17. Clinical Features of the Lung Cancer and Staging Flashcards
What are the risk factors?
Smoking (more than 85%)
Passive Smoking
Exposure to asbestos, radon, air pollution and diesel exhaust
What are the 10 signs and symptoms of Lung Cancer?
Chronic coughing Coughing up blood Wheezing sound Chest and Bone Pain Chest Infections Difficulty swallowing Raspy, Hoarse voice Shortness of Breath Unexplained weight loss Nail Clubbing
What are the advanced disease metastatic symptoms?
Bone pain Spinal cord compression - Limb weakness - Paraesthesia - Bladder/bowel dysfunction Cerebral metastases - Headache - Vomiting - Dizziness - Ataxia - Focal weakness Thrombosis
What are the advanced disease paraneoplastic symptoms?
Hyponatraemia - SIADH Anaemia Hypercalcaemia - Parathyroid hormone related protein - Bone metastases Dermatomyositis/Polymyositis - Proximal muscle weakness Eaton-Lambert Syndrome - Upper limb weakness Cerebellar ataxia Sensorimotor neuropathy
What are the clinical signs of lung cancer?
Chest signs Clubbing Lymphadenopathy Horner's syndrome Pancoast tumour Superior Vena cava obstruction Hepatomegaly Skin nodules (metastases)
What are the initial investigations for lung cancer?
CXR FBC Renal, Liver functions and Calcium Clotting screen Spirometry
What are the investigations for “tissue diagnosis”?
Bronchoscopy EBUS Image guided lung biopsy Image guided liver biopsy FNA of neck node or skin metastasis Excision of cerebral metastasis! Bone biopsy Mediastinoscopy/otomy Surgical excision biopsy
What is a T1 tumour?
Diam:
T1a <2cm
T1b 2-3cm
Scopy:
No invasion lobar bronchus
What is a T2 tumour?
Diam:
T2a 3-5cm
T2b 5-7cm
Scopy:
> 2cm to Carina
Atelectasis:
Lobar atelectasis or obstructive pneumonia to hilus
What is a T3 tumour?
Diam:
> 7cm
Scopy:
<2cm to Carina
Atelectasis:
Whole Lung
Invasion: Chest wall Diaphragm Mediastinum Pleura Pericard
Nodules:
Nodules in same lobe
What is a T4 tumour?
Scopy:
In Carina
Invasion: Heart Great Vessels Trachea Esophagus Spine
Nodules:
Nodules in other ipsilateral lobes
What is N0 nodal involvement?
No regional node involvement
What is N1 nodal involvement?
Involvement of ipsilateral hilarious or ipsilateral peribronchial nodes
What is N2 nodal involvement?
Involvement of ipsilateral mediastinal or subcarinal nodes
What is N3 nodal involvement?
Involvement of contralateral mediastinal or hilarious nodes OR Ipsilateral or contralateral scalene or supraclavicular nodes
What is M0 metastasis?
Distant Metastasis Absent
What is M1 metastasis?
Distant Metastasis Present
What must be taken into consideration for treatment decisions?
Performance status Patient wishes Histological type and stage Multidisciplinary team Aims of treatment e.g. radical or palliative
How is performance status marked?
0 = Fully active 1 = Symptoms but ambulatory 2 = "up and about" > 50%, unable to work 3 = "up and about" < 50%, limited self care 4 = bed or chair bound
What are the treatment options?
Surgery – around 18% of patients – Wedge resection
– Lobectomy
– Pneumonectomy
Radiotherapy – Radical
– Palliative
– Stereotactic
Chemotherapy
– Part of radical or palliative treatment
– Alone, combined with radiotherapy, adjuvant (after surgery)
– Targeted agents e.g Tyrosine Kinase Inhibitors and monoclonal antibodies
• erlotinib, gefitinib, crizotinib
– Small cell e.g. cisplatin/etoposide
– Adenocarcinoma e.g. cisplatin/pemetrexed
– Squamous e.g. cisplatin/gemcitabine
Best supportive care
Co-ordination – Lung Cancer Specialist Nurse
What is palliative management?
Symptom control
- May include chemotherapy
- May include radiotherapy e.g. pain, haemoptysis
- Opiates, Biphosphates, Benzodiazepines
- Treatment of hypercalcaemia, dehydration, hypnoatraemia
Quality of life
Community support
Decisions and planning, resuscitation status, end of life care
Multidisciplinary team including lung cancer nurse and hospice
