lung cancer Flashcards
offer urgent chest xray
40 and over 2 or more
smoker and one or more unexplained
cough fatigue shortness of breath chest pain weight loss appetite loss.
> 40 unexplained haemoptysis
types of lung cacner
non small cell
- adenocarcinoma - most common in non-smoker
- peripheral - sqaumous
- PTHrp
- Hypertrophic pulmonary osteoarthropathy (HPOA)
- finger clubbing
- central
- strongest association with smoking
- large cell
- carcinoid
bronchoalveolar - > small cell lung cancer
- neuroendocrine tumours
- aggressive
- smoking related
staging
Tumour T0 - no sign of cancer T1 cancer within the lung <3cm T2 3-5 cm T3 >5-7 cm T4 >7cm
N0 - no lymph nodes involved.
N1 - ipsilateral bronchopulmonary or hilar nodes involved.
N2 - ipsilateral mediastinal or subcarinal nodes.
N3 - contralateral mediastinal, hilar, any supraclavicular nodes involved.
M0 - no metastases.
M1 - metastases present.
M1a - separate tumour nodule(s) in contralateral lobe or tumour with malignant pleural (or pericardial) effusion.
M1b - distant metastasis.
Ix for lung cancer
Diagnositc tests
Bloods – FBC, U&E, Calcium, LFT’s, INR
• CXR
• Staging CT – CT Thorax and Upper Abdo
Continuous scan from lung apices to midabdomen (liver or adrenal mets common)
• Can be used to calculate TNM stage
Histology
<10mm PET
> 10mm biopsy, bronchoscopy
PET
EBUS
RFs of lung cancer
- smoking - large no of smoking pack years
- increased age
- long term lung diseases ie COPD
- previous Hx of cancer
- exposure to radon gas
- FH of lung cancer
- cacner Mx for other cancers
- exposure to certain chemicals in the workplace
Industrial dust diseases, asbestos, chromium, arsenic, iron oxides and radiation.
symptoms and signs of lung cancer
unexplained cough lasting more than 3 weeks Dyspnoea. Weight loss. Chest pain. Haemoptysis. Bone pain. Fever. Weakness. Dysphagia. Headache. Nausea and vomiting. Hoarseness (recurrent laryngeal nerve involvement). Wheezing and stridor
- Superior vena cava obstruction.
- horners
- Metastatic disease – liver, adrenals (Addison’s),
bone, pleural, CNS
• Paraneoplastic – clubbing, hypercalcaemia,
anaemia, SIADH, Cushing’s syndrome, LambertEaton myasthenic syndrome, thromboembolic
disease
Mx of lung cancer NSCLC
surgical intervention - stage I/II disease - curative intent
radiotherapy - stage I/III who are not suitable for surgery NSCLC
chemotherapy - stage II/III NSCLC
Durvalumab
follow up of lung cacner
within 6 weeks of completing Mx
Mx of SCLC
early stage surgery
extensive stage disease - platinum based combination chemotherapy
complications of lung cancer
LOCAL
- Recurrent laryngeal palsy, phrenic nerve palsy, Horner’s syndrome, Pancoast’s syndrome.
- Cardiovascular: superior vena cava obstruction, pericarditis, atrial fibrillation.
- Rib erosion.
METASTATIC
- Brain: confusion, fits, focal neurological deficit, cerebellar syndrome.
- Bone: bone pain, hypercalcaemia.
- Liver: hepatomegaly.
- Adrenal: Addison’s disease.
epidemiology of lung cancer
biggest cause of cancer related death
- 5 year survival approx. 12%
- 85% of LC occurs in smokers or ex-smokers
commonest sites of metastases
- Liver
- Adrenals
- Lung
- Lymph Nodes
- Pleural
- Brain
- Bone
NSCLC prognosis 5 year survival
All NSCLC – 10-13%
• Stage 1 following surgical resection – 60-70%
• Stage 2 following surgical resection – 30-55%
• Stage 3 – 7%
• Stage 4 – 1%
malignant pleural effusions diagnose by
- Diagnosed by Ultrasound Guided Aspirate: • Exudate • Cytology may be positive, but likely to need pleural biopsy (Thoracoscopy) • Indicates advanced disease (M1)
DDx of a solitary pulmonary nodule
options Mx
• Primary bronchial carcinoma • Infection – consider Tuberculosis / fungal • Non infectious granuloma – Granulomatosis with Polyangiitis (Wegener’s) • Rheumatoid nodule • Bronchial carcinoid • Hamartoma • Metastasis
• Sequential CT surveillance over 24
months
• If patient fit, they may wish to have nodule
removed – lobectomy
