Lung Cancer Flashcards
Risk factors for lung cancer
- Smoking
- Increased age
- Exposure to carcinogens such as asbestos
- FHx
- Airflow obstruction
Presentation of lung cancer
- haemoptysis
- chronic cough - more than 3 weeks
- FLAWS
- SOB
- chest pain
- wheeze
- dysphagia
Signs of lung cancer
- clubbing
- Horner’s syndrome
- asymmetrical chest expansion
- dull to percussion
- reduced breath sounds
- unexplained DVT - swelling in legs
- SVOC - swelling of face, neck and arms
Horners syndrome triad
Partial ptosis
Anhydrosis
Miosis
Pathophysiology of Horner’s syndrome
Pancoast tumour often in the right apex of the lung compresses the sympathetic chain.
When should a CXR be done for chronic cough?
Unexplained, unresolved cough for 3 + weeks
Complications of lung cancer
SIADH - from small cell lung cancer Hypercalcaemia- bone mets or PTHrP SVCO Metastasise VTE Pleural effusion Pneumonitis Pneumothorax Cushing’s syndrome Lambert Eaton myasthenic syndrome Spinal cord compression
Which lung cancer commonly causes SIADH
Small cell lung cancer
Types of lung cancer
Small cell lung cancer
Non small cell lung cancer:
- adenocarcinoma
- squamous cell carcinoma
Features of small cell carcinoma
Often rapid progression
High likelihood to metastasise
Treated with chemotherapy
Causes a paraneoplastic syndrome - SIADH
Features of squamous cell lung cancer
Can release PTHrP
Features of adenocarcinoma
Histology - duct formation
Less associated with smoking
Investigations for lung cancer
Bloods - FBC, U+E, LFTs, Ca2+
FEV1 - lung function
Biopsy - bronchoscopy
Imaging
Causes of pulmonary nodules
FANGS:
Foreign body
Abscess
Neoplasia - Metastasise, Hamartoma, Bronchial carcinoid, primary bronchial carcinoma
Granuloma - Wegener’s granulocytoma - granulomatosis with polyangiitis, TB or fungal infection
Rheumatoid nodule, sarcoidosis
Structural - Arteriovenous malformation
Management of lung nodules
CT surveillance over 24 hours
Lobectomy if good performance status
What causes pneumonitis
Reaction to radiotherapy or targeted immunotherapy
Causes of pneumothorax in lung cancer
Lung biopsy
Malignant pleural effusion
Pleural effusion positive for cytology - showing presence of cancer cells
Indicative of metastasise
Presentation of brain mets
Headache
Confusion
When to do a 2 ww referral
CXR suggestive of lung cancer
40+ with unexplained haemoptysis
40+ with 2+ of:
- fatigue
- breathlessness
- cough
- weight loss
- appetite loss
- persistent or recurrent chest infections
- finger clubbing
- supraclavicular lymphadenopathy
- thrombocytosis
Treatment for squamous cell carcinoma
Surgery
Chemotherapy
Radiotherapy
Targetted therapy - PD L1 inhibitor - pembrolizumab
Radiotherapy in lung cancer
Curative - high dose CHART
Palliative - low dose
CHART
Continuous hyperfractionated accelerated radiotherapy
Given to stage I or II that are unfit or do not want surgery
Treatment of small cell carcinoma
Mainstay of tx - chemotherapy as rapid growth rate and almost always extensive
Palliative radiotherapy
Palliative treatment options
YAG lazer - high risk
Cryotherapy
Diathermy
Bronchial stents for airway obstruction
Endobronchial radiotherapy
What substance is injected for a PET scan
Fluorodeoxyglucose
Imaging for lung cancer
Imaging: 1. CXR 2. CT CAP 3. FNA of lymph nodes in neck \+/- PET scan \+/- CTPA \+/- EBUS -endobronchial USS \+/- Bronchoscopy \+/- CT guided biopsy
Advantages and disadvantages of EBUS
Advantages:
- no radiation
- can locate lymph nodes
Disadvantages:
- cant go deep
- invasive
Advantages and disadvantages of bronchoscopy
Advantages:
- camera guided so can locate tumour and take biopsy
- can go deeper and access central tumours
Disadvantages:
- can’t biopsy lymph nodes
- invasive
Advantages and disadvantages of CT guided biopsy
Advantages:
- good access to peripheral tumours
Disadvantages:
- can cause pneumothorax
- May not be able to have CT
- Radiation
- Invasive
How to assess breathlessness
MRC dyspnoea score
