Diagnosing Lung Cancer Flashcards
If a patient comes in with a chest infection, what questions would you ask?
o Haemoptysis
o Weight loss
o Persistent cough
o Breathlessness
o Pain
o Changes in fingers suggesting clubbing
o Pain in the limbs suggesting hypertrophic osteoarthropathy
What causes lung cancer?
- Tobacco smoke
- Ionising radiation
- Asbestos
- Fibrosing alveolitis
- Industrial chemicals
Who would you send on the 2WW referral for lung cancer?
- Have a CXR that suggests lung cancer
* >40yrs with unexplained haemoptysis
When do you offer an urgent CXR to assess for lung cancer?
People >40yrs with 2+ unexplained symptoms or if they have ever smoked and have 1 unexplained symptom: • Cough • Fatigue • SOB • Chest pain • Weight loss • Appetite loss
When would you consider an urgent CXR to assess for lung cancer in people >40yrs?
- Persistent or recurrent chest infection
- Finger clubbing
- Supraclavicular lymphadenopathy or persistent cervical lymphadenopathy
- Chest signs consistent with lung cancer
- Thrombocytosis
What are the types of primary lung cancers?
- Small cell cancers
- Non-small cell cancers
Squamous cell
Adenocarcinoma
Large cell carcinoma
What is characteristic of small cell cancers?
- Homogenous
- Rapidly dividing
- Neuroendocrine tumours -> associated with paraneoplastic syndromes
What is characteristic of squamous cell cancers?
- Flat cells that cover airways
- Tends to grow near centre of lung
- Strong association with smoking
- Cavitary lesions are common -> lucent area contained within a consolidation, mass or nodule
- Direct spread to hilar lymph nodes
What is characteristic of adenocarcinomas?
- Mucous cells of bronchial epithelium
- Commonly invades mediastinal lymph nodes, brain and bones
- Most common in non-smokers and women
What is characteristic of large cell cancers?
- Anaplastic, poorly differentiated tumours with poor prognosis
- May secreted B-hCG
What symptoms may suggest lung cancer?
- Cough
- Haemoptysis
- Chest pain
- Breathlessness
- Stridor
- Hoarse voice
- Weight loss
- Facial swelling
What may you find on clinical examination that suggests lung cancer?
- Weight loss
- Finger clubbing
- Lymphadenopathy
- Chest asymmetry
- Focal chest signs
- Hepatomegaly
- Neuropathy
- Pancoast syndrome
- Horner’s syndrome
- SVC obstruction
What is Pancoast sydnrome?
o Destruction of T1-C8 nerve roots of lower part of brachial plexus by apical lung tumour
- Pain in inner aspect of arm
- Small muscle wasting in hands
What is Horner’s syndrome?
Tumour presses on sympathetic ganglion
o Ipsilateral ptosis = drooping eyelid
o Enophthalmos = eye bulging
o Miosis = constriction of pupils
o Anhidrosis = reduced sweating
What is Pemberton’s sign?
Raising hands over head causes facial congestion and cyanosis
