FN: Lung Cancer: Investigations and Management Flashcards
1
Q
Investigations:
- Bloods
- Cytology
A
FBC, U+E, calcium, LFTs
Sputum, pleural fluid
2
Q
Imaging
A
CXR
Contrast-enhanced Volumetric CT
PET-CT
Radionucleotide bone scan
3
Q
CXR shows
A
Coin lesion Hilar enlargement Consolidation, collapse Effusion Bony secondaries
4
Q
Contrast-enhanced Volumetric CT
A
- Staging: lower-neck, chest, upper abdomen
- Consider CT brain
5
Q
Pet- CT show
A
Exclude distant mets
6
Q
Biopsy
A
- Percutaneous FNA: peripheral lesions and LNs
- Bronchoscopy: biopsy and assess operability
- Endoscopic bronchial US biopsy: mediastinal LNS
- Mediastinoscopy
7
Q
Lung function tests
A
Assess treatent fitness
8
Q
CXR Coin Lesion Differential
A
Foreign body Abscess: staph, TB, Klebsiella, Mycetoma Neoplasia (primary and secondary) Granuloma: RA, Wegener's, TB, sarcoid Structural: AVM
9
Q
Non small cell carcinoma staging
A
TNM
10
Q
Management
A
- MDT
- Assess risk of operative mortality e.g. thoracoscore
- Cardiorespiratory function
- Co-morbidities - Advise smoking cessation
11
Q
NSCLC
A
- Surgical Resection
- Curative radiotherapy
- Chemo ± radio for more advanced disease
12
Q
NSCLC surgical resection
A
- Rx of choice for peripheral lesions with no metastatic spread = stage I/I (25%)
- Need good cardiorespiratory function
- Wedge resection, lobectomy or pneumoectomy ± adjuvant chemo
13
Q
Curative radiotherapy
A
If cardiorespiratory reserve is poor
14
Q
Chemo ± radio for more advanced disease
A
- Platinum- based regimens
- MAbs targeting EGFR (e.g. cetuximab) or TKI (e.g. erlotinib)
15
Q
SCLC Rx
A
Typically disseminated @ presentation
- May respond to chemo but invariably relapse
16
Q
SCLC Palliation
A
- Radio: bronchial obstruction, haemoptysis, bone or CNS mets
- SVC obstruction: stenting + radio + dexamethasone
- Endobronchial therapy: stenting, bracytherapy
- Pleural drainage/Pleurodesis
- Analgesia
17
Q
Prognosis NSCLC
A
50% 5 yrs w/o spread, 10 with spread
18
Q
Prognosis SCLC
A
1-1.5 yrs median survived treated; 3 mo untreated
