Lung Flashcards
lung cancer is the ? most common cancer in the uk?
third most common
behind breast and prostate
what is the biggest cause of lung cancer?
cigarette smoking
around 80% are thought to be preventable
risk factors
occupational exposure - asbestos
air pollution
smoking
passive smoking
increasing age
radiotherapy to thorax
radon gas
what are the 2 broad categories of lung cancer and their subtypes?
non-small cell lung cancer - around 80%
- adenocarcinoma ~ 40%
- squamous cell carcinoma ~ 20%
- large cell carcinoma ~ 10 %
- other types ~ 10%
small cell lung cancer - around 20%
why are small cell lung cancers responsible for multiple paraneoplastic syndromes?
they contain neurosecretory granules that can release neuroendocrine hormones
why are small cell lung cancers responsible for multiple paraneoplastic syndromes?
they contain neurosecretory granules that can release neuroendocrine hormones
what are some signs and symptoms of lung cancer?
- SOB
- cough
- haemoptysis
- finger clubbing
- recurrent pneumonia - or slow to resolve
- weight loss
- lymphadenopathy - often supraclavicular nodes are first to be found on examination
- pleural effusion
- chest pain - constant, progressive
- hoarse voice
- wheeze, stridor
- SVC obstruction
- horners syndrome
- anorexia, weight loss
- paraneoplastic syndromes
- symptoms from metastatic disease
- scars
- hpoa
why is the presentation of lung cancer often late?
symptoms such as persistent cough and dyspnoea often attributed to smoking
small adenocarcinomas in the periphery of the lung may be asymptomatic - picked up on CXR or CT
what investigations are done for suspected lung cancer?
- Chest x-ray 1st line
- Staging CT (contrast) of chest, abdo and pelvis to look for metastasis and lymph node involvement
- PET-CT
- Bronchoscopy with endobronchial ultrasound (EBUS) - endoscopy of airways with uss at the end to allow for detailed assessment of tumour and uss guided biopsy
- Histological diagnosis - bronchoscopy or percutaneously
what are some chest x ray findings in lung cancer?
- Hilar enlargement
- “Peripheral opacity” – a visible lesion in the lung field
- Pleural effusion – usually unilateral in cancer
- Collapse
who should be referred on the 2ww pathway for lung cancer? to respiratory clinic
- Have chest X-ray findings that suggest lung cancer
- Are aged 40 years and over with unexplained haemoptysis
who should be offered an urgent (within 2weeks) CXR for lung cancer?
People ≥40 if they have ≥2 or more of the following unexplained symptoms, or if they have ever smoked and have 1≥ of the following unexplained symptoms:
- Cough
- Fatigue
- SOB
- Chest pain
- Weight loss
- Appetite loss
when is a CXR considered to assess for lung cancer?
people aged 40 years and over with any of the following:
- Persistent or recurrent chest infection.
- Finger clubbing
- Supraclavicular lymphadenopathy or persistent cervical lymphadenopathy
- Chest signs consistent with lung cancer
- Thrombocytosis
what is the 1st line treatment option for non-small cell lung cancer?
surgery - in pt that have disease isolated to single areas with intention to cure the cancer
lobectomy - removing lung lobe containing tumour is 1st line
segmentectomy or wedge resection - segment or wedge of lung removed - also an option
Other than surgery, what option is available to patients with non-small cell lung cancer?
radiotherapy can also be curative when diagnosed early enough
when is chemotherapy offered in patients with non-small cell lung cancer?
can be offered in addition to surgery or radiotherapy in certain patients to improve outcomes - adjuvant chemotherapy
or used as palliative treatment to improve survival and QOL in later stages
what is the treatment for non-small cell lung cancer?
chemotherapy and radiotherapy
which as a worse prognosis Non-small cell lung cancer or Small Cell Lung Cancer?
small cell lung cancer
what can be used in palliative treatment of lung cancer?
endobronchial treatment with stents or debulking to relieve bronchial obstruction caused by the cancer
Sometimes they can be the first evidence of a lung cancer in otherwise asymptomatic patients.
Name 9 extra pulmonary manifestations and paraneoplastic syndromes associated with lung cancer
- recurrent laryngeal nerve palsy
- phrenic nerve palsy
- superior vena cava obstruction
- horner’s syndrome
- syndrome of inappropriate ADH (SIADH)
- cushings syndrome
- hypercalcaemia
- limbic encephalitis
- Lambert-Eaton myasthenic syndrome
describe how recurrent laryngeal nerve palsy is related to lung cancer?
presents with a hoarse voice
It is caused by the cancer pressing on/ affecting the recurrent laryngeal nerve as it passes through the mediastinum.
describe how phrenic nerve palsy is related to lung cancer?
due to nerve compression causes diaphragm weakness and presents as shortness of breath
describe how superior vena cava obstruction is a complication of lung cancer, how it presents and what is the sign associated with it
caused by direct compression of the tumour on the superior vena cava
presents with facial swelling, difficulty breathing and distended veins in the neck and upper chest
“Pemberton’s sign” is where raising the hands over the head causes facial congestion and cyanosis. This is a medical emergency.
what is horners syndrome and why is it related to lung cancer?
triad of partial ptosis, anhidrosis and miosis
caused by pancoast’s tumour in the pulmonary apex pressing on the sympathetic ganglion
name 5 paraneoplastic syndromes caused by small cell lung cancer?
SIADH - presents with hyponatraemia
cushings syndrome - ectopic ACTH secreted by SCLC
hypercalcaemia - ectopic parathyroid hormone
Limbic encephalitis
lambert-eaton myasthenic syndrome
what is limbic encephalitis and how does it present?
paraneoplastic syndrome where the small cell lung cancer causes the immune system to make antibodies to tissues in the brain, specifically the limbic system, causing inflammation in these areas
symptoms of short term memory impairment, hallucinations, confusion, seizures
anti-Hu antibodies
what is lambert-eaton myasthenic syndrome?
produced by the immune system against small cell lung cancer cells
antibodies also target and damage voltage-gated calcium channels sited on the presynaptic terminals in motor neurones = weakness, particularly in the proximal muscles but can also affect intraocular muscles causing diplopia (double vision), levator muscles in the eyelid causing ptosis and pharyngeal muscles causing slurred speech and dysphagia
Patients may also experience dry mouth, blurred vision, impotence and dizziness due to autonomic dysfunction.
have reduced tendon reflexes - notable finding is that these reflexes become temporarily normal for a short period following a period of strong muscle contraction. eg, the patient can maximally contract the quadriceps muscle for a period, then have their reflexes tested immediately afterwards, and display an improvement in the response. This is called post-tetanic potentiation.
In older smokers with symptoms of Lambert-Eaton syndrome consider small cell lung cancer.
what is mesothelioma?
lung malignancy affecting the mesothelial cells of the pleura
linked to asbestos inhalation
huge latent period between exposure to asbestos and development of mesothelioma of up to 45 years
poor prognosis
chemo to improve survival but essentially palliative
how is lung cancer staged?
TNM staging
where are common places for lung cancer to metastasise to?
BLAB
Bone
Liver
Adrenals
Brain
hypertrophic pulmonary osteoarthropathy
symmetrical painful arthropathy
clubbing periostitis
treat - symptomatic management
5 ways that the lung cancer cells can be obtained for cytology/histology?
bronchoscopy
bronchalveolar lavage
transthoracic needle biopsy
surgical biopsy
aspiration of pleural fluid
