Lung Cancer Flashcards
What are the common clinical symptoms of lung cancer?
Cough
Haemoptysis
Dyspnoea
Chest pain
Weight loss
Nausea and vomiting
Anorexia
What are the common clinical signs of lung cancer?
Cachexia
Finger clubbing
Hypertrophic pulmonary osteoarthropathy (HPOA).
Anaemia
Horners syndrome (if the tumour is apical)
Lymphadenopathy
Skin nodules (metastases)
Superior vena cava obstruction
Chest signs
Paraneoplastic syndromes
What is paraneoplastic syndrome?
Sings or symptoms occurring in a patient with cancer that results from antibodies or ectopic hormones produced by the cancer and are not due directly to local effects of cancer cells.
Removal of the cancer usually resolves the problem.
What are some paraneoplastic symptoms of advanced disease?
Neurological:
- polyneuropathy
- cerebellar degeneration
- lambert-eaton syndrome
Finger clubbing
anaemia
HPOA
carcinoid syndrome
inappropriate ADH secretion > hyponatraemia.
Ectopic ACTH secretion causing Cushing’s syndrome.
Hypercalcaemia due to the secretion of parathyroid hormone related peptides.
What are some metastatic symptoms of advanced disease?
Bone pain
Spinal cord compression: limb weakness, paraesthesia and bladder/bowel dysfunction.
Cerebral metastases: headache, vomiting, dizziness, ataxia, focal weakness.
Thrombosis.
What is the pathology of squamous cell carcinoma?
Usually present as obstructive lesions of the bronchus leading to infection.
Associated with smoking.
What paraneoplastic syndromes are associated with squamous cell carcinoma?
-Often causes hypercalcaemia by bone destruction or production of PTH analogues (PTHrp).
-Also often associated with clubbing and HPOA.
What is the pathology of adenocarcinoma?
Arises from mucous cells in the bronchial epithelium.
Commonly invades the mediastinal lymph nodes and the pleura and spreads to the brain and bones.
Most likely to cause pleural effusion (as are mesotheliomas).
What is the pathology of small cell carcinoma?
-Arise from endocrine cells (Kulchitsky cells). These are ADUP cells, and as a result, these tumours will secrete many poly-peptides mainly ACTH.
What paraneoplastic syndromes are associated with small cell carcinoma?
Due to inappropriate ACTH secretion, it can cause Cushing’s syndrome.
Addison’s disease.
Lambert-eaton syndrome.
Describe the management of non-small cell lung cancer.
- First-line: lobectomy.
- Curative radiotherapy can also be offered to patients with stage I, II and III NSCLC.
-Chemotherapy should be offered to patients with stage III and IV NSCLC to control the disease and improve quality of life.
Small-cell lung cancer management
-Can be combined chemotherapy and radiotherapy.
-However SCLC is usually disseminated on presentation, so generally palliative chemotherapy is the treatment.
What are the risk factors of lung cancer?
Smoking (more than 85%).
Passive smoking.
Exposure to asbestos, radon, air pollution and diesel exhaust.
What are the initial investigations?
CXR.
FBC.
Renal, liver functions and calcium.
Clotting screen.
Spirometry.
What main investigations can be used for a tissue diagnosis?
Bronchoscopy.
EBUS.
Ct biopsy.
What investigations are used to stage the lung cancer?
CT thorax and abdomen.
CT-PET.
Describe the TNM staging system used to stage lung cancer.
How big is it and how far it has spread/size and position of the tumour (T).
Whether cancer cells have spread into lymph nodes (N).
Whether the tumour has spread anywhere else in the body i.e. metastases (M).
What is the difference between a pulmonary nodule/mass?
A pulmonary mass is an opacity in the lung over 3 cm with no mediastinal adenopathy or atelactasis.
A pulmonary nodule is an opacity in the lung up to 3cm with no mediastinal adenopathy or atelectasis.
Describe the other treatment strategies which are important in the palliation of lung cancer.
Chemotherapy.
Immunotherapy.
TKI.
Palliative radiotherapy.
Combination of above.
Describe he pathology of malignant mesothelioma.
Malignant pleural mesothelioma is a rare and aggressive disease and is caused by inhaled asbestos fibres reaching the pleura and causing inflammation, thereby provoking tumour formation.
What is pleural effusion?
Pleural effusion is the collection of fluid in the pleural space when there is an imblance between production and absorption.
What are the types of effusion?
Transudate and exudate.
Describe transudative effusion.
Non-inflammatory, very commonly caused by left ventricular and liver cirrhosis.
Describe exudative effusion.
Inflammatory > protein content 3g/dl or more. Common causes include malignancy (pulmonary and non-pulmonary), parapneumonic effusions, empyema and tuberculosis.
