Bronchial Carcinoma Flashcards
Presentation of lung cancer
Primary tumour, local invasion, metastases, non-metastatic
Signs to detect cancer early
Cough for 3 weeks or more, Feeling breathless for no reason, Chest infection which doesn’t clear, coughing blood, unexpected weight loss, chest/shoulder pain, unexplained tiredness, recurrent pneumonia (on the same lung)
Stridor
A symptom for lung cancer, it is a wheeze on inspiration
Possible areas of local invasion (Symptom for lung cancer)
Recurrent laryngeal nerve, Pericardium, Oesophagus, Branchial pleuxs, Pleural cavity, Superior vena cava
General features of cancer
Malignant growth, uncontrolled replication, local invasion, Metastasis, Non-metastatic systemic effects
Symptoms of local invasion of the Oesophagus
Dysphagia - swallowing problems
Symptoms of breathlessness and weight loss
when the primary tumour invades the pleural space, it generates a large volume of pleural fluid
Local invasion of the superior vena cava
Obstructs drainage of blood from arms and head, patient may describe puffy eyelids and a headache
Common sites for metastases from a primary lung cancer
Liver, Brain, Bone, Adrenal, Skin, Lung
Cerebral metastases symptoms
Weakness (may mimic a stroke), Visual disturbance, Headaches (worse in the morning, not photophobic), Fits
Bone metastases symptoms
Localised pain which is worse at night, pathological fracture. The bone may fracture following a trivial mechanical stress
Non-metastatic: signs and symptoms of the tumour (when the tumour makes changes to the body)
Finger clubbing, Hypertrophic pulmonary osteoarthrophy - HPOA, Weight loss, Thrombophlebitis, Hypercalcaemia, Hyponatraemia - SIADH, Weakness - Eaton Lambert syndrome
Hypercalcaemia definition and symptoms
High Calcium in the blood serum due to the tumour secretions
Symptoms: Stones, Bone pain, Abdominal pain, Constipation, Depression, Anxiety, Coma, Cardia arrhythmia
Treatment of hypercalcaemia
Rehydration
If calcium is very high on admission, then IV bisphosphonate is used
SIADH
Syndrome of inappropriate antidiuretic hormone
Usually small cell lung cancer
Results in low sodium concentration
Generalised non-specific symptoms (nausea, seizures etc.)
Taking a history for Lung Cancer
Cough Haemoptysis Cigarette smoker Breathless Weight loss Chest wall pain Tiredness Recurrent infection Other smoking related disease "Is there anything you are worried about?"
Examination for Lung Cancer
Finger clubbing Breathless Cough Weight loss Bloated face Hoarse voice Lymphadenopathy Tracheal deviation Dull percussion Stridor Enlarger liver
Investigations for Lung cancer
Full blood count, Coagulation screen, Spirometry and FEV1, CXR, CT scan of thorax, etc.
What does a PET scan do?
Scan to asses function rather than structure, tissues with high metabolic activity “light up”
Tests used to make a tissue diagnosis - lung cancer
Bronchoscopy
CT guided biopsy
Endobronchial Ultrasound
Differential diagnosis
Lung cancer TB Vasculitis Pulmonary embolism Secondary cancer Lymphoma Bronchiectasis
