Lung cancer Flashcards
Types of non-small-cell lung cancer
adenocarcinoma
squamous cell carcinoma
large cell carcinoma
other NSCLC unable to classify
Where are squamous cell lung cancers normally located?
central, local nodal disease
Where are adenocarcinoma lung cancers normally located?
often peripheral, can be multifocal, distant mestastases
What mutation is present in ~10% lung cancers (particularly females and never smokers)?
EGFR mutation
Lung cancer presentation
local symptoms = cough, SOB, stridor, phlegm change, pneumonia, haemoptysis, hoarseness, weight loss, chest pain
metastatic symptoms = bone pain, headaches, neurological findings, abdo pain, anorexia, cachexia, jaundice, weight loss
What are the 2 main types of lung cancer?
small cell
non-small cell
What can be used to help stage a lung cancer?
CT chest including liver and adrenal glands
PET-CT for lymph node involvement/distant metastases
MRI-CT head for cerebral metastases
bronchoscopy/mediastinoscopy
EBUS
What staging is used for lung cancer?
TNM
Small cell lung cancer treatment
no surgery
limited stage (inside chest) = chemoradiotherapy, or just chemotherapy +/- prophylactic cranial irradiation
extensive stage (outside chest) = just chemotherapy +/- prophylactic cranial irradiation
Non-small-cell lung cancer treatment
stage 1-2:
surgery if possible
+/- adjuvant chemotherapy
unfit = stereotactic radiotherapy
stage 3 :
radical chemoradiotherapy
radical radiotherapy alone
stage 4:
- palliative intent = chemotherapy
What should be checked in a confused patient with cancer?
calcium
If a patient has hypercalcaemia and no known cancer, what should be done?
myeloma screen
Malignant hypercalcaemia symptoms
bones, stones, groans and psychic moans
bone pain
renal stones
generalised body pain
confusion, low mood
also: constipation, polydipsia/polyuria, generalised fatigue/weakness
Malignant hypercalcaemia management
rehydration - several litres of normal saline
(risk of cardiac failure - consider CVP measurements)
bisphosphonates:
- 60-90mg pamidronate IV over
- can cause renal failure so must be rehydrated first
- takes up to a week to work
systemic management of malignancy
Superior vena cava obstruction symptoms and signs
symptoms = SOB, facial swelling, arm swelling, upper venous engorgement
signs = neck and upper torso venous engorgement, facial swelling
Causes of superior vena cava obstruction
Intrinsic compression:
- clot (DVT)
- foreign body (eg. line)
- tumour in vessel (eg. renal cancer)
extrinsic compression:
- from mass
Superior vena cava obstruction management
steroids (eg. 8mg dexamethasone BD)
chemotherapy (good response in SCLC)
radiotherapy (good response in squamous cell lung cancer)
stent - rapid symptom relief but doesn’t treat cause
caused by clot = anticoagulation
