SU26.4 | Lung Tumors — Summary & Reflection

KEY TAKEAWAYS

Lung cancer is overwhelmingly caused by smoking and usually arises from the bronchial epithelium (bronchogenic carcinoma). It presents in four ways: local (cough, haemoptysis, breathlessness, hoarseness), metastatic (liver, bone, brain, adrenal), paraneoplastic (small-cell → SIADH and ectopic ACTH; squamous → hypercalcaemia via PTHrP), and the special Pancoast tumour at the apex causing Horner's syndrome and arm pain. The surgically decisive classification is small-cell (SCLC) versus non-small-cell (NSCLC). SCLC is central, most smoking-related, usually disseminated at diagnosis, and treated with chemotherapy and radiotherapy — not surgery. NSCLC (adenocarcinoma — commonest, peripheral; squamous — central, cavitating, hypercalcaemia; large-cell) can be cured by surgical resection (lobectomy/pneumonectomy) when localised and the patient is fit, otherwise chemotherapy, radiotherapy, targeted therapy or immunotherapy. Work-up: chest X-ray → contrast CT → tissue biopsy (bronchoscopy/CT-guided) → TNM staging (PET-CT) → fitness for surgery. Smoking cessation is the most powerful preventive measure.

REFLECT

Think of a smoker you have seen with a cough or haemoptysis, or imagine clerking one. Would you have recognised the features that demand urgent lung-cancer work-up, and could you explain to the patient why a tissue biopsy is needed before anyone can say whether an operation might help? Now consider the decisive fork: could you state why small-cell cancer is treated medically while a localised non-small-cell cancer in a fit patient may be cured by surgery, and why the X-ray appearance alone is not enough to decide? Reflect on how the overwhelming link between smoking and lung cancer should shape the way you counsel every smoker you meet, long before any tumour appears.