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Year 3 Med 1 > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

What is this condition?

A

Lung cancer - 2nd most common cancer BUT, highest mortality (usually have many CXRs and GP visits prior to diagnosis)

  • CT best screening technique
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2
Q

Where are most cancers diagnosed?

A
  • Emergency (situations)
  • GP
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3
Q

What is the incidence of lung cancer in the north east?

A
  • Highest incidence and mortality from lung cancer
    • DUE to strong correlation between social deprivation (smoking and asbestos exposure → from ship yard) and late presentation of disease (leads to increased mortality)
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4
Q

What are the clinical presentations of someone with lung cancer?

A
  • Cough (74%)
    • Most common but least specific
    • May occur on background of chronic chest disease and then be a change in quality of cough
    • Failure of a cough to resolve in 2 to 3 weeks should raise suspicion
  • Weight loss (70%)
  • SOB (60%)
    • Common early symptom with cough and sputum
    • May be related to airway obstruction (unilateral fixed wheeze)
    • Often disproportionate
    • May result from local spread to pleura, pericardium, mediastinum or lymphatics
  • Haemoptysis (20-50%)
    • Not easily ignored
    • May be sole presenting symptom
      but more often with other symptoms
    • Typically streaking of sputum on several successive days
    • But not always significant
  • Chest pain (27%)
    • Persistent but often non specific ache
    • Direct invasion of pleura, mediastinum or pericardium
    • Metastatic to ribs or thoracic spine
    • Referred from diaphragm or brachial plexus involvement
  • Hoarse voice and other features of direct intrathoracic invasion
    • Hoarseness (left recurrent laryngeal)
    • SVC obstruction from tumour or thrombosis
    • Dysphagia from oesophageal compression
    • Elevated diaphragm
    • Pericardial involvement with arrhythmia or effusion
  • Also consider cord compression, paraneoplastic
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5
Q

What are the signs of lung cancer?

A
  • Cachexia/weight loss
  • Finger clubbing
  • Pleural effusion
  • Lymphadenopathy
  • Stridor
  • Tracheal deviation (Lobar collapse/whole lung collapse)
  • SVC obstruction
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6
Q

What are the risk factors of lung cancer?

A
  • Smoking
    • Ex-smoker
    • Non-smoker → usually genetic
  • Asbestos exposure
  • Underlying interstitial lung disease
  • COPD
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7
Q

How can you assess functioning status using the WHO performance scale?

A
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8
Q

What is the diagnosis and management of lung cancer?

A
  1. Confirm diagnosis of cancer: Histological/Cytology confirmation (Biopsy)
  2. Confirm stage of disease: Extent/Spread of disease
  3. Assess Patient fitness for treatment/patient wishes:
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9
Q

What is the treatment of lung cancer?

A
  • NSCLC: (75-80% cases) → non-small cell lung cancer
    • Early stage disease is curable by surgery
    • Radiotherapy or chemotherapy can help symptoms
    • New therapies include immunotherapy and biological agents
  • SCLC: (20-25% of cases) → small cell lung cancer
    • Frequently metastatic at diagnosis
    • Not amenable to surgery
    • Often very chemosensitive +/- radiotherapy → as divides very frequently so, MASSIVELY decreases cancer
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10
Q

What is the difference in the prognosis of SCLC and NSCLC?

A
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11
Q

What are the common sites for lung cancer to metastasise too?

A
  • Breast
  • Prostate
  • GI tract
  • Renal
  • Lung
  • Melanoma
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12
Q

What are the symptoms of spinal metastases?

A
  • Cervical or Thoracic spine pain
  • Progressive lumbar pain
  • Nocturnal spinal pain
  • Localised tenderness
  • Spinal pain aggravated by straining
  • Associated neurological symptoms and signs
  • Spinal cord compression → oncological emergency

Neurological symptoms or signs

  • Radicular pain
  • Limb weakness
  • Difficulty walking
  • Sensory loss with typical sensory level
  • Bladder or bowel dysfunction
  • Signs of spinal cord or cauda equina compression
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13
Q

What are the areas of extra-thoracic spread areas for lung cancer?

A
  • Supraclavicular lymphadenopathy
  • Horner’s syndrome (cervical sympathetic trunk)
  • Brain – most common cerebral tumour
  • Bone typically ribs vertebrae and long bones
  • Liver and adrenals also common

Can lead to SVC obstruction

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14
Q

What are the paraneoplastic syndromes of lung cancer?

A
  • Finger clubbing
  • SIADH
    • Water retention causes cerebral oedema
      • –leading to confusion, drowsiness, fits etc
  • Hypercalcaemia
    • Ectopic PTH or usually multiple bone metastases
      • Nausea, constipation, dehydration and drowsiness
  • Ectopic ACTH syndrome
    • Bilateral adrenal hyperplasia
      • –Thirst, polyuria, hypokalaemia and muscle weakness
  • Neurological Syndromes
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15
Q

Case 1:

Female aged 56 yrs

3 wk history cough and non specific chest pain

PH Melanoma

FH Father died lung cancer

Works local post office, smokes 20cpd

Otherwise fit and well

Investigations?

Has adenocarcinoma → what is the treatment?

A

Investigations

  • GP Chest Xray
  • Bronchoscopy
  • CT Staging Scan

Treatment

  • Palliative Chemotherapy with Carboplatin/Pemetrexed x 4 cycles
  • Radiotherapy dependent on response and treatment field
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16
Q

What is the function of the pleural space?

A
  • Lubricate visceral and parietal pleura to allow sliding as lungs inflate and deflate
  • To help create a vacuum as we breath in order to suck air in
17
Q

How is pleural fluid produced?

A
18
Q

How much pleural fluid is produced, absorbed every day and how is it achieved?

A
  • Pleural fluid production: ~15 ml/day
  • Pleural fluid absorption: ~15 ml/day
  • Pleural fluid drainage is achieved by the “Lymphatic pump”
19
Q

How do pleural effusions develop?

A

When rate of production of pleural fluid exceeds the rate of re-absorbtion of the fluid → Accumulation of fluid in the pleural space

20
Q

Explain the classification of pleural fluid…

A
  • TRANSUDATE
    • Low fluid protein
      • Fluid protein / serum protein < 0.5
        • “protein less than 25”
    • Low LDH
      • Fluid LDH / serum LDH > 0.6
  • EXUDATE
    • High fluid protein
      • Fluid protein / serum protein > 0.5
      • “protein greater than 35”
    • High LDH
      • Fluid LDH / serum LDH > 0.6
21
Q

What are the causes of pleural effusions → transudate?

A

“Fluid leaks into the pleural space from elsewhere”

  • Too much fluid in body
    • Heart failure
    • Renal failure
    • Liver cirrhosis
  • Fluid leaking from elsewhere
    • Hypoalbuminaemia
    • Ascites / peritoneal dialysis
  • Other stuff
    • Hypothyroidism
    • Meigs’ syndrome
    • PE
22
Q

What are the causes of pleural effusions → exudates?

A

“Too much fluid produced / failure of reabsorption due to damage to pleural surface”

  • Pleural malignancy – primary or secondary
  • Pneumonia
  • Empyema – infection in pleural space
  • Pulmonary infarction
  • Connective tissue disease
  • Benign asbestos pleuritis
  • Pancreatitis
  • Drug induced
23
Q

What history would a patient with a pleural effusion give?

A
  • Usual symptom is progressive breathlessness
  • Typically develops over days to weeks
  • May have pleuritic chest pain
  • Often have cough – dry or white phlegm
  • Symptoms of underlying cause
    • Weight loss, haemoptysis
    • Fever, symptoms of pneumonia
    • Ankle oedema
24
Q

On examination of a pleural effusion individual what would you find?

A
  • General
    • Breathless, hypoxia
  • Specific
    • Reduced expansion on affected side
    • Dull (stony) percussion note
    • Reduced / absent breath sounds
    • Reduced vocal resonance
25
Q

What investigations for someone with a pleural effusion would you do?

A
  • History and exam
  • Bloods
    • U+E, LFT, FBC, CRP
    • ESR, autoantibodies
    • Amylase
  • CXR
  • Pleural ultrasound
  • Consider CT chest
26
Q

How would you treat someone with a pleural effusion?

A

PLEURAL ASPIRATION

  • Ultrasound guided
  • Pass needle in to pleural fluid
  • Aspirate sample
  • Investigations
    • Colour, viscosity, smell
    • Biochemistry: protein, LDH, glucose
    • Fluid pH
    • Microbiology
    • Cytology
27
Q

What can the cause of benign pleural disease?

A

Indicator of asbestos exposure

28
Q

What is mesothelioma?

A
  • Malignant tumour of serosal surfaces (most commonly the pleura)
  • Usually resulting from asbestos exposure
  • Median survival is 9-12 months from diagnosis
  • Identification of asbestos exposure is essential for the patient to be able to claim compensation
  • On CT shows ROUGH border

Year 3 Med 1 (19 decks)

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