3- clinical aspects of bronchial carcinoma

Question 1

what are general features of cancer?

Answer 1

• malignant growth
• uncontrolled replication
• local invasion
• metastasis - secondary cancer →lymphatic spread, blood stream, serous cavities
• non-metastatic systemic effects

Question 2

what is general components of presentation of lung cancer?

Answer 2

• primary tumour causing symptom
• local invasion
• metastases
• non-metastatic (paraneoplastic)

Question 3

what are some big symptoms of lung cancer?

Answer 3

• haemoptysis (direct consequence of primary tumour)
• recurrent pneumonia
• stridor (inspiration wheeze)
• short of breath

Question 4

what are some important areas that can be invaded in lung cancer?

Answer 4

• recurrent laryngeal nerve →invasion causes hoarse voice
• pericardium →breathless, atrial fibrillation (not that common), pericardial effusion - compresses the heart
• oesophagus →dysphagia (difficulty swallowing)
• brachial plexus
• pleural cavity
• superior vena cava

Question 5

what is a pancoast tumour?

Answer 5

lung cancer that invaded into brachial plexus so T1 root infiltration causing weakness + muscle wasting of hands

Question 6

what is pleural effusion?

Answer 6

primary tumour invades pleural space often generating a large volume of pleural fluid - you stick needle in ribs to drain off fluid

Question 7

what is effect of superior vena cava obstruction?

Answer 7

can occur due to lung cancer invading SVC which obstructs drainage of blood from arms + head leading to puffy eyelids + face and headache that feels like exploding head
- the body can try fix by growing collaterals in stomach to try and get back to inferior vena cava

Question 8

what invasion causes rib pain?

Answer 8

chest wall invasion

Question 9

what is common site for metastasis of lung cancer?

Answer 9

• brain
• liver
• bone (anywhere in skeleton - in lung cancer it sort of eats away at bone but different cancers cause different effects on bones)
• adrenal
• skin
• lung (other areas)
  →different cancers spread to different organs
  = this means usually scan upper body and down to adrenals

Question 10

what is presentation of cerebral metastases?

Answer 10

→slow onset
- weakness
- visual disturbances
- some headaches (worse leaning forward, worse cough →because pressure thing) - not photophobic (sensitive to light)
- fits, uncommon but can happen

= sometimes can help reduce swelling with steroids

Question 11

what is non-metastatic paraneoplastic?

Answer 11

an illness someone got because of cancer, like cancer messing with bodies hormones or biochemistry

Question 12

what are signs of non-metastatic paraneoplastism?

Answer 12

• finger clubbing
• hypertrophic pulmonary osteoarthropathy
• weight loss (sarcemia)
• thrombophlebitis
• hypercalcaemia
• hyponatremia - SIADH
• weakness - eaton lambert syndrome

Question 13

what is hypercalcaemia?

Answer 13

= collection of vague symptoms that means high calcium in blood due to release of hormone by tumour that tricks body thinking it needs calcium

Question 14

what are the vague symptoms that are associated with hypercalcaemia?

Answer 14

• stones = renal/biliary calculi
• bones = general bone pain
• groans = general non-specific abdominal pain, constipation
• thrones = pee a lot, polyuria
• psychiatric overtones = depression, anxiety, coma, low energy levels etc

Question 15

what is treatment of hypercalcaemia?

Answer 15

rehydration through IV, if still greater than 4 then also use IV bisphosphonate and treat underlying cancer (usually squamous cell)

Question 16

what is hypertrophic pulmonary osteoarthropathy?

Answer 16

HPOA (very rare where periosteum in long bones, like splints)

Question 17

what is SIADH (syndrome of inappropriate antidiuretic hormone)?

Answer 17

= presenting with low sodium, it’s very complex

→creates hormone that holds onto water

Question 18

what is presentation and treatment of SIADH?

Answer 18

nausea/vomiting, myoclonus, lethargy/confusion, seizures common

• fluid restriction, drugs, treat underlying cause (usually small cell carcinoma)

Question 19

what is important symptoms to check when taking a history of lung cancer?

Answer 19

• cough
• haemoptysis
• cigarette smoker
• weight loss
• chest wall pain
• tiredness
• recurrent infection

Question 20

what are important signs to look out for on examination of lung cancer?

Answer 20

• finger clubbing
• breathless
• cough
• weight loss
• bloated face
• hoarse voice
• lymphadenopathy
• tracheal deviation
• dull percussion
• stridor
• enlarged liver

Question 21

what tests and scans should be done to assess for lung cancer?

Answer 21

tests:
- final blood count
- coagulation screen
- Na, K, Ca, alk phos

scans:
- chest x-ray
- CT scan
- PET

Question 22

what is a PET scan?

Answer 22

PET scan = positron emission tomography
= assesses function rather than structure

→give glucose and scan to see where it goes, tissues with high metabolic activity light up

Question 23

what can be used to make tissue diagnosis?

Answer 23

• bronchoscopy
• CT guided biopsy
• lymph node aspirate
• aspiration of pleural fluid
• endobronchial ultrasound
• thoracoscopy

Question 24

what is CT guided biopsy?

Answer 24

they can put needle in while watching on CT (increased risk compared to bronchoscopy)

Question 25

what is endobronchial ultrasound?

Answer 25

gets sample from lymph nodes, bronchoscope with ultrasound tip and can press on bronchial wall to find lymph node then put needle in it and sample lymph node. day-case procedure (very quickly)

Question 26

what is thoracoscopy?

Answer 26

= if pleural invasion, can go into pleural space, done not by surgeons, numb skin and put flexible scope in to look around

• Under sedation and with local anaesthetic the semi-rigid scope is inserted between the rib spaces. The lung is deflated to allow visualisation of the pleural surfaces. Biopsies can be taken from the pleura.