Clinical Features of Lung Cancer and Staging Flashcards
Risk factors
Smoking (>80%)
Passive smoking
Exposure to asbestos, radon, air pollution and diesel exhaust.
Symptoms
Chronic coughing Haemoptysis Wheezing Chest and bone pain Difficulty swallowing Raspy, hoarse voice Shortness of breath Unexplained weight loss Nail clubbing
Advanced disease metastatic symptoms
Bone pain
Spinal cord compression
Cerebral metastasis
Thrombosis
Advanced disease paraneoplastic symptoms
Anaemia Hyponatraemia Hypercalcaemia Upper limb weakness (Eaton-Lambert Syndrome) Muscle weakness Cerebellar ataxia Sensorimotor neuropathy
Clinical signs
Chest signs Clubbing Skin nodules Superior vena cava obstruction Inflamed lymph nodes Pancoast tumour Horner's syndrome Enlarged liver
Initial investigations (GP)
Chest xray Full blood count Renal, liver functions and calcium Clotting screen Spirometry
Investigation - tissue diagnosis
Bronchoscopy
EBUS
Image guided lung/liver biopsy
Types of lung cancer
Small cell carcinoma
Adenocarcinoma (most common)
Squamous cell carcinoma
Large cell carcinoma
Staging TNM
Tumour character and size (T1-4)
Nodes
Metastasis
Imaging used for staging
CT scan and PET scan (1-3)
Treatment based on
Performance status (physical ability) Patient wishes Histological type and stage Multidisciplinary team Aims of treatment
Performance status
0 = fully active 1 = symptoms but ambulatory 2 = “up and about” > 50%, unable to work 3 = “up and about” < 50%, limited self care 4 = bed or chair bound
Treatment
Surgery
Radiotherapy
Chemotherapy - targeted agents (tyrosine kinase inhibitors and monoclonal antibodies)
Best supportive care
Co-ordination - lung cancer specialist nurse
Palliative management
Symptom control Quality of life Community support Decision and planning Multidisciplinary team
