Case 17 - Lung Cancer Flashcards
What is the aetiology of lung cancer?
Most common cancer worldwide Occupational - asbestos exposure, exposure to other dusts and smokes Smoking Genetic predisposition Radiation exposure Fibrosing alveolitis Area lived in - radon gas exposure
What are signs of lung cancer?
Cachexia Clubbing Enlarged supraclavicular/cervical lymph node Hepatomegaly Unilateral chest expansion Pleural effusion Dull to percussion Decreased breath sounds Neuropathy
Symptoms of lung cancer?
Cough Haemoptysis Dyspnoea Hoarse voice Stridor Chest pain
Types of lung cancer
Small cell
Non-small cell
Mesothelioma
What is non-small cell lung cancer?
Can be adenoma-Most common in non-smokers. Cancer of the mucus secreting glands. More peripheral
Carcinoid tumours
Squamous cell - cancer of the endobronchial lining, more central
2y survival if not spread
Pancoast tumour is in the apices and most are non-small cell
What is small cell lung cancer?
One types
Most common in smokers
Aggressive and fast growing
Chemosensitive
What is mesothelioma?
Cancer of the pleura caused by asbestos exposure
On CXR May see pleural plaques which indicate asbestos exposure
These themselves don’t cause mesothelioma, but indicate exposure to asbestos severe enough to cause mesothelioma in the future
May have pleuritic chest pain
Uncomfortable as the cancer constricts the chest
What investigations should be done for lung cancer?
Bloods CXR PET CTTAP Biopsy
What will CXR show and what should be noted in lung cancer?
Homogenous opacity
In the apices - Pancoasts tumour
To work out the risk of malignancy: Age Gender Size of the nodule Is it in the upper lobe Type of opacity FHx of lung cancer Emphysema present Number Speculation
What bloods should be done in lung cancer?
FBC - Hb for anaemia, WCC for infection U and E - for SIADH, contrast/chemotolerated LFTs for mets Clotting Calcium - mets, PTH paraneoplastic CRP
What will a CT thorax show in lung cancer?
Can see pleural thickening in mesothelioma Can estimate depth Visualise mets further down the body Lymph node enlargement Assess whether operable
What can a PET scan be used for in lung cancer?
To look for mets and active lymph nodes
Glucose uptake measured
If hot, 95% chance that it is cancerous
Assessed operability before CT
What can a biopsy show in lung cancer?
TTF1 gene
TTF1 positive = primary carcinoma, adenocarcinoma, pleural carcinoma, small cell
TTF1 negative = secondary carcinoma, squamous cell, mesothelioma
How is lung cancer staged?
T1 less than 2cm
T2 larger than 2cm
T3 more than one tumour in one side
T4 two tumours on more than one side
M0-1 if metastasised
N0-2 depending on number of nodes affected
How do you treat non-small cell lung cancer?
Surgical- tumour and fitness, not if spread
Radiotherapy - can be curative
Chemotherapy - used in those with EGFR gene, tyrosine kinase inhibitors
