Lung cancer Flashcards
What is the biggest cause of lung cancer?
Smoking
What are the histological types of lung cancer?
Small cell lung cancer
Non-small cell lung cancer
How can non-small cell lung cancer be further divided?
Adenocarcinoma
Squamous cell carcinoma
Large-cell carcinoma
How does small cell lung cancer cause paraneoplastic syndromes?
Small cell lung cancer contains neurosecretory granules that release neuroendocrine hormones
What is the clinical presentation of lung cancer?
Shortness of breath
Cough
Haemoptysis
Finger clubbing
Recurrent pneumonia
Weight loss
Lymphadenopathy (supraclavicular)
What are the risk factors for lung cancer?
Tobacco smoking
Passive smoke exposure
Occupational exposure
Radon exposure
Family history of lung cancer
Radiation to the chest
Air pollution
Immunosuppression
Increasing age
What nerve palsies can lung cancer cause?
Recurrent laryngeal nerve palsy
- If tumour presses on recurrent laryngeal nerve while passing through the mediastinum
- Causes hoarse voice
Phrenic nerve palsy
- Causes diaphragm weakness and presents with shortness of breath
What are the extrapulmonary manifestations of lung cancer?
Superior vena cava obstruction - direct compression of the tumour on the superior vena cava
Horner’s syndrome - caused by pancoast tumour
SIADH - ectopic ADH secreted by a small cell lung cancer
Cushing’s syndrome - ectopic ACTH secretion by small cell lung cancer
Hypercalcaemia - ectopic parathyroid hormone
Limbic encephalitis - paraneoplastic syndrome where small cell lung cancer causes the immune system to make antibodies to tissues in the brain
Lambert-Eaton myasthenic syndrome
What is the two week wait referral criteria for patients with suspected lung cancer?
Patients over 40 with the following should be offered a CXR within two weeks:
- Clubbing
- Lymphadenopathy
- Recurrent or persistent chest infections
- Raised platelet count
- Chest signs of lung cancer
When else should a CXR be considered?
Patients over 40 with:
- Two or more unexplained symptoms and have never smoked
- One or more unexplained symptoms in patients that have previously smoked
What is the first line investigation in suspected lung cancer?
CXR
What are the findings on CXR suggestive of lung cancer?
Hilar enlargement
Peripheral opacity
Pleural effusion
Collapse
What further imaging is used in the diagnosis of lung cancer?
Staging CT scan - CT-TAP
PET-CT
Bronchoscopy with endobronchial ultrasound
Histological diagnosis - biopsy of tumour cells
What is the management of lung cancer?
Holistic support and MDT approach
Smoking cessation
Advanced care planning where appropriate
First line medical - chemotherapy
Immunotherapy for advanced non-small cell lung cancer
Radiotherapy
Surgical management - lobectomy, wedge resection, pneumonectomy
