, RET
To assess baseline for aggressive treatment
ECG, Echocardiography Lung function test	cardiac, pulmonary function assessment
S creatinine, urea, electrolytes	hyponatremia→ SIADH renal function assessment
S calcium, albumin, Phosphate, PTH	hypercalcemia → paraneoplastic
ALT, ALP, PT, bilirubin	liver metastasis, obstructive jaundice
TSH, blood sugar

 

 

 

 

 

 

 

 

Staging in short:

 

Stage	Definition
Stage I	N0 (no lymphadenopathy), tumor confined within visceral pleura (<4 cm)
Stage II	N1 [Ipsilateral hilar, tumor size < 5 cm (or > 5 cm with N0]
Stage III	Ipsilateral mediastinal or subcarial, OR contralateral or supraclavicular  Tumor size > 7 cm or invading heart, vessel, esophagus, caria etc
Stage IV	Lung metastasis/ Effusio / Extrathoracic metastasis

 

 

Treatment:

Stage of NSCLC	Treatment
I	Surgery
II	Surgery → adjuvant chemotherapy
III	Surgery → chemo with or without radiotherapy
IV *EGFR: Epidermal Growth Factor Receptor	Radiotherapy  Systemic therapy (TIC): which may consist of  Targeted therapy: for EGFR* gene mutation ( adenocarcinoma in non smoker) TKI: Erlotinib Mab to EGFR: Bevacizumab Immunotherapy Cytotoxic chemotherapy platinum based- cisplatin

 

 

Surgical management: 5-year survival rates for 

•  Stage I disease: over 80% 
• stage II disease:  70% in stage II disease, 

 

Palliative treatment:

• Radiotherapy:

1. • SVCO, recurrent haemoptysis
   • pain caused by chest wall invasion or by skeletal metastasis. 
   • obstruction of the trachea and main bronchi 

• For major airway obstruction 

1. • bronchoscopic laser treatment to clear tumor tissue. 
   • Endobronchial stents to maintain airway patency in case of extrinsic compression by malignant nodes. 

 

 

General aspects of management 

• managed in specialist centers by multidisciplinary teams, including 

• • oncologists, thoracic surgeons, respiratory physicians and specialist nurses. 

• Effective communication, pain relief and attention to diet are important. 
• For depression and anxiety → specific therapy. 
• Management of non-metastatic endocrine manifestations 
• For malignant pleural effusion 
  • intercostal drain; 
  • long-term indwelling pleural catheters 
  • pleurodesis with sclerosing agents such as talc. 

 

Prognosis 

• The overall prognosis is very poor
• mortality rate from diagnosis 
  • 1 year mortality rate approximately 60% 
  • 5 year mortality rate over 80% 
• The best prognosis is for
  • well-differentiated squamous cell carcinoma that have not metastasised and are amenable to surgical resection. 

 

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SCLC: Chemo + Radiotherapy

• SCLC is a highly aggressive disease characterized by its rapid doubling time, high growth fraction, early development of disseminated disease, and dramatic response to first-line chemotherapy and radiation. 
• In general, surgical resection is not routinely recommended for patients because even patients with LD-SCLC still have occult micrometastases. 

 

Chemotherapy agents (davidson): VCDE

• vincristine (oncovin brand name!!)
• cyclophosphamide, cisplatin 
• doxorubicin
• etoposide 

 

Prognosis (SCLC): median survival from 3 months to over a year.

 

Eye features of lung cancer:

• Horner syndrome
• Cancer associated retinopathy