Lung Cancer Flashcards
Epidemiology, prognosis
No 1 cancer worldwide and death cause
Risk factors
- environmental
- genetics
Cigarette/passive smoking
Occupational exposures
-asbestos, radon, vinyl chloride
Diet
Lung disease
Air pollution
HPV
Genes - EGFR, ALK, ROS, KRAS
Presentation
-2ww criteria
2ww - CXR with potential lung cancer findings/40+ with unexplained haemptysis
Persistent cough, haemoptysis
SOB, chest pain
Anorexia, weight loss
Hoarseness
SVC obstruction
Clubbing
Cervical, supraclavicular LN
Horners
Recurrent chest infections
Small cell
- prevalence and prognosis
- location
- features
15% of all cases - v aggressive, poor prognosis, treatment often palliative
Small for SMOKING, CENTRAL syndrome
ADH => low Na
ACTH => Cushings
LES => proximal limb weakness that improves with mv
Responds well to chemo
Responds poorly to surgery
Diagnosis and investigations needed
CXR, CT
-coin lesion/solitary nodule
DEFINITIVE - tissue, cell biopsy
- EBUS => tissue sample
- FNA => cell sample
Staging - FDG PETCT
Management
- when is surgery suitable
- what are the options
Surgery - pneunectomy, lobectomy, segmentectomy
- based on patient’s surgical fitness score
- if S3+, unlikely to be used
Radiotherapy
Chemotherapy
Immunotherapy
EGFR overexpression
Checkpoint inhibition - ipilimumab, nivolumab
-SE from T cell overactivation - fatigue, nausea, rash, AI -itis
Squamous
- population
- location
- features
S for SMOKING, CENTRAL syndrome
PTHrp => high Ca
TSHrp => hyperthyroid
HPOA
Clubbing
Responds well to surgery
Adenocarcinoma
- population
- location
- features
Peripheral - Most common in non smokers but majority do smoke
Related to glandular tissue
Gynecomastia
HPOA
Responds well to surgery
Large
- location, prognosis
- features
Peripheral - anaplastic, poorly differentiated => poor prognosis
bhCG
How may lung cancer contribute to delirium and dementia
Hypoxia
-from tumour, infective consolidation, pleural effusions and pain from intercostal nerve
Paraneoplastic syndromes => electrolyte imbalances
- SiADH in SCLC => low Na
- PTHrP in NSCLC => high Ca
Brain metastases
Asbestos and lung conditions - management and risk
-pleural plaques
-asbestosis
Pleural plaque - benign, no malignant change
-no follow up needed
Asbestosis - severity linked to length of exposure
-latency of 15-30 years
Features
-SOB, SOBOE
-clubbing
-bilateral end-inspiratory crackles
-restrictive pattern
Conservative treatment but can lead to bronchogenic carcinoma
Mesothelioma - malignant pleural disease
- associated with asbestos but link to lung cancer is greater
Features
-SOB
-chest pain
-pleural effusion
Palliative chemo, poor prognosis
Bronchioloalveolar carcinoma
-presentation on imaging
-location
-prognosis
Pneumonia like consolidation on imaging
Peripheral
Good prognosis
Metastasis of lung cancer
-common locations
Adrenal - unique to lung
Bones
Adrenal
Liver
Lymph node
Brain
