Clinical Aspects of Bronchial Carcinoma Flashcards
Characteristics of cancer?
Key is uncontrolled growth of tumour cells (malignant growth)
Local invasion
Metastasis - secondary cancer:
Lymphatic spread
Blood stream
Serous cavities
Non-metastatic systemic effects (paraneoplastic features)
Describe paraneoplastic features of a cancer
Systemic effects from biologically active molecules released from tumour cells
Can mimic effects of naturally occurring hormones
Describe incidence, prevalence and importance of lung cancer
Incidence - high
Prevalence - low, as patients fo not live long. 50% will not be alive 6 months after diagnosis
Reasons for poor prognosis of lung cancer?
Tends to not cause any symptoms until disease has become too advanced for any hope of cure
Lung cancer as a presenting complaint?
Symptoms due to: Primary tumour Local invasion Metastases Non-metastatic (paraneoplastic)
Why is haemoptysis a symptoms of lung cancer?
Inflamed mucosa; fresh haemorrhaging can occur from tumour which is ulcerating through the endothelial surface
In other words, the haemoptysis is a direct consequence of the primary tumour
Why is recurrent pneumonia a potential symptom of lung cancer?
Primary tumour can cause obstruction of an airway; thus, airway cannot be cleaned and this would be a common site for re-infection
Which lung is normally the diseased one on a chest X-ray and why?
Usually, the smaller lung
When a lobe becomes obstructed, all air beyond the obstruction is absorbed and lung tissue shrinks down to a much smaller size
Stridor as a symptom of lung cancer and how it can be used to rule out other conditions?
Difficulty breathing in (likened to having a rope around neck); usually accompanied by a coarse audible wheeze on inspiration (obstruction of main airways)
Asthma & COPD produce an expiratory wheeze and symptoms of difficulty breathing out
Why are CT scans important in diagnosis of lung cancer?
Tumours outwith the, e.g: carina, cannot be sampled via biopsy
Why is hoarseness a symptom of lung cancer?
Due to RECURRENT LARYNGEAL NERVE PALSY
In other words, primary tumour had invaded the recurrent laryngeal nerve
Local invasion sites of a primary lung tumour and explain resulting symptoms?
Pericardium - can cause breathlessness, atrial fibrillation and pericardial effusion (fluid around heart - could result in cardiac tamponade)
Oesophagus - can cause dysphagia (trouble swallowing); dysphagia of solids is often a pointer to tumour
Brachial plexus - can cause neurological symptoms, like weakness (surprisingly, most of these patients do not develop chest wall pain)
Pleural space - can generate large volumes of pleural fluid, causing breathlessness
Superior vena cava - obstructs drainage of blood from arms and head ; often causes distension of superficial veins in the neck (normal pulsation is lost), puffy eyelids, headaches, plethoric face, etc; can also cause distension of veins on the abdomen and thorax (blood flow is bypassing the obstructed SVC by opening up ANASTAMOSES with the IVC tributaries)
How is SVC obstruction (due to a primary tumour) treated?
Insertion of a stent to open occluded vein (must be done before the vein is permanently occluded by thrombosis)
Describe chest wall invasion by a primary tumour
Can grow through intercostal spaces
Clinical presentation is localised chest wall pain (worse with movement; if there is bone erosion, it can cause pain which is worse at night
If a tumour encases a pulmonary artery, what are the likely symptoms?
Could cause breathlessness and symptoms much like a pulmonary embolism
Sometimes, tumour can erode into the artery and into a major bronchus (can cause sudden death due to massive haemoptysis)
Common sites for lung cancer metastases?
Liver Brain Bone - any bone potentially Adrenal glands Skin Lung
Clinical presentation of cerebral metastases?
INSIDIOUS (GRADUAL) ONSET:
Weakness
Visual disturbances
Headaches - due to raised intracranial pressure (worse in the morning, when bending down - due to pressure - and not photophobic)
Seizures/fits - if metastases involves the cortex
Differentiation of cerebral metastases from stroke?
Weakness may mimic a stroke but onset in cerebral metastases can be gradual, whereas a classical stroke can develop in minutes
Describe a contrast enhanced CT scan
Masses can appear as “ring enhanced” - inject contrast into the venous system
How can symptoms of cerebral metastases be relieved?
High dose corticosteroid therapy, e.g: Dexamethasone, can improve symptoms in short-term by removing all oedema
However, benefit is short-lived and, within a few weeks, symptoms will return
Describe liver metastases
On a CT scan, are the dark regions; in rare cases, a metastasis can obstruct the biliary drainage and present as obstructive jaundice
Live functions tests are usually ABNORMAL, particularly alkaline phosphatase; sometimes liver function tests can be normal
Describe bone metastases
Common presentations are:
Localised pain which is worse at night
Pathological fracture - bone can fracture following a trivial mechanical stress
Tests for bone metastases?
Isotope bone scan
Non-metastatic (paraneoplastic) symptoms?
NOT INDICATIVE OF METASTATIC DISEASE (result of biochemically active products released from the primary tumour):
Finger clubbing
Hypertrophic pulmonary osteoarthropathy (HPOA) - (NOT DUE TO METASTATIC DISEASE) symptoms of pain and tenderness of long bones, near adjacent joints, is due to elevation of periosteum away from bone surface; bone scan shows increased activity, particularly in distal part of tibia and fibula
Weight loss (cachexia) - common feature of many cancers; due to metabolic activity of tumour
Thrombophlebitis - common manifestation of many cancers and is inflammation of veins (due to increased coagulability of blood in cancer patients)
Hypercalcaemia - tumour producing a substance that mimics para-thyroid hormone (PTH); causes headaches, confusion, thirst and constipation
Hyponatraemia - production of substance that mimics ADH (SIADH); confusion is main symptoms (plasma Na often less that 120 in this setting)
Weakness - Eaton Lambert syndrome (mimics myaesthenia gravis - abnormal weakness of certain muscles); resolves if primary tumour is resected
