Lung Cancer Flashcards
Screening programe for lung cancer
no national screening programe
test screening in CT. However its not quick and uses a large dose
Site Specific signs and symptoms
hoarseness due to the recurrent larygneal nerve (innervation of larynx) goes down the chest and comes back up
Sign and symptoms
svco
pancoast tumour which can cause horners syndrome
pancoast tumour
tumour at apex of lung
horners syndrome
invasion of the preganglionic neurons exiting the ventral spinal roots.
Some Signs/Symptoms of Horner Syndrome
MIOSIS:
PTOSIS / NARROWING PALPEBRAL FISSURE:
ANHIDROSIS:
miosis
difference in size of pupils , accentuated in dim light as the effected pupil does not dilate
PTOSIS / NARROWING PALPEBRAL FISSURE
lip drops due to paralysis of levator palpebrae.
ANHIDROSIS:
lack of sweating on ipsilateral side
Paraneoplastic Syndrome:
triggered by
abnormal immune system response to a cancerous tumour
Not directly related to invasion by the primary tumour or its metastases
likely investigations for lung cancer?
sputum cytology = asked to cough up something
bronchoscipy w/ biopsy = camera down trachea into bronchi
CT or PET/CT
staging NCCP Guidelines
• Contrast enhanced CT scanning of the chest and upper abdomen
staging NCCP Guidelines:
PET/CT recommened
–patients with NSCLC w bone metastasis
-patients clinically limited satged SCLC, to exclude occult metastases
staging NCCP guidelines:
brain metastases
contrast enchanced CT followed by contrast enhanced MRI
LUNG CANCER PATHWAY : 1
presented at GP or A&E
urgent CXR
LUNG CANCER PATHWAY : 2
Rapid access clincal assessment
clincal assess. = pulmonary fucntion tests PFT, performance status PS, bronchoscopy and CT thorax
LUNG CANCER PATHWAY : 3
multi-disciplinary conference
tissue diagnosis , staging, PS ,weight loss, PFT
LUNG CANCER PATHWAY : 4
primary treatment
surgery, combined chemo/RT , palliative care , chemo
TNM Staging
types of staging assessments
clinical (c)- before tx
pathologic (p) -after resection
restaging (y) - after part or all tx given
reocurrence (r) - stage at time reoccurence
autopsy(a)-
T1 : tumours less than 3cm in diameter
T1a(mi). - miniumly invasive adenocarcinoma
T1a(ss) superficial spreading tumour in central airways
T1a- less than 1cm
T1b-1cm - 2cm
T1c-2cm -3cm
T2:
T2= 3cm - 5cm OR involved with visceral pluera or main bronchus
T2a=3cm -4
T2b=4cm - 5cm
likely investigations for lung cancer:
CLINICAL
Hx and physical exam (Co-morbidities)
performance score
PFT
ECG
FBC
likely investigations for lung cancer:
Radiological
-CXR
-CT chest and abdomen
- +/-PET Scan
– +/- MRI Brain
likely investigations for lung cancer:
histology
-sputum cytology
-bronchoscopy w biopsy
-Bronchial brushings and washings
-EBUS (ENDOSCOPIC ULTRASOUND)
histology : How is the diagnosis confirmed?
-imaged-guided biopsy
-EBUS
-bronchial washings
-fine needle aspiration(takes sample of lymph node)
-plueral fluid aspiration (remove pleural fluid for investigation)
Small Cell Lung Cancer
12-15% of lung cancers
-small cell carcinoma
-Mixed small cell/large cell carcinoma.
-Combined small cell carcinoma (SCLC combined with neoplastic squamous)
Non-Small Cell Lung Cancer
85-88% of lung cancers
– Squamous cell carcinoma
– Adenocarcinoma
– Large cell carcinoma
Mesothelioma
plueral based lesions
Staging of SCLC
limited stage
extensive stage
limited stage
tumour confined to the hemi-thorax of origin
extensive stage
tumour that is too widespread
Histology Mesothelioma (plueral based tumours)
–Relatively rare
– 80% related to asbestos exposure
– Treated by chemotherapy
– palliative RT generally
Patterns of Spread
local- intrathoracic
Regional - Lymphatic (eg mediastinal ,hilar ,lobar)
Distant - Haematogenous. ( most common lung,liver,brain,bone)
Patterns of Spread
Related to cell histology:
SCLC
adenocarcinomas
-higher incidence of brain mets than NSCLC (15% of ptx at presentation ,further 50% go on to develop them)
-highest potential of brain mets in NSCLC
