Lung cancer Flashcards
2 histological classifications?
which is more common?
which has worse prognosis?
small cell (about 15%, worse prognosis) non small cell
types of NSCLC?
adenocarcinoma (mostly non-smokers) SCC large cell alveolar cell carcinoma bronchial adenoma (mostly carcinoid)
commonest type of lung cancer?
adenocarcinoma
T/F: alveolar cell carcinoma is often seen in heavy smokers
false - not related to smoking
which lung cancer type is normally related to production of large volumes of sputum
alveolar cell carcinoma
when might a lung cancer cause hoarseness
pancoast tumour > pressure on recurrent laryngeal nerve
examination findings in lung cancer?
fixed monophonic wheeze
supraclavicular/ persistent cervical lymphadenopathy
clubbing
thrombocyt OSIS/ OPENIA may be noted on bloods
thrombocytosis
investigation of choice to investigate suspected lung cancer?
CT
CXR often done first, around 10% normal
when might PET scan be indicated
in NSCLC to determine eligibility for curative treatment
improves diagnostic sensitivity of both local and distant mets
SCC
1) typically CENTRAL/ PERIPHERAL
2) associated with secretion of what hormone
3) strongly associated with what finger sign
4) associated with hypertrophic ___ ___
1) central (SCC - Central)
2) PTHrP > hypercalcaemia
3) clubbing
4) pulmonary oestroarthropathy (🔺periositis, clubbing, painful arthralgia)
Adenocarcinoma
1) typically CENTRAL/ PERIPHERAL
2) T/F: the majority of patients who develop lung adenocarcinoma are smokers
1) peripheral
2) true (although it’s the commonest type of LC in non-smokers)
Large cell lung carcinoma
1) typically CENTRAL/ PERIPHERAL
2) T/F: poor prognosis
3) may secrete ____
1) peripheral
2) True - anaplastic, poorly differentiated
3) β-HCG
T/F: most NSCLC are amenable to surgical treatment
false - only 20% suitable for surgery
what procedure must be performed prior to surgery in NSCLC
mediastinoscopy (CT doesn’t always show mediastinal lymph node involvement)
NSCLC has a poor response to CHEMO/ RADIO -therapy
chemotherapy
contraindications to surgery in NSCLC?
general health stage IIIb or IV (i.e. mets present) FEV1 < 1.5L malignant pleural effusion vocal cord paralysis SVC obstruction tumour near hilum
paraneoplastic features of SCLC?
ADH
ACTH - not typical, hypertension, hyperglycaemia, hypokalaemia, alkolosis and muscle weakness more common than buffalo hump etc
Lambert-Eaton Syndrome
what is Lambert-Eaton syndrome?
Abs against pre-synaptic voltage gated calcium channel in PNS
weakness improves after exercise (c.f. myasthenia)
limb girdle weakness (LL first)
hyporeflexia
autonomic symptoms
paraneoplastic features of SCC?
PTHrP > hypercalcaemia
clubbing
HPOA
hyperthyroidism due to ectopic TSH
paraneoplastic features of adenocarcinoma?
gynaecomastia
HPOA
SCLC
1) usually CENTRAL/ PERIPHERAL
2) arise from ___ cells
3) associated with ectopic secretion of what?
1) central
2) APUD
3) ADH > hyponatraemia
ACTH > cushings, b/l adrenal hyperplasia, hypokalaemia alkalosis
management of SCLC?
usually metastatic by time of diagnosis - most get combo of chemo and radio therapy (palliative chemo for more extensive disease)
v early stage now considered for surgery
Refer people using a suspected cancer pathway referral (appointment within 2 weeks) if:
CXR findings suggestive of LC
Unexplained haemoptysis in >40
Offer an urgent CXR (2 weeks) to assess lung cancer if >40 and 2 or more of the following unexplained symptoms (1 or more if ever smoked):
- cough
- fatigue
- SOB
- chest pain
- weight loss
- loss of appetite
Consider an urgent CXR (2 weeks) to assess lung cancer if >40 with any of:
- persistent/ recurrent chest infection
- finger clubbing
- supraclavicular/ persistent cervical lymphadenopathy
- chest findings consistent with LC
- thrombocytosis
transudative vs exudative pleural effusion?
transudative: <30g/L protein
exudative: >30g/L protein
causes of transudative pleural effusion?
heart failure (commonest cause)
hypoalbuminaemia
hypothyroidism
Meig’s syndrome
causes of exudative pleural effusion?
infection: pneumonia (commonest cause), TB, subphrenic abscess Connective tissue disease Neoplasia Pancreatitis PE Dressler's
Mesothelioma
1) what is it
2) strongly associated with ____ exposure
3) features
4) T/F: most have pre-existing asbestosis
5) metastasises where?
6) prognosis?
1) cancer of the mesothelial layer of the pleural cavity
2) asbestos
3) dyspnoea, weight loss, chest wall pain, clubbing
4) false- only 20%
5) contralateral lung and peritoneum
6) poor- median survival 12months
what CXR finding would raise suspicion of a mesothelioma?
next step for investigation?
painless pleural effusion or pleural thickening
next step: pleural CT
Ix
1) 1st line
2) for staging?
3) for looking for mets?
1) CXR
2) contrast enhanced CT
3) PET-CT
T/F: In small cell lung cancer, surgery is usually not
an option
true
mainstay of treatment in SCLC?
chemotherapy with platinum based drugs
symptoms of hypercalcaemia?
“stones, bones, abdominal moans
and psychic groans”
- Renal stones, and also diabetes insipidus.
- Bone problems e.g. osteoporosis, pathological #
- Abdominal moans (abdo pain, constipation, N&V)
- Psychic: depression, anxiety, irritability, psychosis.
