L13 - Lung Cancer Flashcards
Lung cancer may arise from…
- Bronchial epithelium
- mucous glands.
Common cell types causing lung cancer…
Adenocarcinoma
Squamous
Small-cell
Large-cell
Clinical features of lung cancer
- Cough, often dry, purulent sputum?
- Haemoptysis
- Breathlessness
Haemoptysis
Coughing of blood from resp tract below level of larynx
Haematemesis
Vomiting of blood from the GI tract
Psuedohaemoptysis
Cough reflex is stimulated by blood not derived from the lungs or bronchial tubes.
Possible causes of bronchial obstruction
- Lung cancer, adenoma
- Enlarged tracheobronchial lymph nodes
- Inhaled foreign bodies esp. Right lung
- Bronchial plug of inspissated mucus or blood clots
Pleural pain may indicate
Malignant pleural invasion
Intercostal nerve involvement causes pain…
Pain in distribution of thoracic dermatome.
Cancer in lung apex may cause…
Horner’s syndorme
What characterises Horner’s syndrome?
- Ipsilateral partial ptosis
- Enophthalmos: posterior displacement of eyeball in orbit due to changes in volume.
- Miosis: excessive constriction of pupil of the eye
- Hypohidrosis: person exhibits diminished sweating
Describe what may happen in the mediastinal spread of lung cancer? (3)
- Involvement of oesophagus - dysphagia
- If pericardium invaded - arrhythmia or pericardial effusion
- If superior vena cava obstructed
- suffusion (swelling neck and face)
- conjucntival oedema
- headache
- dilated veins on chest wall
Obstruction of SVC may lead to
- Suffusion
- swelling of neck and face - Conjunctival oedema
- due to oozing of exudate from abnormally permeable
capillaries - Headache
- Dilated veins on chest wall
Tumours at left hilum of lung may affect which nerve
- Left recurrent laryngeal nerve
2. Leading to left vocal cord paralysis, voice alterations
What is finger clubbing?
- Overgrowth of soft tissue of the terminal phalanx.
- Leads to increased nail curvature.
- Nail bed fluctuation.
HPOA - Hypertrophic pulmonary osteoarthropathy
Painful periostitis of :
- distal tibia
- fibula
- radius
- ulna
Summarise some endocrine manifestations of lung cancer
- Inappropriate ADH secretions - hyponatraemia
- Ectopic ACTH secretions
- Secretion PTH related peptide - hyperkalemia
- Gynaecomastia
- Carcinoid syndrome
Carcinoid syndrome
Caused by endogenous secretions of serotonin & kallikrein, paraneoplastic syndrome
Symptoms that occur secondary to carcinoid tumours - flushing, diarrhea, heart failure.
Invasion of the phrenic nerve may lead to…
Diaphragmatic paralysis
What may be seen / heard on examination of a patient to aid in the diagnosis of parenchymal lung disease…
- Crackles: typically bilateral and basal
- Clubbing: common in idiopathic pulmonary fibrosis and abestosis
- Central cyanosis
- Signs of right heart failure
How may radiology be used to diagnose parenchymal lung disease?
X-Ray may show :
- smaller lung volume
- reticulonodular shadowing
Which view is preffered when taking X-ray of lungs
Posterior-Anterior
- to get a good view of lung fields, heart and mediastinum
How might you interpret a chest X-ray?
- Look at Lung fields –> transluency, masses, consolidation, cavitation
- Check behind lung apices
- Trachea
- Heart
- Hila –> L should be higher than R
- Diaphragm –> R should be higher than L
- Costophrenic angle –>acute, well defined
What may pulmonary and pleural shadowing indicate?
- Consolidation
- Lobar collapse
- mucus plugging, tumour, compression by lymph nodes - Pleural abnormalities
Increased transluency on X-ray
Due to:
- Bullae (fluid filled sac)
- Pneumothorax
- Oligoaemia
Pneumothorax
Collapsed lung
Oligoaemia
AKA hypvolaemia
- decreased volume of circulating blood in body
Increased shadowing on X-ray may indicate
- Accumulation of fluid
- lobar collapse
- consolidation
Advantages of using CT
- Displays range of densities.
- Can be adjusted to highlight different structures.
- Can identify extent and appearance of pleural thickenings
Describe PET scan
Uses Radiotracer FDG
Quantifies rate of glucose metabolism
Describe MRI in lung disease
Role in differentiation of benign from malignant in pleural disease
Why is USS useful?
Can distinguish between pleural fluid from pleural thickening.
Why might laryngoscopy be important?
- Important as left hand side tumour may affect Left recurrent laryngeal nerve.
- Hence paralysing left vocal cord.
- Leading to hoarse voice
What occurs during bronchoscopy
Abnormal tissue can be biopsied.
Describe endobronchial USS
- Direct needle aspiration from peribronchial node
- used to increasingly stage lung cancer.
Thoracoscopy
- Insertion of endoscopy through chest wall.
- Minimally invasive.
- Facilitates biopsy under direct vision.
- Gold standard for evaluation of pleural interface.
Describe the TNM tumour metastasis staging system
T - Size of primary tumor
N - Spread of cancer to regional lymph nodes
M -Indicate whether cancer has metastasized
Lobectomy
Removing section of lung
Pneumonectomy
Removing entire lung
Wedge resection
Removing part of lobe
Is lung cancer inherited?
Majority of cases: genetic changes acquired during persons lifetime and only present in certain cells of lung. Somatic mutations are not inherited!
Describe lung cancer susceptibility genes
Chromosome 6
There is a gene which may given a genetic predisposition to nicotine addiction.
Tumour at apex of lung could affect what plexus…
Sympathetic plexus.
Examples of places of extrathoracic metastatic manifestations
Brain
Liver
Bone
Adrenals
