Carcinoma of the Bronchus Flashcards
What is the second most common cancer in the UK?
Carcinoma of the bronchus
What is the most important clinical differentiation in carcinoma of the bronchus?
Small cell (SCLC)(25%) and non-small cell (NSCLC)(75%)
Which non-small cell lung cancer is this describing?
Primary lung malignancy, smoking link, from larger airways. Well-defined ‘metaplasia, dysplasia, carcinoma’ sequence.
Squamous cell carcinoma
Which non-small cell lung cancer is this describing?
Commonest in non-smokers, peripheral small airways. Precursor lesion is called atypical adenomatous hyperplasia and is asymptomatic.
Adenocarcinoma
What is this describing?
Cancer, not graded (too aggressive). Arises in central location in lungs. Commonly distant metastases at presentation. Strongest smoking link.
Small cell lung cancer
What are the risk factors for carcinoma of the bronchus? (lifestyle, environmental, genetic)
- Lifestyle - cigarette smoking (90%), passive smoking
- Environmental - industrial hazards (asbestos, arsenic, chromium, radiation), air pollution, radon gas in Cornwall.
- Genetic factors - EGFR mutations in non-smokers, KRAS mutations in smokers
What is this a presentation of?
Male, persistent cough with weight loss or haemoptysis in a smoker over 50. Some dyspnoea and chest pain.
Carcinoma of the bronchus
What is this a presentation of?
Lung cancer, SOB, facial swelling, head fullness, arm swelling, chest pain, dysphagia and stridor.
SVC obstruction (cerebral oedema, low cardiac output)
What is this describing?
Cancer in the apex of the lung which manifests as shoulder pain radiating in ulnar distribution down the arm of Horner’s syndrome.
Pancoast’s tumour
What are the metastatic effects of lung cancer?
- Lymphadenopathy
- Bone pain and hypercalcaemia, anaemia
- Neurological signs
- Hepatomegaly
- Proximal myopathy, peripheral neuropathy
What is the important paraneoplastic syndrome in squamous cell lung cancer?
Hypercalcaemia (PTHrP)
What are the important paraneoplastic syndromes in small cell lung cancer?
- SIADH - cerebral oedema: clumsiness, tiredness, confusion.
- Cushing’s (ectopic ACTH)
What are the complications of lung cancer?
- Hoarse voice (recurrent laryngeal invasion)
- Raised hemidiaphragm (phrenic nerve palsy)
- Horner’s syndrome (ptosis, miosis, facial anhidrosis)
- Lambert-Eaton syndrome (proximal limb weakness)
How is a suspected lung cancer investigated?
- CXR - nodules, hilar enlargement, consolidation, collapse, effusion.
- Sputum cytology
- CT CAP - smokers with worrying CXR signs, stage and guide bronchoscopy.
- Bronchoscope for central lesions
- FNA - peripheral lesions and lymph nodes only
- MRI/CT brain - brain mets
- Bone scan - bone mets
How is lung cancer staged?
TNM:
T with CT
N and M with PET-CT 1st line
What is the management for limited small cell lung cancer?
Chemotherapy and radiotherapy concurrently.
What is the management for extensive small cell lung cancer?
Chemotherapy (relapses), radiotherapy to palliate (refer to palliative care), surgical intervention not of much use as people present late.
What is the management for non-small cell lung cancer?
- Excision for small, peripheral tumours with no metastatic spread.
- Initially - lobectomy with curative intent
- Pre-op chemotherapy, post-op radiotherapy and chemo in higher stage patients.
- Stand-alone chemo and radiotherapy in more advanced patients.
What is the prognosis for small cell lung cancer?
- Limited - 12-24% 5-year survival
2. Extensive - 1-5% 5-year survival
What is the prognosis for non-small cell lung cancer?
Depends on staging, from 67% 5-year survival to 1%
What is this describing?
A malignant tumour of the pleura associated with asbestos exposure. Latent period between exposure and development of condition may be up to 45 years.
Mesothelioma
What is this a presentation of?
Male, >60 years old, breathlessness, chest pain, pleural effusion, asbestos exposure.
Mesothelioma
How is mesothelioma managed?
- CXR/CT
- Diagnosis on cystological examination of pleural fluid or on histology of a pleural biopsy.
- Manage using chemotherapy
What is asbestosis?
Diffuse fibrosis of the lung parenchyma caused by high levels of asbestos exposure.
