Lung Flashcards
What is the most common type of lung cancer?
non-small cell lung cancer - adenocarcinoma
PC - central, PTHrP and hypercalcaemia associated, finger clubbing, central cavitating lesions
Squamous cell cancer
PC - peripheral, anaplastic, poorly differentiated with poor prognosis, B-hCG + gynaecomastia
large cell
PC - peripheral, most common type among non-smokers, majority of those who develop this are smokers
female
endocarditis association
Adenocarcinoma
PC - rapidly growing, central, SIADH, cushings, lambert-eaton, subacute cerebellar degeneration
*poor prognosis
Small cell lung cancer
What is lambert Eaton syndrome ?
antibodies against presynaptic calcium channels of NMJ presenting as proximal muscle weakness
*calcium channels present on small cell LC cells also present at NMJ hence confused as those and attacked by immune system
PC - hx of asbestos exposure, pleural plaque thickening and effusion on imaging
mesothelioma
What are some risk factors for developing lung cancer?
- smoking
- asbestos exposure
- air pollution
- radon gas exposure
- ionising radiation exposure
How might lung cancer present?
70% dyspnoea
cough
chest or shoulder pain
weight loss, anoresia
haemoptysis
lethargy
In what specific ways might local invasion of lung cancer present?
horners - sympathetic invasion or pancoast compression
SVCO - compression or thrombosis
dysphagia, hoarse coice
C8-T1 pain
tachyarrhythmias
raised hemidiaphragm
How might metastatic disease present?
- lymph nodes - compression, lymphangitis, carcinomatosa
- brain - seizures, N+V, focal neurology, personality change
- further lung nodules or effusions
- adrenal glands - asymptomatic, electrolyte imbalance, pain
- bone pain, #, hypercalcaemia, MSCC
- liver - jaundice, liver capsule pain, itch
When might you refer a patient on the 2ww pathway?
CXR suggestive of cancer
>40 with unexplained haemoptysis
What investigations might you carry out for suspected lung cancer?
bloods - FBC, U&E, LFT, CRP, bone profile
imaging - CXR, CT CAP, PET
histology - sputum, bronchoscopy, percutaneous needle biopsy
how do you stage lung cancers?
TNM staging
What are the management options for non-small cell lung cancers?
20% suitable for surgery - mediastinoscopy pre surgery
curative or palliative radiotherapy
poor response to chemo
What are some contraindications for surgery?
assess general health
stage IIIb or IV (i.e. metastases present)
FEV1 < 1.5 litres is considered a general cut-off point*
malignant pleural effusion
tumour near hilum
vocal cord paralysis
SVC obstruction
What are the management options for small cell lung cancers?
*usually metastatic at diagnosis
- T1-2s, N0, M0 considered for surgery
- combo chemo and radio
- palliative chemo
*prophylactic radiotherapy to brain for SCLC
What types of surgeries are available in lung cancers?
lobectomy, pneumonectomy
wedge resection - part of one lobe
sleeve resection - one lobe and part of bronchi
What is the 5 year survival for lung cancers?
- stage 1 - 55%
- stage 2 - 35%
- stage 3 - 15%
- stage - 5%
What are the paraneoplastic features of small cell LC?
ADH
ACTH
Lambert-eaton
What are the paraneoplastic features of squamous cell?
PTHrP
clubbing
hypertrophic pulmonary osteroarthropathy
ectopic TSH
What are the paraneoplastic features of adenocarcinoma?
gynaecomastia
hypertrophic pulmonary osteoarthropathy
