Lung cancer Flashcards
Non-small cell lung cancers
Around 80%
Adenocarcinoma (40%)
Squamous cell carcinoma (20%)
Large-cell carcinoma (10%)
Small cell lung cancer
Around 20%
Contain neurosecretory granules that release neuroendocrine hormones
Responsible for multiple paraneoplastic syndromes
Signs and symptoms
Shortness of breath
Cough
Haemoptysis
Finger clubbing
Recurrent pneumonia
Weight loss
Lymphadenopathy
Hoarseness
Small cell paraneoplastic features
ADH
ACTH (HTN, hypercalcaemia, hypokalaemia, alkalosis, muscle weakness)
Lambert-Eaton syndrome
Squamous cell paraneoplastic features
PTH-rp secretion causing hypercalcaemia
Clubbing
Hypertrophic pulmonary osteoarthropathy
Hyperthyroidism due to ectopic TSH
Adenocarcinoma paraneoplastic features
Gynaecomastia
Hypertrophic osteoarthropathy
Chest xray
Often first line investigation
Hilar enlargement
Peripheral opacity
Pleural effusions (usually unilateral)
Collapse
CT
Investigation of choice
Staging CAP
Should be contrast enhanced
PET-CT
Useful in identifying areas that cancer has spread to
Typically done for non-small cell lung cancer to establish eligibility for curative treatment
Bloods
Raised platelets may be seen
Adenocarcinoma
Most common type of lung cancer
Often seen in non-smokers
Typically peripheral
Squamous cell
Cavitating lesions are more common than other types
Typically central
Associated with PTH-rp secretions (cause hypercalcaemia)
Strongly associated with finger clubbing
2 week wait referral
Chest xray findings that suggest lung cancer
Aged over 40 and unexplained haemoptysis
Offer urgent chest xray
Over 40 and 2 of (or 1 of an never smoked)
- cough
- fatigue
- SOB
- chest pain
- weight loss
- appetite loss
Large cell lung carcinoma
Typically peripheral
Anaplastic, poorly differentiated tumours with poor prognosis
May secrete B-hCG
Small cell lung cancer
Usually central
Arise from APUD cells
Associated with ectopic ADH and ACTH
Management of small cell lung cancer
Usually metastatic by time of diagnosis
Patients with very early (T1-2a, N0, M0) considered for surgery
Most patients with limited disease receive combination of chemo and radiotherapy
More extensive disease offered palliative chemotherapy
Non-small cell management
Only 20% suitable for surgery
Curative or palliative radiotherapy
Poor response to chemotherapy
