Clinical Features & Staging of Lung Cancer Flashcards
What are the risk factors associated with lung cancer?
3+
- smoking
- passive smoking
- environmental factors:
asbestos, radon, air pollution, diesel exhaust
What are the local pressure effects of lung cancer?
- chronic coughing
- SOB
- wheeze
- chest and bone pain
- haemoptysis
What is a local pressure effect?
a symptom caused directly by the lung cancer (opposite of a systemic effect).
What are the main symptoms of lung cancer?
10
- chronic cough (>3 weeks)
- wheeze
- haemoptysis
- chest and bone pain
- recurrent chest infection
- difficulty swallowing
- raspy, hoarse voice
- SOB
- unexplained weight loss
- nail clubbing
What are the symptoms of metastases to the bones?
bone pain
What are the symptoms of compression on the spinal cord by a tumour?
(3)
- limb weakness
- paraesthesia
- bladder/bowel dysfunction
What are the symptoms of cerebral metastases?
5
- headache
- vomiting
- dizziness
- ataxia (lack of voluntary coordination of muscle movements)
- focal weakness
what may lung tumour metastases cause in the CVS?
thrombosis
What are paraneoplastic syndromes?
Clinical syndromes involving nonmetastatic systemic effects that accompany malignant disease.
What are some paraneoplastic effects of lung cancers?
4
- hyponatraemia
- hypercalcaemia
- anemia
- sensorimotor neuropathy
What are the clinical signs of lung cancer?
8
- Chest signs
- Clubbing
- Lymphadenopathy
- Horner’s syndrome
- Pancoast tumour
- SVC obstruction
- Hepatomegaly
- Skin nodules (metastases)
What are the initial investigations carried out for lung cancer?
(5)
- CXR
- FBC: Ca, Renal & Liver function
- Clotting screen
- Spirometry
Why is a FBC carried out if lung cancer is suspected?
to check for anaemia
Why is a renal function carried out if lung cancer is suspected?
good renal function is essential for a contrast CT to be carried out
Why is a calcium test carried out if lung cancer is suspected?
in lung cancers calcium levels are often elevated (bone metastasis)
What is the investigation carried out after an abnormality is discovered on the CXR?
Why is it done?
CT or PET CT scan
to stage the cancer
Outline the investigations done after the CT scan for tissue diagnosis?
(9)
- Bronchoscopy
- EBUS
- Image guided lung biopsy
- Image guided liver biopsy
- fine-needle aspiration(FNA) of neck node or skin metastasis
- Excision of cerebral metastasis!
- Bone biopsy
- Mediastinoscopy/otomy
- Surgical excision biopsy
What is the most common type of lung cancer?
adenocarcinoma
What is the second common type of lung cancer?
small cell carcinoma
What type of lung cancer has the best prognosis?
adenocarcinoma
In which stage does a tumour invade other tissues?
T3
What is characteristic of a T1 tumour?
2
- no invasion
- lobar bronchus
In TNM staging, what does M0 mean?
distant metastasis absent
In TNM staging, what does M1 mean?
distant metastasis present
In TNM staging, what does N1 mean?
involvement of ipslateral hilar/peribronchial nodes
In TNM staging, what does N0 mean?
no nodal involvement
In TNM staging, what does N2 mean?
involvement of ipslateral mediastinal/subcarinal nodes
How does a PET scan show up ‘hot spots’?
cancer cells take up the glucose AND the isotope
What is radical treatment of lung cancer?
treatment with the intent to cure
What is palliative treatment?
treatment with the intent to improve quality of life, not cure.
What must be taken into account before treatment is started?
4
- performance status
- patient’s wishes
- histological type and stage
- the aims of treatment, radical or palliative
What is a performance status of 0?
fully active
What is a performance status of 1?
symptoms but ambulatory
What is a performance status of 2?
up and about for >50% of the day but unable to work
What is a performance status of 3?
up and about <50% of the day and limited self care
What is a performance status of 4?
bed or chair bound
What is important to bear in mind when discussing cancer diagnosis with patieint?
- pragmatic, open
- no false promise
- empathy
What surgical treatment options are considered in lung cancer?
(3)
- wedge resection
- lobectomy
- pneumonectomy
