Bronchial Carcinoma Flashcards
What are the key subcategories of lung cancers?
Small-cell
Non-small-cell (SCC, adeno and large-cell)
What is the most common type of lung cancer?
Non-small-cell
Which of the following is true of Small Cell Lung Cancer:
A. Most common type of lung cancer
B. Metastasis is rare
C. Arise from Kulchitsky cells
D. Not associated with smoking
C. Arise from Kulchitsky cells
SCLC:
- Neuroendocrine Tumour
- 80% present with advanced disease V. chemosensitive but v. poor prog
- Ectopic hormone secretion, ADH or ACTH (arise from endocrine Kulchitsky cells)
- Rapid growth and early metastasis
- May cause Eaton-Lambert syndrome (paraneoplastic syndrome)
Who is most at risk of lung cancers?
Smokers, over 60, male, family history
90% of lung cancer is in smokers; passive smoking also increases risk by 1.5
Occupational exposures (asbestos, radon, arsenic, coal tar) tend to lead to which type of lung cancer?
Adenocarcinoma
Which lung cancer is being described:
Most common lung cancer in non-smokers and overall (except for metastases)
Activating mutations include KRAS, EGFR and ALK
Adenocarcinoma
Which lung cancer is being described:
- Hilar mass from bronchus
- Cavitation
- Hypercalcemia (produced PTHrP)
Squamous cell carcinoma
Which lung cancer is being described:
- Rapid growth and early metastasis
- May produce ADH or ACTH or cause Eaton-Lambert syndrome (paraneoplastic syndrome)
Small cell carcinoma
What symptoms are likely to be reported by a patient with lung cancer?
Cough (80%)
Haemoptysis (70%)
Dyspnoea (60%)
Chest pain (40%)
Recurrent or slowly resolving pneumonia
Lethargy
Anorexia
Weight loss
What signs might you expect to find in a patient with lung cancer?
Cachexia; Anaemia; Clubbing
Hypertrophic Pulmonary Osteoarthropathy (HPOA)
Supraclavicular or axillary nodes.
[Hoarseness]
[Horner’s Syndrome: Pancoast’s tumour compresses sympathetic chain; Features: Miosis, Ptosis, Anhidrosis]
Chest Sx: None/consolidation; Collapse; Pleural effusion.
Metastases:
- Bone tenderness; hepatomegaly
- Confusion; fits; focal CNS signs; cerebellar syndrome.
- Proximal myopathy; peripheral neuropathy
What differentials would you consider alongside lung cancer?
Secondary malignancy
Arteriovenous malformation; Abscess; Cyst
Bronchial adenoma: Rare, slow-growing. 90% are carcinoid tumours; 10% cylindromas.
Hamartoma: Rare, benign; CT: lobulated mass +/- flecks of calcification
Granuloma
Encysted effusion: fluid, blood, pus
Foreign body; Pneumonia; TB
How is lung cancer staged?
TMN
What investigations may help you diagnose lung cancer?
Initial Diagnosis
Imaging:
- CXR: peripheral nodule; hilar enlargement; consolidation; lung collapse; pleural effusion; bony secondaries. [If cancer is causing symptoms, it will be visible on CXR]
Cytology
- Cytology: sputum and pleural fluid (send at least 20mL).
Biopsy
- Bronchoscopy: to give histology and assess operability ± endobronchial ultrasound for assessment and biopsy.
- Fine needle aspiration or biopsy: peripheral lesions / lymph nodes.
Other tests
- Lung function tests: help assess suitability for lobectomy.
Staging Workup
Imaging:
- CT: to stage the tumour and guide bronchoscopy
- 18F-deoxyglucose PET or PET/CT EBUS scan: to help in staging
- Radionuclide bone scan: if suspected metastases
What treatment options would you suggest for non-small-cell lung cancer?
Key points:
- Surgical resection in early stages.
- Supplement surgery with radiation or chemotherapy (depending on the stage).
- Palliative radiation and/or chemotherapy is appropriate for symptomatic but unresectable disease.
Lobectomy (open or thoracoscopic) is the treatment of choice if medically fit.
Radical radiotherapy for patient with stages I-III NSCLC.
Chemotherapy +/- radiotherapy for more advanced disease.
Regimens may be platinum based, e.g. with monoclonal antibodies targeting the epidermal growth factor receptor (cetuximab).
What treatment options would you suggest for small-cell lung cancer?
Key points:
- Unresectable
- Often very sensitive to chemo and radiation but usually recurs
- Poor survival rates
Consider surgery with limited stage disease.
Chemotherapy +/- radiotherapy if well enough.
Palliation:
- Radiotherapy is used for bronchial obstruction, SVC obstruction, haemoptysis, bone pain, and cerebral metastases.
- SVC stent + radio therapy and dexamethasone for SVC obstruction.
Endobronchial therapy: tracheal stenting, cryotherapy, laser, brachytherapy (radioactive source is placed close to the tumour).
Pleural drainage/ pleurodesis for symptomatic pleural effusions.
Drugs: analgesia; steroids; antiemetics; cough linctus; bronchodilators; antidepressants.
