4) Lung Cancer Flashcards
Risk Factors for lung cancer?
- SMOKING
- HIV, Pulmonary fibrosis and prev radiotherapy can predispose
- Asbestos, chromium, arsenic exposure all risk
Red Flag symptoms for CXR in lung cancer?
Haemoptysis Persistent or unexplained (>3 weeks) -cough -chest/shoulder pain -hoarseness -dyspnoea -Wt loss
Suspicious signs on examination of lung cancer?
Features suggesting mets eg cerebral/bone mets
Clubbing
Lymphadenopathy
SVCO warrants urgent referral to physicians
Symptoms of lung cancer?
COugh Haemoptysis dyspnoea chest pain recurrent pneumonia lethargy wt loss
Signs of lung cancer?
cachexia anaemia clubbing Hypertrophic pulmonary osteoarthropathy (wrsit pain) nodes consolidation/collapse pleural effusion bone tenderness, hepatomegaly, focal cns, myopathy
Local complications of lung cancer?
Recurrent laryngeal nerve palsy Phrenic nerve palsy horners syndrome svco rib erosion pericarditis af
Metastatic sites of lung ca?
Brain
Bone
Adrenals
Liver
Endocrine complications of lung cancer?
Ectopic hormone secretion by small cell tumours:
- ACTH
- SIADH
PTH- Squamous cell
Non metastatic cerebral complications of lung cancer?
Proximal myopathy Confusion fits lambert eaton syndrome cerebellar syndrome
Other complications of lung cancer?
Acanthosis nigricans clubbing HPOA dermatomyositis Thrombophlebitis migrans
How should patients be Ix?
CXR -> CT Staging -> Bronchoscopy or alternative biopsy-> PET Scan- Lung fx (for surgery)
Types of NSCLC?
Adenocarcinoma
Squamous
Large cell
other
DD of nodule on Xray?
Malignancy (1/2) Abscess Granuloma AV malformation Cyst Foriegn body Skin tumour Carcinoid tumour Pulmonary hamartoma
Important things to ask in Hx?
Smoking Asbestos? DHX? Blood thinners? Previous imaging and where? WHO performance status
How is survival affected by staging in NSCLC?
1a= 60mo median survival IV = 6mo median survival
indications for surgery in NSCLC?
MEdically fit, no damage to lungs from other diease and tumour should be resectable (usually 1-3a). Must be discussed in MDT
When would you give radiation with curative intent in NSCLC?
Not fit for surgery but WHO PC 0/1
2-3 disease
Disease in suitable field (not huge or close to vital organs)
lung fx acceptable (fibrosis/breathless)
What uses does chemo have in NSCLC?
CHemoradio in 2 or 3 if not suitable for surgery
Surgery and chemo if 0/1 PS and early stages, improves DFS
Palliative if stage 3/4, good performance status. Improves survival and QoL
Small cell carcinoma staging?
Limited- one hemithorax affected (incl LN)
Extensive- everywhere else
Who receives chemo?
Most, though less intense if low performance status. V good response but relapses
Why is cerebral radiotherapy given post chemo?
Improves survival by 5%- micromets (can be palliative)
What do you need to consider in palliation?
Drain pleural effusions if symptomatic
Opiates for cough and pain control
ENT for hourseness
Dex for symptomatic brain mets
Treatment for mesothelioma?
Pemetrexel and cisplatin- prognosis is poor
