Clinical features and Investigations of Lung Cancer Flashcards
What % cancer deaths are attributed to lung cancers
22%
What are the Risk factors of lung cancers
Tobacco (smoking: active and passive)
Asbestos exposure
Radon gas
Pollutants, air pollution, car exhaust fumes etc
Signs of Lung cancer
Both directly related to the lung tumour: Chronic cough Wheeze Coughing up blood Chest/bone pain Chest infections
And indirectly: Difficulty swallowing Raspy,hoarse voice Nail clubbing Unexplained weight loss Difficulty breathing
Why can tumour cause breathlessness (3)
Tumour blocking airways
Tumour caused pleural effusion
Pulmonary embolism
Spread to the liver can cause what?
Jaundice, abdominal pain
Spread to the spinal chord can cause what?
weakness
Spread to the brain can cause what?
Headaches, nausea, vommiting and sometimes a reduced GCS.
What is a paraneoplastic symptom and what can these include?
A symptom that isn’t directly related to the tumour but because of the tumour, ie caused as releases inappropriate hormones and chemicals)
EG
Anaemia, Hyponatraemia (SIADH) (low calcium levels), Hypercalcaemia (PTH/bone metastases), proximal muscle weakness (dermatomyositis/Polymyositis), Eaton-Lambert syndrome (upper limb weakness), Cerebellar ataxia, Sensorimotor neuropathy
Metastatic symptoms include
Bone Pain,
Spinal chord compressions -limb weakness, paraesthesia, bladder/bowel dysfunction
Cerebral metastases - Headahe, vommiting, Dizziness, Ataxia, Focal weakness
Thrombosis
Where would you expect lymph node enlargements
(lymphadenopathy)?
Cervical lymph nodes
What is cannonball metastasis?
Usually a metastasis from another cancer, looks like cannonballs in lung. Can present as a cavity lession.
What scan is used to stage cancer?
CT scan used to clarify findings and then chest and abdomen CV with IV contrast
How are Biopsys done for:
If around airways then…
Medialsteinal nodes?
Perhiphary?
If around airways then a bronchoscopy
Medialsteinal nodes Ultrasound
Perhiphary Ultrasound or CT
After the biopsy, what are you trying to differentiate the CT results into?
WHich type of cancer-
Small cell carcinoma or non small cell carcinoma?
Then if non-small cell, which type? (Adenocarcinoma/Large cell mcarcinoma/squamous cell carcinoma)
Within staging what does T/M and N mean? and what does staging help with?
T = size of tumour M = Distant Metastases N = Has it spread to any nodes? If so, how many??
What does a PET scan pick up?
Helps further with staging because it picks up micro metastatic disease elsewhere in the body.
What factors are treatment decisions made on?
Performance status Patient wishes Histological type and stage MDT Aim of treatment (radical/palliative)
What are the levels of performance status?
0 - fully active
1 - symptoms but ambulatory
2 - “up and about” more than 50%, unable to work
3 - “up and about” less than 50%, limited self care
4 - Chair/Bed bound
0-1 = will get some form of treatment 2 = potentially get some form of treatment 3/4 = mainly palliative
What do these forms of treatment mean? Radical/palliative/Sterosatic radiotherapy
Radical - Aim to cure cancer
Palliative - control symptoms
Sterosatic - 3D focal radiotherapy
What are the aims of palliative care?
Symptom control (may include Chemotherapy/radiotherapy), Opiates, Bisphosphonates, Benzodiazepines and Treatment of Hypercalcaemia, dehydration/hyponatraemia
Quality of Life
Community support
Decisions on planning, DNR, End of Life Care,
MDT - lung cancer nurse and hospice
Why is lung cancer so difficult to treat?
Nature of Malignancy
Age group
Late presentation
As a GP, as well as an X-ray, what other tests do you send them for?
FBC, liver and renal functions, calcium and clotting screen.If facilities spirometry.
