CSI Flashcards
ECOG
fully active able to carry on pre disease performance
grade 0
ECOG grade 1
restricted in physical activity but ambulatory and able to carry out work in light/ sedentary nature
eg office work/ house work
ambulatory and capable of self care but unable to carry out any work activities
50% of waking hours up and about
stage 2 ecog
stage 3 ecog
capable of only limited selfcare, confined to bed/chair more than 50% of waking hours
stage 4 ecog
completely disabled cannot carry on any self care
totally confined to bed/chair
stage 5ecog
dead
signs of lung cancer?
examination findings?
what paraneoplastic signs?
consolidation, collapse
supraclavicular and axillary lymph node enlargement
pleural effusions: stony dull percussion note and decreased vocal resonance and breath sounds
cushing syndrome and siadh and lambert eaton - small cell
bony mets/ pth related peptide secretion
management of SCLC
limited disease
cisplatin
etoposide
chest irradiation
extensive disease?
Mx
chemo
cisplatin / etoposide
radiotherapy can be aplliative to reduce effects of metastatic disease
complications of SCLC?
pneumonia
SVC compression
common metastatses?
brain breast liver adrenals skin
endocrien complications?
Ectopic ACTH (1%): Cushings syndrome; ectopic ADH production (7–10%): SIADH; hypercalcaemia (bony metastases or PTH-related peptide secretion).
Investigations?
other
Lung function tests fbc u&e ca2+ alkphos lft
Ix
diagnosis
Staging
Diagnosis:
flexible bronchoscopy
Endobronchiol ultrasounded guided transbronchiol needle aspiration
> 3cm so not a central lesion
Sputum cytology, bronchoscopy with brushings and biopsy or percutaneous biopsy, thoracoscopy.
Staging: CT of chest, abdomen, head. Isotope bone scan.
features of sclc
adh release?
acth?
muscle fatiguebility
hyponatraemia
cushings syndrome
acth levels can cause bilateral adrenal hyperplasia > high levels of cortisol > hypokalaemic alkalosis
lambert eaton syndrome
which patients are considered for surgery?
t1-2a
N0
M0
SVC obstruction
swelling of face/neck and arms
conjunctival and periorbital oedema
headaches worse in morning
visual disturbances
pulseless JVP distension
mx: radical chemo/radiotherapy
why does SCLC present with addisons and cushing
Arise from endocrine cells (Kulchitsky cells). These are APUD cells, and as a result, these tumours will secrete many poly-peptides mainly ACTH.
They can also cause various presentations such as Addison’s and Cushing’s disease.
what ct scan?
contrast enhanced
should also include adrenals and liver
how is limited stage disease determined?
t1-4
n0-3
m0
Mx limited disease SCLC
4 to 6 cycles of cisplatin-based combination chemotherapy.
Consider substituting carboplatin in people with impaired renal function, poor performance status (WHO 2 or more) or significant comorbidity.
when can surgery be considered?
SCLC t1-2a
n0
mo
t1a
tumour measuring 3cm without invasion in the main bronchus
t1a <1cm
t1b
t1c
t1b 1-2cm
t1c 2-3cm
t2
3-5cm
bronchus
associated with atelactasis
t3?
5-7cm
invades chest wall
parietal pericardium
phrenic nerve
t4?
> 7
associates with another lobe ipsilateral lobe
carina
n1
- N1: involvement of ipsilateral intrapulmonary, peribronchial, or hilar lymph nodes
n2
N2: involvement of ipsilateral mediastinal or subcarinal lymph nodes
n3
- N3: involvement of contralateral mediastinal or hilar nodes, or scalene or supraclavicular
nodes on either side
what is a central lesion
Central lesions are those located within 3 cm of the proximal bronchial tree, heart, great
vessels, trachea, or other mediastinal structures
when do you offer flexible bronchoscopy?
central lesion onCT
for paratracheal and peri-bronchial intra-parenchymal lung lesions.
endobronchial ultrasound-guided transbronchial needle aspiration (EBUSTBNA
small round or spindle-shaped cells with scanty cytoplasm, illdefined borders, and finely granular nuclear chromatin (salt-and-pepper
pattern)
sclc
most common lung cancer?
adenocarcinoma
nsclc
Glandular differentiation with mucin-containing elements.
o Most express thyroid transcription factor-1 and napsin A.
Characterised by the production of keratin, which may take the form of
squamous pearls or cells with very eosinophilic cytoplasm
squamous cell carcinoma
pthrp
hyperparathyroidism but pth is low
when do you offer EBUS TBNA?
paratracheal
peribronchial intra parenchymal lung lesions
central lesions are located within 3cm of where?
bronchial tree heart great vessels trachea mediastinal structures
m1a
nodules contralateral lobe
pleura
pericardium / effusions in pleural cavity /pericardium
m1b
single extrathoracic mets
m1c
multiple extra thoracic mets in 1> organs
t4 is invades which structures
carina diaphragm great vessels heart mediastinum oesophagus recurrent laryngeal nerve trachea vertebral body
thorascore
55< male asa physical status 2< who 3< dyspnea 3< diagnosis comorbid 3
glandular differentiation with mucin containing elements
adenocarcinoma
expresses thyroid transcription factor 1 and napsin A
adenocarcinoma
charecteristic protein markers of squamous cell?
p63
p40
Cells have large nuclei, prominent nucleoli, and a moderate amount of
cytoplasm.
large cell carcinoma
category 2 dyspnea
moderate degree walks slower
moderately severe degree
3
Moderatly severe degree of dyspnea (has to stop because of breathlessness when walking at own pace on the level)
stage 4 dyspnea
category 4, Severe degree of dyspnea (stops for breath after walking about 100 yards or after a few minutes on the level)
won’t leave the house too breathless when dressing etc
stgae 5
