3- clinical aspects of bronchial carcinoma Flashcards
what are general features of cancer?
- malignant growth
- uncontrolled replication
- local invasion
- metastasis - secondary cancer →lymphatic spread, blood stream, serous cavities
- non-metastatic systemic effects
what is general components of presentation of lung cancer?
- primary tumour causing symptom
- local invasion
- metastases
- non-metastatic (paraneoplastic)
what are some big symptoms of lung cancer?
- haemoptysis (direct consequence of primary tumour)
- recurrent pneumonia
- stridor (inspiration wheeze)
- short of breath
what are some important areas that can be invaded in lung cancer?
- 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
what is a pancoast tumour?
lung cancer that invaded into brachial plexus so T1 root infiltration causing weakness + muscle wasting of hands
what is pleural effusion?
primary tumour invades pleural space often generating a large volume of pleural fluid - you stick needle in ribs to drain off fluid
what is effect of superior vena cava obstruction?
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
what invasion causes rib pain?
chest wall invasion
what is common site for metastasis of lung cancer?
- 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
what is presentation of cerebral metastases?
→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
what is non-metastatic paraneoplastic?
an illness someone got because of cancer, like cancer messing with bodies hormones or biochemistry
what are signs of non-metastatic paraneoplastism?
- finger clubbing
- hypertrophic pulmonary osteoarthropathy
- weight loss (sarcemia)
- thrombophlebitis
- hypercalcaemia
- hyponatremia - SIADH
- weakness - eaton lambert syndrome
what is hypercalcaemia?
= collection of vague symptoms that means high calcium in blood due to release of hormone by tumour that tricks body thinking it needs calcium
what are the vague symptoms that are associated with hypercalcaemia?
- 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
what is treatment of hypercalcaemia?
rehydration through IV, if still greater than 4 then also use IV bisphosphonate and treat underlying cancer (usually squamous cell)
what is hypertrophic pulmonary osteoarthropathy?
HPOA (very rare where periosteum in long bones, like splints)
what is SIADH (syndrome of inappropriate antidiuretic hormone)?
= presenting with low sodium, it’s very complex
→creates hormone that holds onto water
what is presentation and treatment of SIADH?
nausea/vomiting, myoclonus, lethargy/confusion, seizures common
- fluid restriction, drugs, treat underlying cause (usually small cell carcinoma)
what is important symptoms to check when taking a history of lung cancer?
- cough
- haemoptysis
- cigarette smoker
- weight loss
- chest wall pain
- tiredness
- recurrent infection
what are important signs to look out for on examination of lung cancer?
- finger clubbing
- breathless
- cough
- weight loss
- bloated face
- hoarse voice
- lymphadenopathy
- tracheal deviation
- dull percussion
- stridor
- enlarged liver
what tests and scans should be done to assess for lung cancer?
tests:
- final blood count
- coagulation screen
- Na, K, Ca, alk phos
scans:
- chest x-ray
- CT scan
- PET
what is a PET scan?
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
what can be used to make tissue diagnosis?
- bronchoscopy
- CT guided biopsy
- lymph node aspirate
- aspiration of pleural fluid
- endobronchial ultrasound
- thoracoscopy
what is CT guided biopsy?
they can put needle in while watching on CT (increased risk compared to bronchoscopy)
what is endobronchial ultrasound?
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)
what is thoracoscopy?
= 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.
