Lung Cancer

Lung Cancer Show Notes 

Shownotes – Dr Hyerim Suh

Differentials for a solitary pulmonary nodule on CXR

Common causes 

• Lung cancer 
  • Consider CT chest, PET scan for staging and bronchoscopy or CT guided transthoracic biopsy  
• Metastatic cancer 
  • Consider CT chest, PET scan for staging and bronchoscopy or CT guided transthoracic biopsy 
• Hamartoma 
  • Consider CT chest 
• Infectious 
  • Consider CT chest, fungal serologies and PPD 
• Uncommon causes 
  • Carcinoid tumour, lymphoma, sarcoidosis, AV malformation, intrapulmonary nodule 

Treatment algorithm for small cell lung cancer 

• Limited disease 
  • Chemotherapy 
  • Radiotherapy 
  • Prophylactic cranial irradiation 
  • Surgery for those with a NFR status 
• Extensive disease 
  • Chemotherapy 
  • Prophylactic cranial irradiation 
  • Radiotherapy if they have had a good response to chemotherapy 

Treatment algorithm for non-small cell lung cancer 

• Stage I & II 
  • If suitable, then for surgery and then adjuvant chemotherapy and radiotherapy 
  • If not suitable, then for radiotherapy and adjuvant chemotherapy 
• Stage IIIA 
  • If suitable, then for neoadjuvant chemoradiotherapy then surgery and adjuvant chemoradiotherapy 
  • If not suitable for surgery, then chemoradiotherapy and monoclonal therapy 
• Stage IIIB and IIIC 
  • If resectable, then neoadjuvant chemotherapy then surgery then adjuvant chemotherapy 
  • If not suitable for surgery, then chemoradiotherapy and monoclonal therapy 
• Stage III or IV (extensive disease) 
  • Palliative treatment 

References: Non-small cell lung cancer, small cell lung cancer, BMJ 2021