2: Carcinoma of the bronchus Flashcards
Define carcinoma of the bronchus
Malignant neoplasm arising from epithelium of bronchioles or bronchus
What are two types of bronchial carcinoma
Small cell lung cancer
Non small cell lung cancer
What is most common type of bronchial carcinoma
Non small cell lung cancer (85%)
What % of bronchial carcinomas are small cell lung cancer
15%
what are the three types of non small cell lung cancer
- Squamous Cell Lung Cancer
- Adenocarcinoma
- Large cell carcinoma
What is the most common type of non small cell lung cancer
Squamous cell lung cancer (35%)
Where to small cell lung cancers arise
Arise from neuroendocrine - Kluchitsky cells
What does small cell lung cancers arising from Kluchitsky cells mean
Most paraneoplastic syndromes are associated with small cell lung cancer
What % of small cell lung cancers have metastasised at presentation
70%
What two cancers arise from central part of the lung
2S’s:
Squamous cell lung-cancer
Small cell lung cancer
What is squamous cell lung cancer strongly associated with
Smoking
Where does squamous cell lung cancer arise
Larger central airways adjacent to the hilum
How do squamous cell lung cancers develop
Metaplasia- Dysplasia- Carcinoma sequence
What is squamous cell lung cancer strongly associated with
Clubbing
Hypertrophic osteoarthropathy
what is the most common type of lung cancer in non-smokers
Adenocarcinoma
what is adenocarcinoma a type of
Non small-cell lung cancer
where do adenocarcinomas arise
Smaller peripheral airways
what is most common lung-cancer type in women
Adenocarcinoma
what is the precursor for adenocarcinoma
atypical adenomatous hyperplasia
what is a large cell carcinoma
cancer that cannot be histologically classified into other types
where do large cell carcinomas usually arise
peripheries
what can large cell carcinomas secrete
bHCG
what cancers have strongest association with smoking
small cell lung cancer
where do small cell lung cancers arise
central airways
explain grading of small cell lung cancers
all small cell lung cancers are highly aggressive and therefore by definition are all high-grade
what is the second most common cancer in the uk
lung cancer
which gender is bronchial carcinoma more common it and what cancer is an exception to this rule
- Men. Except adenocarcinoma which is more common in women (6:1)
what are 5 RF for bronchial carcinoma
- Smoking (90%)
- FH
- Radiation
- Asbestos
- Heavy metals
what is the most common presenting symptom of bronchial carcinoma
Cough (90%)
what are three symptoms of bronchial carcinoma
Cough
Haemoptysis
Dyspneoa
what are systemic symptoms of bronchial carcinoma
- Fever
- Weight loss
- Anorexia
What cause stridor in lung cancer
Obstruction larger airways (SCLC, SCC)
What does chest pain in lung cancer indicate
Chest wall involvement
What does pain in arm or shoulder in bronchial carcinoma indicate
Pancoast tumour
What does ptosis, miosis and anhydrosis in bronchial carcinoma indicate
Horner’s syndrome - compression sympathetic trunk
what does hoarse voice or bovine cough in bronchial carcinoma indicate
Compression recurrent laryngeal nerve
what can bronchial carcinoma (mainly SCLC and squamous cell lung cancer) cause
superior vena cava syndrome
what causes dysphagia in bronchial carcinoma
lymph nodes can compress oesophagus
what is a nail sign of lung cancer
clubbing
what are two other pulmonary sequelae of lung cancer
- Pleural effusion
- Pnuemonia
what is SVC syndrome
tumour compresses SVC - impeding venous return from upper extremities presenting as dyspneoa and facial oedema
what is a paraneoplastic syndrome
substance secreted by tumour that acts at a distance site
what paraneoplastic syndromes are associated with squamous cell carcinoma
PTHrp
what is the action of PTHrp
Increases bone reabsorption causing Hypercalcaemia
what 3 paraneoplastic syndromes are associated with small cell carcinoma
- SIADH
- ACTH
- Lambert-Eaton Myasthenia
what does SIADH cause
Increases water absorption - results in low serum sodium
what will patients with SIADH present with and why
Confusion, tiredness and drowsiness - due to cerebral oedema caused by fluid retention
what does ectopic ACTH cause
Bilateral adrenal enlargement - and excess adrenal hormone secretion
how can ectopic ACTH be differentiated
Bilateral enlargement of adrenal glands
how does ectopic ACTH usually present
Polyuria and polydipsia (due to excess aldosterone). Symptoms due to increase cortisol are rare
what causes LEMS syndrome
small cell carcinoma
what antibodies are released in LEMS syndrome
antibodies to pre-synaptic voltage-gated calcium channels
how does LEMS present
repeated contraction causes increased strength
what is a pancoast tumour
peripheral lung cancer located in superior sulcus involves cervical nerves and brachial plexus (C8, T1, T2)
what does a pan coast tumour cause
- Horner syndrome
- Shoulder pain that radiates down the arm
what is the clinical presentation of Horner syndrome
Miosis
Anhydrosis
Endopathalmos
what is pre-cursor to adenocarcinoma
atypical adenomatous hyperplasia
where does squamous cell carcinoma originate
metaplasia-dysplasia-carcinoma
explain metaplasia-dysplasia-carcinoma sequence of SCC
- Columnar glandular epithelium undergoes metaplasia to form squamous epithelium
- Squamous epithelium undergoes dysplasia to form carcinoma in situ
- Carcinoma in situ transforms to SCC
what are indications for referring under 2W pathway
- Over 40 with: haemoptysis, cough, dyspneoa, recurrent chest infections, fatigue, weight loss
- Abnormal findings on CXR
what will be seen on CXR
Solitary nodule
what is performed after CXR for lung-cancer
CT Neck, Thorax, Abdomen
what is CT neck, thorax, abdomen used for
Stage lung cancer
what are peripheral lung cancers
large cell
adenocarcinoma
if a peripheral lung cancer is present and nodes less than 10mm what is ordered
PET-CT Endobronchial US (US-guided transbronchial biopsy)
if a central lung cancer or peripheral lesion with nodes more than 10mm what is performed
- Biopsy of nodes
- Flexible bronchoscopy
if evidence of bone metastases what is performed
- X-ray
if x-ray is negative, but individual has bone pain what is performed
MRI
what is offered for high-stage lung cancers
CT Head
in summary what is ordered to stage lung cancer
CT Neck, Thorax, Abdomen
what is ordered to biopsy following
a. central lesions
b. peripheral lesions
a. Bronchoscopy
b. US guided transbronchial biopsy
what is offered for small cell lung cancer
platinum based chemoradiotherapy
what may be offered in small cell lung cancer
prophylactic cranial irradiation
what is problem with non-small cell lung cancer
poor response to chemotherapy
what is offered for low stage non-small cell lung cancer
surgery
what should be done before surgery in non-SCLC
mediastinoscopy - to view mediastinal lymph nodes
what is offered for N-SCLC
radiotherapy