Lung cancer Flashcards
Investigations for lung cancer
Biopsy vua bronchoscope, EBUS, or CT
Pleural fluid samples
PET scan
MRI - more advanced, check for metastases
Lung function tests eg spirometry
6 minute walk test
ECHO if indicated
Baseline bloods
What are the two types of lung cancer
Small cell lung carcinoma
Non-small cell lung carcinoma
Depending on histology
Features of SCLC
Rapidly growing
Highly malignant
Features of SCLC
Rapidly growing
Highly malignant
What do the membrane bound chemosecretory granules release in SCLC?
Caclitonin, ADH, ACTH, PTH released peptide
Types of NSCLC
Squamous cell carcinoma - 42%
Adenocarcinoma - 39%
Large cell carcinoma - 8%
Where do SCLC arise from?
Kulchitsky cells
Where do squamous cell carcinomas arise in lung?
Proximal segmental bronchi, most present at obstructive lesions bronchus
Where do adenocarcinomas originate from?
Mucous cells of brochal epithelium
Which lung cancer is ass with asbestos/non-smokers?
Adenocarcinomas
Which lung cancer is likely to metastasise early? Where?
adenocarcinoma, brain and bone
What do large cell carcinomas consist of? Where arise and how differentiated?
Sheets of large, round polygonal cells w large nuclei and prominent nucleoli
Arise centrally and poorly differentiated
Bloods for lung cancer
FBC - anaemia, raised platelets
U+Es - May show hyponatremia in ADH -producing tumours
Calcium - May increase in PTHrP secreting tumours or bone metastases
Albumin may be low
Imaging lung cancer
CXR - 1st investigation done in patients with sus lung cancer
CT chest - investgiate suspected
PET scan - NSCLC
What are PET scans used for in lung cancer?
Assess eligibility for curative treatment in NSCLC
Histology investigations lung cacner
Bronchoscopy - obtain biopsies and washings for biopsy
Pleural effusion analysis
Sputum - centrally placed nodules or masses who decline/can’t tolerate bronchoscopy
Transthoracic fine needle aspiration biopsy - histology peripheral lesions
Risk factors for lung cancer
Cigarette smoking - 90%
COPD
Previous malignancy - head and neck
Industrial dust diseases - asbestos, chromium, arsenic, radon gas
FH
Increasing age
Symptoms of lung cancer
Cough
Haemoptysis
Dyspnoea
Chest pain
Recurrent or slow resolving pneumonia
Anorexia
Weight loss
Signs lung cancer - locoregional spread
Shoulder/inner arm pain/weakness - brachial plexus compression
Horner syndrome - sympathetic ganglion compression
Hoarseness - recurrent laryngeal nerve
Upper limb oedema, facial congestion + distended neck veins (SVC obstruction)
Signs of paraneoplastic syndrome
Finger clubbing
Signs of hypercapnia - bone metastases, release of PTHrP release
Hypertrophic osteoarthropathy
Which cancers release PTHrP
Small cell carcinoma or squamous cell carcinoma
What is used for staging in lung cancer?
Tumour
Nodal
Mets
What investigation should be used to stage lung cancer
Contrast CT of chest, liver, adrenal glands and symptomatic area
Which lung cacner has a poorer prognosis?
SCLC has a much poorer prognois than NSCLC
65-70% patients have disseminated or extensive disease at presentation
What is the treatment of choice for stage I or II NSCLC?
Lobar resection surgery
What should patients undergoing lobar resection have aswell?
Hilar and mediastinal lymph node sampling - provide accurate pathological staging
When should radiotherapy be offered for NSCLC?
Whne surgery not an option and stage I-III
When is chemo offered for NSCLC? What is its purpose?
Stage III - IV + good performance status
Improve survival, disease control and quality of life
When are tyrosine kinase inhibitors indicated?
Metastatic NSCLC in individuals with epidermal growth factor receptor mutation
Examples of tyrosine kinase inhibitors
Afatini b, erlotinib, gefitinib
What is 1st line managemenet for SCLC?
Chemotherapy
Surgery often not possible as early mets
SCLC much more sensitive to chemo than NSCLC
Multi drug treatments often used
What features of lung cancer suggest that radiotherapy should be used palliatively?
Bronchial obstruction, cough, chest paun, haemoptysis, SVC obstruction, bone and brain mets, spinal cord compression
What do you treat bone mets with medically?
Bisphosponates
Management of palliative lung cancer
Radiotherapy, palliative care team
Debulking surgery
Stent insertion
Opiates
Aspiration or drainage +/- pleurodesis -
When is debulking surgery vs stent insertion used in palleative lung cancer?
Debulking - Bronchial obstruction, haempoptysis
Stent insertion - bronchial OR SVC obstruction
Aside from pain relief, what is morphine useful for in lung cancer?
Breathlessness, cough
What is a mesothelioma?
Malignancy of mesothelial cells, occurs in pleura, peritoneum, pericardium and testes
What are the main risk factors for mesothelioma?
Male
Age - over 75
Asbestos exposure - crocidolite/blue os most dangerous
Clinical features of mesothelioma
SOB
Chest pain
Fatigue, sweats, fever
Finger clubbing
Signs of pleural effusion
Palpable chest wall mass
Signs of metastases
Signs of metastases
Lymphadenopathy, hepatomegaly, bone pain, bone tenderness, abdominal pain, GI obstruction
Investigations for mesothelioma
CXR + CT scan
MRI/PET scan for more detail
Pleural fluid, pleural biopsy - US or CT guided percutaneous
Mediastinoscopy and vide assisted thorascopy - stage determining
Stage determining investigations mesothelioma
Mediastinoscopy and vide assisted thorascopy
What see on CXR or CT thorax in mesothelioma
Pleural effusion, ,obulated or nodular pleural thiclenign, pleural mass and rib destruction
Management for mesothelioma
Surgery - only possible in stage I
Chemotherapy - palliative for unresectable
Radiotherapy? little evidence supporting
What legal information can ypu give someone with asbestos indiced mesothelioma?
Uk industrial injuries act - compensation
What is the staging and prognosis used for mesothelioma?
TNM
1 year
