Clinical Aspects of Lung Cancer Flashcards
give 5 general features of cancer
malignant growth uncontrolled replication local invasion metastasis non-metastatic systemic effect
d: paraneoplastic features
is the consequence of cancer in the body but that, unlike mass effect, is not due to the local presence of cancer cells
why is the prevalence of Lung cancer low/
patients do not live for long
what is one reason for poor prognosis of lung cancer?
lung cancer tends not to cause any symptoms until the disease has become too advanced for any hope of cure
give some common symptoms of a common potential cancer
cough of 3 weeks or more feeling breathless for no reason a chest infection that doesn't clear up coughing blood unexplained weight loss chest/shoulder pains unexpected tiredness or lack of energy a prevalent hoarse voice
d: haemoptysis
coughing up blood
what is haemoptysis a direct consequence of?
primary tumour
which lung is normally the diseased lung in an X ray?
the smaller one
what may recurrent pneumonia be a sign of?
primary lung cancer
causing a partial obstruction of the upper lobe bronchus
What is a shrinking lung explained by?
a shrinking lung is explained by the obstruction of proximal divisions of the bronchial tree. 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.
d: stridor
distressing symptom of breathing in; a coarse audible wheeze during inspiration
why may a patient with lung cancer be SOB?
tumour may block bronchioles narrowing airway
why might someone have a hoarse voice?
paralysis of the left vocal cord and a tumour at the origin of the left upper lobe. The primary tumour had invaded the recurrent laryngeal nerve
medical term for hoarse voice
recurrent laryngeal nerve palsy
d: atrial fibrillation
irregular and rapid heart beat
the heart’s two upper chambers (the atria) beat chaotically and irregularly — out of coordination with the two lower chambers (the ventricles) of the heart
d: pericardial effusion
fluid around the heart
d: dysphagia
pain whilst swallowing
what symptom may indicate a tumour in the oesophagus?
dysphagia for solids eg bread
d: Pancoast tumour
tumour in the pulmonary apex
why may a man who had hand pain have a lung tumour?
The wasting of the small muscles of the hand is due to T1 root infiltration by a primary lung cancer in the apex of the left lung. The tumour has eroded through the ribs and into the lower part of the brachial plexus
the tumour destroys the bone
d: pleural effusion
in cancer, condition in which a tumour invades plural space it often generates a large volume of pleural fluid
why may a patient have a distended external jugular vein?
a local invasion of the superior vena cava obstructs drainage of the blood from the arms and head
if the patient describes localised chest wall pain which is worse with movement and the pain is worse at night, what may have happened?
primary tumour has grown through the intercostal spaces and we can see the mass lying deep to the pectoralis muscle
if bone has be eroded, there has been destruction of part of the adjacent ribs
name the 6 common sites for metastases
liver brain bone adrenal skin lung
why may a patient with cerebral metastasis experience an epileptic fit?
metastasis involves the cortex
what does a cerebral metastasis look like on a CT scan?
ring surrounds
dark halo of swollen brain
name 7 non-metastatic(paraneoplastic) features
Finger clubbing Hypertrophic pulmonary osteoarthropathy - HPOA Weight loss Thrombophlebitis Hypercalcaemia Hyponatraemia - SIADH Weakness - Eaton Lambert syndrome
what does HPOA stand for and what does it show? what are the symptoms?
Hypertrophic pulmonary osteoarthropathy - bone scan
Symptoms of pain and tenderness of the long bones near the adjacent joints are due to elevation of the periosteum away from the bone surface
why do patients with a tumour experience unexplained weight loss?
tumour requires energy using up stores
d: hypercalcaemia
abnormally high level of calcium in the blood
name the effects of hypercalcaemia
stones bones groans thrones pscychiatric overtones
treatments of hypercalcaemia
initial is rehydration
then IV Bisphosphate
treat underlying cancer- usually squamous epithelium
d: SIADH
– Syndrome of inappropriate antidiuretic hormone
d:diuresis
excessive urine production
what are the generalized symtoms of SIADH and what is it normally caused by?
Nausea/vomiting Myoclonus Lethargy/confusion Seizures/coma usually small lung cancer results in low sodium concentration
treatment of SIADH
teat the cancer
fluid restriction
drugs- demeclocycline
what colour is the sputum that smokers normally cough up?
clear
if the patient tells you that they try to cough something up but cant, what is this a sign of?
In lung cancer, the sensation which triggers a desire to cough is distortion of the normal bronchial mucosa by the tumour
name some lung cancer tests
FBC Coagulation screen Na K Ca Alk Phos spirometry, FEV1 Chest X ray CT scan of the Thorax PET scan Bronchoscopy Endobronchial US
what does PET scan assess?
function over structure
analysis of tissue uptake of radiolabelled glucose
tissues with high metabolic activity light up
what bits always shine bright on PET? Why?
brain
urine
tumours
glucose content
name some ways we can make a tissue diagnosis
Bronchoscopy CT guided biopsy Lymph node aspirate Aspiration of pleural fluid Endobronchial Ultrasound Thoracoscopy
describe how the endobronchial US works
Bronchoscope with ultrasound tip
Enables visualisation of hilar and mediastinal structures
Target and sample lymph nodes
