Lung Cancer Flashcards
Lung cancer statistics
-25% cancer related deaths Scotland
-5000 new diagnoses a year
-25% adults smoke
-5-year survival 8.7%
-Mortality rates declined
Differentials for lung cancer
-Pneumonia/ organising pneumonia (inflammatory)
-Sarcoidosis
-Vasculitis
-TB-acute or old
-Pulmonary metastases
-Alternative malignancy (lymphoma)
-Benign nodules
Common causes of pulmonary metastases
-Renal cell
-Breast
-Colorectal
-Bladder
Risk factors for lung cancer
-Cigarette smoking
-Smoking cannabis
-Asbestos exposure
-Pulmonary fibrosis
How do lung cancers present?
-Incidental
=Asymptomatic
=Ix performed for alternative reason
-Local symptoms
=Cough
=Haemoptysis
=Wheeze/ stridor
=SOB
-Invasive symptoms
=Chest wall pain
=Hoarse voice
=Vascular invasion
-Systemic symptoms
=Weight loss, anorexia
=Fever/ sweats
=Metastatic symptoms
Invasive presentations
-Chest wall- chest wall pain
-Superior vena cava
-Hoarse voice (left recurrent laryngeal nerve)
-Dysphagia (oesophagus)
-Horner’s syndrome (from Pancoast tumour)
=meiosis, ptosis, enophthalmos, anhidrosis
=Sympathetic trunk involvement (apex)
-Shoulder pain, arm weakness/ wasting
Symptoms of superior vena cava obstruction
-Facial and upper limb oedema
-Venous distension of upper body
-Pemberton’s sign (stridor when lifting arms above head)
-Headache
Management of SVCO
-Dexamethasone (reduce oedema)
-Anticoagulation (thrombosis)
-Urgent radiotherapy
-Urgent chemotherapy
-SVC stenting (immediate relief)
Common sites of lung cancer spread
-Supraclavicular/ mediastinal/ hilar lymph node
-Adrenal glands
-Pleura
-Liver
-Skin
-Bone
-Brain
Paraneoplastic syndromes
-Squamous cell carcinoma
-Small cell lung cancer
Symptoms and signs of squamous cell carcinoma
-Hypercalcaemia- ectopic PTH
-Finger clubbing
-HPOA (hypertrophic osteoarthritis)
Symptoms and signs of small cell lung cancer
-SIADH
-Ectopic ACTH
-Cerebellar syndrome
-Eaton Lambert syndrome
-Limbic encephalitis
Common symptoms of hypercalcaemia
-Confusion
-Constipation
-Thirst
-Fatigue
First management step in hypercalcaemia
-IV fluid hydration
=Diuretic helps excrete renal calcium
-IV bisphosphonate
Assessing patient fitness
-ECOG performance status 0-4 (PS), ET (exercise tolerance), ADL’s
-Pulmonary function tests
-Cardiac status (ECG, ECHO)
-Renal or hepatic dysfunction
-Comorbidities- diabetes, vascular disease
-Other lung disease- ILD
-Cognitive impairment, frailty
Fitness for lung cancer surgery
-FEV1, transfer factor (TCO)
-Incremental walk test
-ABG
-ECHO
-Cardiopulmonary exercise test (CPEX)
-Q scan
Staging investigations
-1. CT chest/ abdomen (contrast)- early indication
-3. CT head
-2. CT PET (metabolic activity, identifies 10-15% metastases)
-Mediastinoscopy
-Pleural aspiration
False negatives in CT PET
-Adenocarcinoma with lepidic growth
-Carcinoid tumour (neuroendocrine)
-Renal cell carcinoma
-Hepatoma
-Low grade lymphoma
-Hyperglycaemia (therefore fast)
False positives in CT PET
-Other inflammatory infective aetiologies (Pneumonia, TB, abscess)
-Thyroid
-Bowel
Lung cancer pathology
-Small cell lung cancer (15%)
-Adenosquamous
-Adenocarcinoma (40%)
-Squamous (30%)
-Large cell (10%
Lung cancer pathology
-Small cell lung cancer (15%)
-Adenosquamous
-Adenocarcinoma (40%)
-Squamous (30%)
-Large cell (10%
Describe cytology
-Cells
-Fine needle aspirates
-Pleural fluid
-LN sampling
=Peripheral FNA
=EBUS-FNA
-Bronchoscopy= washings, brushings
-Skin FNA
Describe histology
-TISSUES
-Bronchial biopsy
-CT guided biopsy (peripheral lesions, larger lesions as otherwise risk pneumothorax)
-Liver biopsy
-VATS/ thoracoscopy
-Mediastinoscopy
-EUS biopsy
-Resection
When is EBUS used?
-Sampling of mediastinal and hilar lymphadenopathy external to bronchial tree
-Same contraindications as bronchoscopy
-EUS-FNA for poorer respiratory reserve
-EUS- biopsy (lymphoma)
Treatment options for lung cancer
-Nodal involvement= radio and chemotherapy
-Early signs of lung cancer= surgical resection if fit for surgery and lobectomy
-SABR radiation
