Clinical Features of Lung Cancer and Staging Flashcards
What is the leading cause of cancer death?
Lung cancer
How many cancer related deaths in the UK are due to lung cancer?
1 in 5
Why is lung cancer considered the most preventable cancer?
Smoking accounts for >85% of lung cancers
How does lung cancer rates differ with gender and age?
- Men are at higher risk
- Risk increases with age
What are the risk factors for lung cancer?
- Smoking
- Passive smoking
- Exposure to asbestos, radon, air pollution and diesel exhaust
What are the 10 symptoms to look out for with lung cancer?
- Chronic cough
- Coughing up blood
- Wheezing sound
- Chest and bone pain
- Chest infections
- Difficulty swallowing
- Raspy, hoarse voice
- Shortness of breath
- Unexplained weight loss
- Nail clubbing
What are the metastatic symptoms of lung cancer?
- Bone pain
- Spinal cord compression
- Cerebral metastases
- Thrombosis
What are the paraneoplastic symptoms of lung cancer?
- Hyponatraemia
- Anaemia
- Hypercalcaemia
- Dermatomyositis/ polymyositis
- Eaton-Lambert syndrome
- Cerebellar ataxia
- Sensorimotor neuropathy
What can spinal cord compression cause?
- Limb weakness
- Paraesthesia
- Bladder/bowel dysfunction
What can cerebral metastases cause?
- Headache
- Vomiting
- Dizziness
- Ataxia
- Focal weakness
What can cause hyponatraemia?
SIADH syndrome
What can hypercalcaemia cause?
-Parathyroid hormone related protein
What can dermatomyositis/polymyositis cause?
Proximal muscle weakness
What does Eaton-Lambert syndrome cause?
Upper limb weakness
What are the clinical signs of lung cancer?
- Chest signs
- Clubbing
- Lymphadenopathy
- Horner’s syndrome
- Pancoast tumour
- Superior vena cava obstruction
- Hepatomegaly
- Skin nodules
What initial investigations should be carried out?
- Chest X-ray
- Full blood count
- Renal, liver functions and calcium
- Clotting screen
- Spirometry
What are CT scan useful in?
Staging
What investigations are used in tissue diagnosis?
- Bronchoscopy
- EBUS
- Image guided lung biopsy
- Image guided liver biopsy
- FNA of neck node or skin metastasis
- Excision of cerebral metastasis
- Bone biopsy
- Mediastinoscopy/otomy
- Surgical excision biopsy
What are the 4 most common types of lung cancer by histology?
- Adenocarcinoma
- Squamous cell carcinoma
- Small cell carcinoma
- Large cell carcinoma
How is cancer stages?
Based on metastasis and cell type
What is the staging system for cancer called?
TNM staging
How does prognosis differ between stages/
Prognosis decreases with the increasing stage i.e Stage I has a better prognosis than stage IV
What scans are useful in staging?
CT and CT-PET
What must be considered when thinking about treatment?
- Performance status of patient
- Patient wishes
- Histological type and stage
- Multidisciplinary team involvement
- Aims of the treatment
How is performance status ranked?
- = fully active
- = symptoms but ambulatory
- = ‘up and about’ more than 50% of the time but unable to work
- = ‘up and about’ less than 50% of the time and has limited self care
- = bed or chair bound
What is extremely important when working with patients?
Communication skills especially when delivering bad news
What treatment options are there for lung cancer?
- Surgery
- Radiotherapy
- Chemotherapy
- Best supportive care
- Co-ordination with lung cancer specialist nurse
What palliative management options are there?
- Symptom control
- Quality of life
- Community support
- Decisions and planning, resuscitation status, end of life care
- Multidisciplinary team including lung cancer nurse and hospice
How can symptoms of lung cancer be controlled?
- May include chemotherapy
- Mya include radiotherapy
- Opiates, bisphosphonates, benzodiazepines
- Treatment of hypercalcaemia, dehydration and hyponatraemia
