Lung Cancer Flashcards
Types of lung cancer
Small cell carcinoma
Non small cell carcinoma:
- Adenocarcinoma
- Large cell carcinoma
- squamous cell carcinoma
Squamous cell carcinoma
RF:
M>F
Smoking
Radon gas
Behaviour: Locally invasive Metastasise late via LN PTHrP → ↑ Ca2+ V. chemo sensitive
Adenocarcinoma
RF: F>M Non-smokers Far East Can cause gynaecomastia
Behaviour:
- Metastasise early
Large cell carcinoma
Poor prognosis
Symptoms
Cough and haemoptysis Dyspnoea Chest pain Recurrent or slow resolving pneumonia Anorexia and ↓wt. Hoarseness of voice
Signs
Chest:
Consolidation - dull to percussion and increased vocal resonance
Collapse - asymmetrical lung expansion
Pleural effusion - stony dull
General: Cachexia Anaemia Clubbing Supraclavicular and/or axillary LNs
Metastasis:
Bone tenderness
Hepatomegaly
Confusion, fits, focal neuro
Complications
Local:
Recurrent laryngeal N. palsy - hoarse voice
Phrenic N. palsy - breathless
SVC obstruction - JVP raised and malar flush
Horner’s (Pancoast’s tumour)
AF
Pancoast tumour
Normally present in right upper lobe
Causes Horner’s syndrome - sympathetics affected
Horner’s syndrome
Pupil constriction
Partial ptosis
Anhydrosis
Paraneoplastic syndrome
ADH → SIADH - hyponatraemia
ACTH → Cushing’s syndrome
PTHrP → ↑Ca2+, bone pain) – SCC
Lambert Eaton syndrome - antibodies against voltage gated Ca2+ causing proximal muscle weakness especially in the legs
Investigations
Respiratory examination
Basic obs
Bloods - FBC, U+Es, LFT, CRP, Ca2+
CXR
CT with contrast - staging
PET - mets
Bronchoscopy + Biopsy
Signs of lung cancer on CXR
Coin lesion
Hilar enlargement
Consolidation, collapse
Effusion
Management of NSCLC
MDT Smoking cessation Surgical Resection Curative radiotherapy Chemo ± radio for more advanced disease
Mx of SCC
Radiotherapy as normally advanced
Referral
- CXR findings
- > 40 with unexplained haemoptysis
40+ and 2 + symptoms of:
- cough
- fatigue
- SOB
- chest pain
- weight loss
- appetite loss
