Lung Cancer Flashcards
What are the important aspects of the history of cough SOB and occasional hemoptysis
Age - more elderly patients more likely
Chronic illnesses - COPD, Immunocompromising illnesses like HIV, other cancers
cough- when, during certain activities, more at night productive/non-productive
hemoptysis - color, amount, how often
Occupation - exposure to asbestos
Constitutional symptoms - weight loss, rigors, night sweats
Chest pain - Lung cancers are associated with chest pain due to invasion of the tumor into the chest wall specifically invasion of the intercostal nerves
Hoarseness- invasion of the recurrent laryngeal nerve - most likely to be on the left because it goes around the ligamentum arteriosum on this side because that is a chest lesion
Paralysis of the phrenic nerve - causing SOB and diaphragmatic issues
Compression of the superior vena cava leading to congestion of blood in the head and neck - known as SVC syndrome.
Compression of the oesophagus - patients presents with dysphagia
Horners syndrome- ptosis, invasion of the superior cervical celiac ganglion which leads to ptosis ,
Invasion of subclavian vein
Metastatic symptoms - headache, seizures
Drug Hx -
Family hx - lung cancer
What are some differentials for lung CA
Tuberculosis Pneumonia Bronchiectasis (more significant hemoptysis) Fungal infection Pulmonary embolism (SOB and hemoptysis)
What lung cancers typically metastasize to the brain
adenocarcinoma
and small cell carcinoma
WHere does lung cancer like to metastasize to?
brain, liver, adrenals, bone
Why is hypercalcemia seen in lung cancer patients
- paraneoplastic syndromes
- bony mets
What are some Paraneoplastic syndromes asscociated with lung cancer?
- Lambert Eatons syndrome - Proximal muscle weakness
- Cushings syndrome
- SIADH
- gynacoemastia
- hypercalcemia
What type of lung cancer ususally presents paraneoplastic syndromes
seen in the small cell carcinomas
What blood investigations would you order and what derangement would you expect?
- CBC - anemia, WBC count infection, platelets
- U&E - if patient has
- LFTs- mets to liver will cause derangements/coagulaopathy, transaminases
If patient has SIADH, what do you expect to see in his U&Es?
Sodium would be decreased - hyponatremic
What do you look for in the mediastinum on xray of an individual with a lung mass?
Normal width of the superior mediastinum is
you look for widening of the superior mediastinum
What is the most appropriate investigation after x-ray when a lesion is seen in the lung?
CT chest and upper abdoemen with IV contrast . - we need to look at the LIVERRR for mets !!!!!
On CT of the chest which lung nodule is more suggestive of malignancy? well circumscribed or irregular margins?
IRREGULAR MARGINS
Which of these features of the lung nodule is more suggestive of malignancy? heterogenous or homogenous?
HETEROGENOUS
Which feature of a lung nodule is more suggestive of malignancy? no calcification OR densely calcified?
NO CALCIFICATIONS
malignancies are not densely calcified
What other features on CT scan are important to look out for?
- Size and Shape of tumor - necessary for staging
- Mediastinal lymph node involvement - enlargement may be seen, lymph nodes are matted and you lose their usual architecture
- presence of an effusion
- invasion to the chest wall
- loss of the fat plane between the mediastinum and the lung
- squamous and small cell are more central tumors while adeno is peripheral
