Lung Flashcards
What are the risk factors for lung cancer?
Smoking x10
Asbestos x5
TB
COPD
RT
Outline the histology of lung cancer
SCLC - smoking related as well
NSCLC
- adenocarcinoma (most common in smokers)
- squamous cell carcinoma (MOST COMMON, smoking related as well)
- large cell carcinoma
What is the 2WW referral criteria for suspected lung cancer?
> 40 with 2+ unexplained symptoms
OR
Smoker with 1 symptom
- Seen within 14 days
- 31 days from referral to diagnosis
- 62 days from referral to treatment
How should lung Ca be investigated?
Bloods = FBC, U+E, LFT, CRP, bone (hyperCa in SCLC)
CXR –> staging CT NTAP –> PET scan
Biopsy
Radionuclide bone scan (?mets)
Lung function testing - suitability for lobectomy
Tumour markers = CEA, Ca 19.9, Ca 125, PSA
How should lung Ca be managed?
NSCLC =
- Curative: surgery, if unfit = radical RT (CHART Continuous hyperfractionated accelerated RT)/chemo (platinum-based), targeted therapy (EGFR TKIs), immunotherapy (pembrolizumab)
- Immune checkpoint inhibitors = Nivolumab
SCLC =
- Chemo (cisplatin) + RT (if limited disease), surgery
Palliative: stents, brachytherapy, palliative chemo/DXT
Outline the complications of lung Ca
Lung collapse
Effusion
SVCO
RLN palsy
Horner’s syndrome
What are the possible symptoms and signs of lung Ca?
Symptoms =
- dyspnoea (60%)
- cough (50%)
- chest pain (33%)
- haemoptysis (25%)
- anorexia, weight loss
Signs =
- consolidation
- collapse
- pleural effusion
- cachexia
- SVCO
- horners syndrome
- hypertrophic pulmonary osteoarthropathy (HPOA) wrist, ankles, knees (common in adenocarcinoma)
What is the prognosis for a pt with lung Ca?
NSCLC =
- without spread: 50% 2y survival
- spread: 10%
SCLC =
- treated: 1-1 1/2y
- untreated: 3m
Outline the features of SCLC
Most commonly associated with low Na and LN mass
Kulchitsky Cells (sometimes called neuroendocrine cancer)
Rapidly growing highly malignant
Almost always inoperable at presentation
Responsive to chemotherapy
Poor prognosis
Outline the features of NSCLC
Squamous (SCC)
- Grows slowly, spreads late
- Obstructive CENTRAL lesion of bronchus leading to infection
- Common local spread but late widespread mets
- Can present as cavitating lesion
- PTHrP = hyperCa
Adenoacarcinoma
- Arise from mucous cell in bronchial epithelium
- Invasion of pleural + LN common, PERIPHERAL
- Mets to brain/bones
- More common in non-smokers vs. other types
- Associated with asbestos
- Bronchoalveolar
- Peripeheral solitary nodule of diffuse nodular lesion
Large-cell
- PERIPHERAL
- Less differentiated
- Early mets
- May secrete beta-hCG
What are the classical CXR changes seen for each type of lung Ca?
Hilar mass = squamous and SCLC
Peripheral = adenocarcinoma
Cavitation = squamous
How can tissue be obtained for biopsy with regards to lung Ca?
- Diagnostic pleural tap
- Bronchoscopy
- CT-guided biopsy
- Pleural biopsy
- Thoracoscopy (pleural effusion or peripheral lesion)
- Excision biopsy
- EBUS (central lesions)
- Mediastinoscopy
Mediastinal node involvement = EBUS guided transbronchial needle aspiration is the optimal initial strategy for nodal sampling
How is a pleural tap tested?
3 samples – microbiology, biochemistry, cytology
pH, albumin, protein, LDH, glucose (need grey bottle), acid-fast bacteria culture
If necessary can also check cholesterol, triglyceride, haematocrit, amylase
LIGHTS criteria
- If normal serum protein, pleural fluid protein >30g/l is an exudate
Otherwise:
- Pleural fluid protein/serum protein >0.5
- Pleural fluid LDH/serum LDH ratio >0.6
- Pleural fluid LDH > two-thirds upper limit of normal serum LDH
What cancers are lytic vs sclerotic?
LYTIC:
- lung
- thyroid
- renal (RCC)
- myeloma
- melanoma
SCLEROTIC:
- lung (SCLC)
- prostate
- breast
- TCC
- lymphoma
What paraneoplastic syndromes are associated with lung Ca?
Acromegaly
Carcinoid syndrome
Gynecomastia
Hyperthyroidism
