Lung Cancer : Mnemonics

Types

Most common cancer: Metastases

Primary lung cancer:

Type	Frequency	Location	Association	Features
Small (oat) cell carcinoma	15%	Sentral (central)	Smoker	Neuroendocrine differentiation (Kulchitsky cells) Aggressive (disseminate early – lymphadenopathy) Paraneoplastic syndrome (ACTH, ADH, Antibodies – Lambert eaton) Inoperable Chemosensitive
Adenocarcinoma	40%	Peripheral	Non-smoker (most common)	k-Ras, EGFR, ALK mutations Nodule/mass Hypertrophic osteoarthropathy (clubbing) Bronchio-alveolar subtype (pneumonia-like): Excellent prognosis, apparent “thickening” of alveolar walls
Squamous cell carcinoma	25%	Sentral (central)	Smoker (most common)	Hilar mass Obstruction Cavitation Calcium (PTHrP) Keratin pearls and intracellular bridge
Large cell carcinoma	10%	Peripheral	Smoker	Poor prognosis Pleomorphic giant cells
Carcinoid tumor	2%	Central	Non-smoker	Excellent prognosis Mass effect Carcinoid sydrome (rare) Chromogranin A +

Growing rate (Doubling time)

Mnemonic: SmS LA

1. Small cell carcinoma: 30 days
2. Squamous cell carcinoma: 90 days
3. Large cell carcinoma: 120 days
4. Adenocarcinoma: 150-180 days

TNM and Staging of Lung Cancer Simplified

Management

1. Small cell lung cancer (SCLC): Chemotherapy +/- Radiotherapy

2. Non-small cell lung cancer (NSCLC):

• Stage I, II, IIIA: Surgical resection +/- Chemo-radiotherapy
• Stage IIIB, IV: Chemo-radiotherapy
  • >1 lobe involvement (ipsilateral or contralateral)
  • 2 sides local nodes involvement (contralateral mediastinal/hilar)
  • Mediastinal structure invasion
  • Distant lymph node metastases
  • Distant metastases

Contra-indications to lung surgery:

1. SVC obstruction
2. FEV1 <1.5
3. Malignant pleural effusion
4. Vocal cord paralysis