Lung Cancer Flashcards
What is the epidemiology of lung cancer?
- Third commonest cancer behind breast/prostate.
- Commonest cause of death from malignancy,
- Most common tumours in lung are caused by a metastasis (commonly breast, colon, head and neck, kidney)
what are the risk factors for lung cacner?
- Smoking is the biggest risk factor.
- Environmental tobacco smoke,
- Ionising radiation,
- air pollution
- Asbestos,
- Others, eg, fibrosing conditions of the lung
What are the signs and symptoms of lung cancer?
- Cough,
- Haemoptysis,
- Shortness of breath,
- Chest pain,
- Weight loss/anorexia,
- General malaise
What are the signs and symptoms of central lung cancer vs peripheral lung cancer?
Central - Ulceration of bronchus (haemoptysis) and can cause bronchial obstruction (pneumonia, wheeze, bronchiectasis, SOB)
Peripheral - Can have few symptoms. Can have pleural involvement which can cause pain and effusions
What are the effects of a local spread of malignancy?
- If invades pleura then can cause haemorrhagic effusion.
- Invasion of hilar lymphnodes,
- Invasion of adjacent tissue (which if invades BVs then causes haemoptysis)
- Invasion of pericardium which can cause pericardial effusion
- Invasion of mediastinum which can cause SVC obstruction, RL nerve obstruction and phrenic nerve obstruction.
- Pancoast tumours
What are the effects of SVC obstruction?
Facial oedema, headaches and a raised JVP
What are the effects of a phrenic nerve paralysis?
Raised right hemi diaphragm
What can occur due to recurrent laryngeal nerve paralysis?
Hoarseness of the voice
What are the effects of an apical/pancoast tumour?
- Severe pain,
- Weakness of arm/hands,
- Horner’s syndrome (ptosis, miosis and anhidrosis)
What are the routes of distant spread and the effects?
- Haematogenous (invasion of pulmonary veins which allows cancer to spread to liver, bone, brain and adrenal),
- Lymphatic spread to cervical lymph nodes.
What are the non-metastatic effects of lung cancer?
- ACTH secretion which causes adrenal hyperplasia, raised blood cortisol and Cushing’s syndrome.
- ADH secretion causing retention of water and SIADH.
- Parathyroid hormone related peptide (PYHrP) secretion which increases osteoclast activity causing hypercalcaemia.
- Encephalopathy, cerebellar degeneration, neuropathy, myopathy, Eaton Labert myasthenia-like syndrome, cancer associated retinopathy.
What is the histological classification of lung cancer?
- Small cell lung cancer (usually advanced at diagnosis and treated with chemo)
- Non-small cell lung cancer (treated surgery or radiotherapy)
- Adenocarcinoma
- Large cell carcinoma
- Others (tumours of mesenchymal tissue, salivary gland-type tumour, tumours of ectopic origin, neuroendocrine cells, lymphoma)
What are the likely tumours if central or peripheral in lung?
- Central tumours are likely to be squamous or small cell carcinomas.
- Peripheral are adenocarcinomas
Describe features of squamous cell carcinomas of the lung
- Arises centrally from major bronchi.
- Slow growing and metastasize late so good candidate for surgery.
- May undergo cavitation and block the bronchi leading to pneumonia or collapse.
- Microscopically presents as a malignant epithelial tumour with keratinization and/or intercellular bridges.
Describe features of adenocarcinomas of the lungs
- Common tumours seen in females and is seen in non smokers
- Appears microscopically as a glandular/solid/papillary or lepidic lesion. Has malignant glands seen
