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.