clinical lung cancer Flashcards
risk factors for squamous cell carcinoma?
Smoking
Age > 40
Environmental
– Radon Gas
– Urban Living
Occupational
– Asbestos
– Uranium Mining
– Tin Mining
Pulmonary Scarring
– Cryptogenic Fibrosing Alveolitis
– Sarcoidosis
when to refer?
Persistent haemoptysis in smokers of ex
smokers over 40 years of age
Signs of superior vena caval obstruction
(swelling of face/neck with fixed elevation
of JVP
Stridor
examinations?
Hands - Clubbing, muscle wasting
Face - Eyes, mucous membranes
Neck - Lymph nodes, trachea
Breasts - Axillae
Chest signs - collapse, consolidation,
stridor, wheeze
Abdo - hepatomegaly
Neurological assessment -
mental status, muscle wasting, pain,
paraneoplastic manifestations
Skin lesions – primary, secondary
Musculoskeletal- bony tenderness,
mobility
spirometry?
lung performance score?
lung cancer investigations?
Blood Tests
FBC, Coag, UEC, LFT, Bone profile
CXR
CT
– Chest
– Abdomen
– Brain
PET Scan
Ultrasound Scan
CXR
Staging CT scan
PET scan (staging)
Bone scan
U/Sound
invasive
Percutaneous needle biopsy
Bronchoscopy
EBUS
Mediastinoscopy
purpose of bronchoscopy?
Diagnostic
– Endobronchial Biopsy
– Extraluminal Biopsy - TBNA
– Transbronchial Biopsy
– Bronchoalveolar Lavage
Therapeutic
– Foreign Body
– Removal of Tumour
– Stent Insertion
CP-EBUS?
convex probe endobronchial ultrasound
other biopsy
Pleural Aspiration/Biopsy
Lymph Node Aspiration/Biopsy
Skin Metastasis Aspiration/Biopsy
Surgical Biopsy
– VATS
– Medistinoscopy
squamous cell cancer
Arises in metaplastic squamous epithelium
25 - 35% of all Ca lung
Male preponderance
Cigarette smoking
Bulky mass, central or peripheral,
cavitation and necrosis common
all plasias
Anaplasia – dedifferentiation
Aplasia – when an entire organ or a part of an organ is missing
Hypoplasia – inadequate or below-normal number of cells
Hyperplasia – physiological proliferative increase in number of cells
Neoplasia – abnormal proliferation
Dysplasia – change of phenotype (size,shape and organization of tissue)
Metaplasia – cell type conversion
Prosoplasia – cell type develops new function
Desmoplasia – connective tissue growth
adenocarcinoma
Usually in periphery
Commonest form of primary lung cancer
Female preponderance
Several morphological subtypes
Cuboid to columnar cells, often mucin
secreting forming acinar and papillary
structures
small cell carcinoma
Small cells, scant cytoplasm
Clinically often centrally located
Neuroendocrine cell origin
Chemosensitive
Aggressive course
tnm stage?
Tumour
– X,1,2,3,4
– Size of Tumour
– Where it Invades
Node
– 0,1,2,3
– Extent of Nodal Spread
Metastasis
– 0,1a, 1b
– Are there any?