Clinical Aspects of Bronchial Carcinoma Flashcards
Key characteristics of cancer?
Uncontrolled growth of tumour cells
Invasion
Malignant growth
What is the presentation of lung cancer?
Primary tumour
local invasion
metastases
non-metastic (paraneoplastic)
what are early symptoms of lung cancer?
Cough for 3 weeks or more Breathlessness for no reason Persistent chest infection Coughing blood unexplained weight loss chest/shoulder pains unexplained tiredness or lack of energy hoarse voice
what is haemoptysis?
coughing up blood
why is recurrent pneumonia a problem with lung cancer?
Consolidation can block screening of tumours
what is stridor?
wheeze on inhalation
what could cause shortness of breath?
A tumour blocking airway
Local invasion sites of lung cancer?
recurrent laryngeal nerve pericardium oesophagus brachial plexus pleural cavity superior vena cava
symptoms of pericardial local invasion?
Breathlessness
Atrial fibrillation
Pericardial effusion
Symptoms of oesophageal local invasion?
Dysphagia
what tumour invades the brachial plexus?
Pancoast tumour
wasting of the arm
whats a pleural effusion?
excess fluid in pleural space
what can a primary tumour in the pleural space cause?
pleural effusion
what can a tumour obstructing the superior vena cava cause?
Significant dilated veins on face/neck
high pressure in the head
what can tumours encasing pulmonary arteries cause?
clotting- embolism
common sites for metasteses?
liver brain bone adrenal skin lung
common sites for metastases?
liver brain bone adrenal skin lung
cerebral metastases symptoms?
Insidious onset weakness visual disturbance headaches (worse in morning, sneezing, leaning forward/not photophobic) fits
what would a ring enhancing lesion on CT indicate?
Cerebral metastases
what would help improve symptoms of cerebral metastases?
High dose corticosteroid therapy
what can metastases in the bone present as?
- new localised aches/pains worse at night
2. pathological fracture
what do isotope bone scans show?
multiple skeletal metasteses
What are some paraneoplastic syndrome?
Finger clubbing Hypertrophic pulmonary osteoarthtopathy (expansion of periostium on lng bone lining) -can cause finger clubbing Weight loss thrombophlebitis hypercalcaemia hyppnatraemia- SIADH Weakness- Eaton Lambert syndrome
what is associated with hypercalcaemia?
Stones (renal/bilaiary calculi)
Bones
Groans (aabdominal pain/constipation, N+V)
Thrones (Polyuria)
Psychiatric overtones (depression, anxiety, reduced GCS)
Cardiac arrhythmias
initial treatment of hypercalcaemia?
Rehydration
IV Bisphosphate used for very high calcium/ if fluid doesnt correct it
what is SIADH?
syndrome of ina[pproprite antidiuretic hormone- causes low sodium concentrationd
what are some symptoms of SIADH?
Nausea/vomiting
Myoclonus
Lethargy/confusion
Seizures/coma
What are some investigations for lung cancer?
Full blood count coagulation screen Na, K, Ca, Alk Phos Spirometry, FEV1 Chest X ray CT of thorax PET scan bronchoscopy endobronchial ultrasound
how can a PET scan detect cancers?
tissues with high metabolic activity will light up
How to get a tissue diagnosis for lung cancer?
Bronchoscopy CT guided biopsy (RISK OF PNEUMOTHORX) Lymph node aspirate Aspiration of pleural fluid Endobronchial Ultrasound Thoracoscopy (looking into pleural space)
What are some cause of smoker, haemoptysis, abnormal chest X-ray?
Lung cancer TB Vasculitis PE Secondary cancer Lymphoma Bronchiectasis
