Clinical Aspects of Bronchial Carcinoma (DISEASE MECHANISMS) Flashcards
What are the general features of cancer? (5)
Uncontrolled replication Malignant growth Local invasion Metastasis Non-metastatic systemic effects?
What aspect of cancer causes non-metastatic systemic effects?
Biologically active cells released from tumour cells
What are para-neoplastic symptoms?
Symptoms that come up because of chemicals or hormones that the malignant tissue produce
What are the early symptoms of lung cancer? (8)
Cough for > 3 weeks Breathlessness without reason Persistent chest infection Haemoptosis Unexplained weight loss Chest/Shoulder pains Unexplained fatigue/lethargy Hoarse voice
What lines the bronchial mucosa?
Ciliated epithelium
What tool is used to take a sample during bronchoscopy?
Cytology Brush
What can be the underlying cause of recurrent pneumonia?
Underlying primary tumour
What is stridor?
Distressing symptom of difficulty breathing in
What sound is stridor typically associated with?
Coarse audible wheeze dring inspiration
What are the 6 common sites of local invasion of lung tumours?
Recurrent laryngeal nerve Pericardium Oesophagus Brachial plexus Pleural cavity Superior vena cava
How would a local invasion of the recurrent laryngeal nerve present?
Hoarse voice / Inability to speak
How would a local invasion of the pericardium present?
Breathless
Atrial fibrillation
Pericardial effusion
How would a local invasion of the oesophagus present
Dysphagia
What is dysphagia?
Difficulty/Inability swallowing
What is pericardial effusion?
Fluid build-up in the pericardium
What can pericardial effusion lead to?
Tamponade
Tachycardia
Fibrillations
What is a pan coast tumour?
Tumour in the apex of the lung
What can brachial plexus invasion of a tumour cause?
Wasting of muscles in the upper limb/pectoral girdle?
What does the brachial plexus supply?
Upper limbs and pectoral girdle
What can a tumour invading the pleural cavity cause?
Pleural effusion
What does local invasion of the SVC cause?
Obstruction of blood drainage from the arms and head
How do patients with a SVC obstruction present?
Puffy eyelids
Headache
Distension of superficial veins
Blood bypasses obstructed SVC by opening _______ with __ tributaries
Anastomoses
IVC
How does a patient with chest wall invasion by lung cancer present?
Localised chest wall pain - worse with movement
If there is bone erosion, often worse pain at night
How do patients with a pulmonary artery obstruction present?
Breathless
What is the danger of a tumour eroding the pulmonary artery and major bronchus?
Sudden death due to massive haemoptysis
What are the common sites for metastases of primary lung cancer? (6)
Liver Brain Bone Adrenal Skin Lung
How would a patient with cerebral metastases present?
Insidious onset of: Weakness Visual disturbance Headaches Fits/Seizures
What distinguishes headaches caused by cerebral metastases?
Worse in the morning
Not photophobic
Worse when leaning forward
Why do cerebral metastases cause headaches?
Raised intracranial pressure
If cerebral metastases involve the cortex, the patient may present with ______
Epileptic fits
Cerebral metastases can displace vessels in the brain causing ______
Oedema
Oedematous brain can be treated with _____
Corticosteroid therapy
Which corticosteroid could be used to treat oedematous brain?
Dexamethasone
How would a patient with liver metastases adjacent to the liver capsule present?
Abdominal pain
How would a patient with liver metastases obstructing the biliary drainage present?
Obstructive jaundice
How can liver metastases often be identified?
Felt upon palpation - liver can become enormous
How do patients with bone metastases commonly present?
Localised pain, usually mid-shaft that is worse at night
What is the issue with adrenal metastases?
Often don’t show many symptoms
What are the most common neoplasms in the adrenal?
Adenomas
What are the common paraneoplastic symptoms of lung cancer?
Finger clubbing Hypertrophic pulmonary osteoarthropathy (HPOA) Weight loss Thrombophlebitis Hypercalcaemia Hyponatraemia (SIADH) Weakness - Eaton Lambert syndrome
How can tumours cause hypercalcaemia?
By producing a substance that mimics th effects of the parathyroid hormone
What are common features of hypercalcaemia?
Headaches, confusion, thirst and constipation
How can tumours cause hyponatraemia?
Production of a substance which mimics anti-diuretic hormone
What is the main symptom of hyponatraemia?
Confusion
What characterises Eaton-Lamber syndrome
Muscle weakness of the limbs
How would you identify hypertrophic pulmonary osteoarthropathy on an X-ray?
Fuzzy appearance around the outer layer of the bone
Where are common sites for hypertrophic pulmonary osteoarthropathy?
Hands, legs, and lower legs
What is Thrombophlebitis?
Inflammation of the wall of a vein associated with thrombosis
How do patients with thrombophelibits present?
Painful red tracking up the veins that doesn’t settle down very easily
What important things should you ask for in a history in regards to lung cancer?
Cough Haemoptysis Cigarette smoker Breathless Weight loss Chest Wall pain Tiredness Recurrent infection Other smoking-related disease
Why do lung cancer patients present with a cough?
Distortion of normal bronchial mucosa stimulates signal to cough
How can tumours cause haemoptysis?
Ulcerate through mucosa - prone to bleeding
Almost all smokers cough up ___ sputum in the morning
clear
Why do patients with lung cancer often get recurrent lung infections?
Due to partial obstruction of a bronchial division by a tumour
Why do many lung cancer patients present breathless?
Obstruction of airways
What things should be watched out for in terms of signs of lung cancer during examination?
Finger clubbing Breathless Cough Weight loss Bloated face Hoarse voice Lymphadenopathy Tracheal deviation Dull percussion Stridor Enlarged liver
What are the possible investigation at clinic?
Full blood count Coagulation screen Na, K, Ca, Alk Phos Spirometry, FEV1 Chest X-ray CT scan of thorax PET scan Bronchoscopy Endobronchial Ultrasound (EBUS)
How does a PET scan work?
Analysis of tissue uptake of radio labelled glucose - tissues with high metabolic activity “light up”
Why does the bladder always light up during a PET scan?
Because the bladder is where contrast is excreted
Why does the brain always light up during a PET scan?
Because it is highly metabolically active
How can a tissue diagnosis of lung cancer be made?
Bronchoscopy CT guided biopsy Lymph node aspirate Aspiration of pleural fluid Endobronchial ultrasound Throacoscopy
Why is video-bronchoscopy more suitable for central disease?
Can’t reach too far
