6. Lung Malignancy

📄Definition

Lung Malignancy is a malignant tumour originating in the lung tissue. It is the leading cause of cancer-related death in the UK.

🔬 Pathophysiology

Uncontrolled growth of abnormal lung epithelial cells, often linked to carcinogen exposure (e.g. smoking, asbestos).

🧠 Two Main Types:

  • NSCLC (Non-small cell lung cancer – ~85%)
      – Adenocarcinoma (peripheral), squamous cell carcinoma (central), large cell carcinoma

  • SCLC (Small cell – ~15%)
      – Aggressive, early metastasis, strong paraneoplastic links

📋 Risk Factors

🧠 Mnemonic: CARS SMOKE

  • Chronic lung disease (COPD, ILD)

  • Asbestos exposure

  • Radon gas

  • Secondhand smoke

  • Smoking (most important)

  • Male sex

  • Occupational dusts (arsenic, chromium, silica)

  • Kin history (family)

  • Environmental pollution

📋Clinical Features

🧠 Mnemonic: SPHERE

  • Symptoms: cough (persistent/new/change), dyspnoea

  • Pain: chest pain

  • Haemoptysis

  • Effusion (pleural)

  • Recurring infections (e.g. pneumonia)

  • Energy low (weight loss, fatigue)

🧠 Late signs: hoarseness (recurrent laryngeal nerve), SVC obstruction, clubbing, Horner’s syndrome, bone pain, seizures (mets)

Paraneoplastic Syndromes (Especially in SCLC)

🧠 Mnemonic: LEAD

  • Lambert-Eaton (proximal weakness, improves with use)

  • Ectopic ACTH (Cushing’s)

  • ADH → SIADH

  • Dermatological (acanthosis, hypercalcaemia in squamous cell)

🔎 Investigations

🧠 Mnemonic: CXR CT PET

  • CXR: 1st-line for persistent cough ≥3 weeks

  • CT thorax with contrast: confirms lesion

  • PET-CT: staging

  • Bronchoscopy + biopsy

  • Sputum cytology

  • EUS/EBUS for central lesions or nodal sampling

  • MRI brain if concern for metastases

  • LFTs – fitness for surgery

🚩Red Flags (2-Week Referral)

Refer if ≥40 with:

  • Haemoptysis

  • Persistent cough or breathlessness

  • Unexplained weight loss

  • Chest pain

  • Hoarseness >3 weeks

  • Finger clubbing

  • Signs of mets (bone, neuro)

🧾 Management

🧠 Mnemonic: STAGE

  • Surgery – preferred for early-stage NSCLC

  • Targeted therapy – if mutations (e.g. EGFR, ALK)

  • Anti-PD-1 immunotherapy (e.g. pembrolizumab)

  • Guided radiotherapy (SBRT) – non-surgical candidates

  • Etoposide + cisplatin – SCLC chemotherapy backbone

Palliative: chemo/radio, stents, pleurodesis for effusions, pain control
MDT involvement is essential at all stages

📌 PARA Revision Tips

  • Persistent cough + haemoptysis = CXR & 2WW

  • Know paraneoplastic syndromes → high yield

  • CT chest + PET + histology = gold standard

  • SCLC is NOT surgical — usually chemo/radio

  • NSCLC early = surgery best chance

🧐Differential Diagnoses

🧠 Mnemonic: PENCIL

  • Pneumonia

  • Empyema

  • Non-malignant mass (e.g. hamartoma)

  • Cryptogenic organising pneumonia

  • Infectious granulomas (TB, fungal)

  • Lung abscess

🔎Last updated in line with NICE NG122 – Lung Cancer
Published: March 2019 • Last updated: February 2024
Last reviewed: July 2025
🔒PASSMAP ensures all content is NICE-aligned and reviewed for Physician Associate Registration Assessment (PARA) success.

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