7. Lung cancer Flashcards
Discuss the histology of lung cancers?
Main classes: Small cell (20%)
Non small cell- squamous, adenocarcinoma, large cell
What is significant about small cell carcinoma’s?
Arise from endocrine cells and therefore can cause paraneoplastic syndromes e.g. cushing’s
Describe the common process of lung carcinoma forming
Squamous dysplasia–> Carcinoma in situ–> Invasive bronchogenic carcinoma
Explain the common mutations associated with adenocarcinoma?
KRAS (smoking induced)
EGFR
BRAF, HER2
ALK
What are the symptoms of lung cancer?
Cough, heamoptysis, dyspnoea, chest pain,
lethargy, weight loss, anorexia
What are the clinical signs of lung cancer?
Aneamia, clubbing, wrist pain, enlarged supraclavicular or axillary nodes
Consolidation, collapsed lung, PE
Metastatic signs: bone pain, hepatomegaly, confusion, fits, peripheral neuropathy
What are the various tests involved in lung cancer?
CXR
Cytology of sputum and pleural fluid
PET/PET CT to assess in staging
Fine needle aspiration or biopsy
Radionucleotide bone scan to assess for metastasis
Lung function tests to assess suitability for lobectomy
What are the complications of lung cancer?
Recurrent laryngeal nerve palsy (hoarse voice)
SVC obstruction
Phrenic nerve obstruction
Horner’s syndrome
What are some common sites of metastisis in lung cancer?
Other lung Bone Brain Liver Lymph nodes Adrenals
What are some signs of metastasis in lung cancer?
Bone pain, anemia
Addisons
Non metastatic neurological syndrome- confusion, fits, cerebellar syndrome, proximal myopathy
What is the mainstay of treatment of non small cell cancer
Lobectomy
Radical radiotherapy
Chemotherapy+radiotherpay for more advanced disease
May also consider monoclonal antibodies
What is the treatment of small cell cancer?
Surgery with limited disease
Chemotherapy and radiotherapy
Palliative radiotherapy for bronchial obstruction
Dexmethasone for SVC obstruction
What is mesothelioma?
A tumour of mesothelial cells that usually occurs in the pleura. It occurs with previous exposure to asbestos.
What are the clinical features of mesothelioma?
chest pain, dyspnoea, weight loss, finger clubbing, recurrent PE’s,
How do you diagnose mesothelioma?
Made on histology usually followed by a thoracoscapy
