Clinical aspects of lung cancer Flashcards
What are the general features of cancer?
Malignant growth Uncontrolled replication Local invasion Metastasis - secondary cancer, lymphatic spread, blood stream, serous cavities Non-metastatic systemic effects
What is the presentation of lung cancer?
Primary tumour
Local invasion
Metastases
Non-metastatic (panaeneoplastic)
How can you detect cancer early?
Cough for more than 3 weeks Feeling breathless for no reason Chest infection that doesn't clear up Coughing blood Unexplained weight loss Chest of shoulder pain Unexplained tirdness or lack of energy Hoarse voice
What s haemoptysis?
The bronchial mucosa is lined with cilated epithelium and when it gets damages by an invading tumour which has its own vascualr suppy it can start to bleed
Why is recurrent pneumonia a sign of lung cancer?
If there is a tumour, it can cause a partial obstruction of the lung
When a lobe becomes obstructed, all of the air beyond the obstruction is absorbed and the lung tissue shrinks down to a much smaller size. The net effect is a reduction in size
What is stridor?
A distressing symptom of difficult breathing in. It is usually accompanied by a coarse audible wheeze during inspiration. Almost all other forms of airway disease (asthma and COPD) produce an expiatory wheeze and symptoms of difficulty breathing out
Where can local invasion occur?
Recurrent laryngeal nerve palsy Pericardium Oseophagus Brachial plexus Pleural cavity Superior vena cava
What does recurrent laryngeal nerve palsy cause?
Hoarse voice
Complaint of hoarse voice at a GP and a bronchoscopy is performed and the paralysis of the left vocal chord and a tumour at the origin of the left upper lobe. A primary tumour had invaded the recurrent laryngeal nerve at the left hilum
What are the syptoms when a tumour invades the pericardium?
Breathless
Artrial fibrilation
Pericardial effusion
What are the symptoms if the primary tumour invades the oesophagus?
Dysphagia
What are the symptoms if the tumour has invaded the brachial plexus?
Can cause muscle wasting due to T1 root infiltration by a primary lung cancer in the apex of the left lung. It has eroded through the ribs and into the lower part of the brachial plexus
Why is a pleural effusion needed?
If the primary tumour invades the pleural space, it often generates a large volume of pleural fluid. Litres of fluid can accumulate and causes breathlessness
What does local invasion of the SVC cause?
It obstructs the drainage of blood from the arms and head. The patient may describe puffy eyelids and a headache
The symptoms can be palliated by insertion of a stent to open up the occluded vein but this must be done before the vein is permanently occluded by thrombosis
What is the clinical presentation of chest wall invasion by lung cancer?
Localised chest wall pain, worse with movement. When there is bone erosion, the patient will often describe pain which is worse at night
What happens when a tumor encases the left pulmonary artery?
The patient will have hardly any perfusion of the left lung due to a tumour encasing and compressing the left pulmonary artery
If the tumour erodes the artery or a main bronchus. This results in sudden death due to massive haemoptysis
