Lung Flashcards
Epidemiology of lung cancer
3rd most common cancer
Most common cause of cancer death
More common in men and over 75s
Risk factors for lung cancer
Smoking Lung disease - TB, COPD Radiotherapy Pulmonary fibrosis HIV FHx Radon gas Asbestos - mesothelioma
Types of lung cancer
Small cell - 20%
- develop from APUD cells - produce hormones
- central, grow quick and metastases early
Non-small cell
- adenocarcinoma - 32% - arises from gland linging lungs - common in women and non-smokers
- squamous cell carcinomas - arises from flat cells of airways - 35% - central and metastasise later
- large cell - 10% - undifferentiated
- bronchoalveolar carcinoma - 1-2% - non invasive initially
Mesothelioma
Presentation of lung cancer
Symptoms - persistent cough - SOB - haemoptysis - recurrent chest infections - pain - tumour invades chest wall Signs - weight loss/cachexia - clubbing - NSCLC - effusion, lobe collapse, consolidation - monophonic wheeze
Ix of lung cancer
Bloods - FBC, U+Es, LFTs, bone profile, CRP - baseline and signs of mets Tumour markers - CEA Sputum cytology - malignant cells CXR - mass - mediastinal widening - hilar lymphadenopathy - lobe collapse CT - extent of tumour and metastasis - PET CT - light up area of metastasis Biopsy - bronchoscopy - VATS - video assisted thoracoscopy surgery - CT guided biopsy
Mx of lung cancer
Surgery - NSCLC - removal of affected lobe/lung Radiotherapy - SC + NSCLC - prophylactic cranial if limited disease and good response after primary tx Chemo - SC - adjuvant in NSCLC - locally advanced and metastatic Biological - metastatic NSCLC
NICE urgent CXR criteria
Age over 40 and 2 of the following or smoked and one of the following - cough - fatigue - SOB - chest pain - anorexia - weight loss Age over 40 and any of the following - persistent/recurrent chest infection - finger clubbing - persistent supraclavicular/cervical lymphadenopathy - chest signs consistent with lung cancer - thrombocytosis
Staging of small cell lung cancer
Limited disease - within tolerable radiation field
Extensive disease - distant metastases
Staging of NSCLC
1 - cancer is small (3-5cm) and not spread to lymph nodes
2 - tumour spread to nearby lymph nodes
3a - cancer extends to surrounding tissues and structures
- lining of lung and chest wall
- has spread to ipsilateral lymph nodes
3b - > 2 tumours present
- spread to contralateral lung and lymph nodes
4 - metastatic spread to other parts of body
- bone, brain, liver and adrenal gland
TNM staging of lung cancer
T 1 < 3cm 2 3-7cm 3 > 7cm 4 - invasion of other organs/structures N 0 = none 1 = ipsilateral 2 = ipsilateral mediastinal 3 = contralateral M 0 = none 1 = present
Common sites of lung metastases
Liver Adrenals Lung Lymph nodes Pleural Brain Bone
Mx of hypercalcaemia
IV normal saline
Bisphosphonates - IV Pamidronate
Symptoms of hypercalcaemia
> 3 mmol/l usually symptomatic Confusion Weakness Nausea Constipation Reduced fluid intake
Define pneumonitis
Inflammation of lung tissue
Causes of pneumonitis
Recurrent lung infections
Chemotherapy
Radiation treatments
Exposure to feathers or bird excrement
Mx of pneumonitis
Reduced exposure
Corticosteroids
Oxygen therapy
Symptoms of pneumontitis
SOB Cough Fatigue Loss of appetite Unintentional weight loss
Features of recurrent laryngeal nerve palsy
Hoarse voice
Caused by cancer pressing on of affecting recurrent laryngeal nerve as it passes through the mediastinum
Features of phrenic nerve palsy
Presents as SOB
Due to nerve compression causing diaphragm weakness
Features of SVCO
Caused by direct compression on tumour on superior vena cava
Presents with facial swelling, difficulty breathing and distended veins over neck and upper chestf
Features of horners syndrome
Partial ptosis, anhidrosis and miosis
Caused by Pancoast’s tumour (pulmonary apex) pressing on sympathetic ganglion
Features of SIADH
Syndrome of inappropriate ADH
Caused by ectopic ADH secretion by SCLC
Presents with hyponatraemia
Features of Cushing’s syndrome
Caused by ectopic ACTH secreted by small cell lung cancer
Presents as increased abdo fat with skinny arms/legs, buffalo hump, easy bruising, purple stretch marks, low libido and depression
Define limbic encephalitis
SCLC causes immune system to make antibodies to tissues in the brain
- limbic system -> inflammation
A/w anti-Hu antibodies
Features of limbic encephalitis
Causes short term memory impairment, hallucinations, confusion and seizures
Define Lamber-Eaton Myasthenic syndrome
Result of antibodies produced against SCLC
Also target voltage-gated Na channels in presynaptic terminals of motor neurons
Features of Lambert-Eaton Myasthenic syndrome
Weakness of proximal muscles Diplopia (double vision) Ptosis Slurred speech Dysphagia Reduced tendon reflexes
Define mesothelioma
Lung malignancy affecting mesothelial cells of pleura
Strongly a/w asbestos inhalation
- latent period of up to 45 years
Mx of mesothelioma
Prognosis very poor
Palliative chemotherapy - improves survival
Mx of lung cancer
Small cell
- chemoradiotherapy
- prophylactic cranial radiotherapy
NSCLC
- stage 1+2 - surgical resection/radical radiotherapy
- stage 2/3 - adjuvant chemo
- stage 3 - concurrent chemo/RT, RT alone, palliative
- metastatic - chemo, targeted, immunotherapy
- EGFR tyrosine kinase inhibitors - gefitinib
- monoclonal antibody - pembrolizumab
