Clinical Features of Lung Cancer Flashcards
What are risk factors for lung cancer?
Smoking (85%)
Passive smoking
Exposure to asbestos, radon, air pollution
List symptoms
Cough > 3 weeks Haemoptysis (endobronchial tumour) Wheeze Chest pain Chest infections Difficulty swallowing Hoarse voice SOB Weight loss
What are some symptoms of advanced metastatis lung cancer?
Bone pain Paraesthesia Ataxia Dizziness Anaemia Hypercalcaemia Thrombosis
What are clinical signs of lung cancer?
Nail clubbing Lymphadenopathy Horner's syndrome (pupil constriction) Pancoast tumour SVC obstruction Hepatomegaly Skin nodules (metastases)
What is a pan coast tumour and how can it present?
Tumour of apex of the lungs, it might put pressure on or damage a group of nerves that runs from the upper chest into your neck and arms
Initial investigations carried out
CXR FBC - anaemia U+Es LFT Biochem - Ca increase, Na decrease Clotting screen (normal = not PE) Spirometry
Can a CXR diagnose lung cancer?
No, it is a screening test
What test is used for staging cancer?
CT and CT-PET
What investigations are used for tissue diagnosis?
Bronchoscopy Endobronchial ultrasound (EBUS) Image guided lung/liver biopsy Fine needle aspiration of neck nodes or skin Excision of cerebral metastases Bone biopsy Mediastinoscopy/otomy Surgical excision biopsy
What is classification is used to stage tumours?
TNM classification
T - size of primary tumour and its invasion
N - lymph node involvement
M - distant metastasis
Define stages of T classification
Tx - malignant cells in bronchial secretion
Tis - carcinoma in situ
T1 - < 3cm in distal airway
T2 - > 3cm and 2cm form carina
T3 - > 7cm and invasion to chest was, diaphragm, mediastinal pleura
T4 - invasion to mediastinum, heart, great vessels, trachea, vertebrae, oesophagus
Define stages of N classification
N0 - No node involvement
N1 - involves ipsilateral hilar
N2 - involves ipsilateral mediastinal nodes
N3 - involves contralateral mediastinal or hilar nodes
Define stages on M classification
M0 - no distant metastases
M1 - distant m present
How can tumour be staged from CT scan?
Size Mediastinal nodes Metastatic disease Pleural/pericardial effusion Diaphragmatic involvement
How can MRI help stage tumour?
Determines degree of vascular and neurological involvement in pancoast tumour
How can bone scan help stage tumour?
Chest wall invasion and bony metastasis
How can echo help stage tumour?
Show presence of pericardial effusion
What is treatment dependent on?
Performance status
Patient wishes
Histological types and stage
Aims of treatment i.e. radical or palliative
What surgery types are available?
Wedge resection
Lobectomy
Pneumonectomy
What types of radiotherapy are available?
Radical
Palliative
Stereotactic
What is chemo used for in treatment?
Radical or palliative treatment Alone, with radiotherapy, adjuvant (after surgery) Small cell Adenocarcinoma Squamous
What can be used for palliative treatment?
Chemo
Radiotherapy
Opiate, bisphosphonates, benzodiazepines
Treatment of hypercalcaemia, dehydration, hyponatraemia
