Lung Cancer Flashcards
What are some common presentations of lung cancer?
SOB
Haemoptysis
Weight loss
Hoarse voice
Horners syndrome
Paraneoplastic syndrome
Wheeze
Infection
What type of wheeze do you get with lung cancer?
Monophonic wheeze
What type of wheeze do you get with lung cancer?
Monophonic wheeze
What type of wheeze do you get with COPD and asthma?
Polyphonic wheeze
Why do you get a polyphonic wheeze with asthma and COPD?
Varying degrees of inflammation and narrowing all around the lungs
What are some extrapulmonary symptoms/signs of lung cancer?
Hoarseness of voice
SVC obstruction symptoms
Dysphagia
Shoulder/inner arm pain
Chest pain
Facial/upper body swelling
Arrhythmia
Horners syndrome
What are some signs of SVC obstruction which can be caused by a lung cancer?
Breathlessness
Faint
Headaches
Facial / upper body swelling
How can you clinically test for SVC obstruction?
What is the name of the sign?
Get patients to raise arms above head, will make have a headache or make headache worse
Pembertons sign
What is Horner’s syndrome?
What typically causes it?
Triad of:
-partial Ptosis
-miosis
-anhydrosis
Pancoast Tumor (apical lung Tumor) compresses sympathetic chain
Why does Horners syndrome cause partial Ptosis not full Ptosis?
Sympathetic chain is damaged
Sympathetics supply the smooth muscle part of levator palpebrae superioris, whereas the majority of levator palpebrae superioris is skeletal muscle supplied by the Occulomotor nerve
Majority of LPS still has innervation so not full Ptosis
What are some extrathoracic symptoms/signs of lung cancer?
Poor appetite
Cachexia
Weight loss
Pain
Neurological issues
Skin nodes and lymph nodes
Palpable liver
Clubbing
What are essential parts/questions in a Hx where you think it might be lung cancer?
Do you smoke?
Have you ever smoked?
How much for how long?
Do you smoke anything else?
What occupation do you do?
Any exposures to toxins?
Nature of exposure?
How long exposed for?
Who was you employer?
What protective gear was provided?
What scoring system is used to assess patients with potential lung cancer to aid in management decisions?
Performance status
What is performance status scored between?
0-4
What is a 0 performance status score?
Asymptomatic
What is a 1 performance status score?
Symptomatic but completely ambulatory
What is a 2 performance status score?
Symptomatic but less than 50% of time in bed during the day
What is a 3 performance status score?
Symptomatic but over 50% of time spent in bed but NOT BED BOUND
What is a 4 performance status score?
BED BOUND
What investigations are done for a potential lung cancer?
U+Es
LFTs
Ca2+
FBC
Clotting
Spirometry + transfer factor
What imaging techniques would you do for a potential lung cancer?
CXR (first line)
Staging CT CAP
Biopsy if possible
PET CT after biopsy if possible
Echo if CVS issues
What techniques can be used to biopsy a ?lung cancer?
Bronchoscopy
Endobronchial US guided transbroncial fine needle lymph node aspiration
What are the 2 categories of lung cancer?
Small cell lung cancer
Non small cell lung cancer
What are the 3 types of Non small cell lung cancer?
Squamous cell carcinoma
Adenocarcinoma
Large cell
What gene does squamous cell carcinoma often have?
PDL1
What genes do adenocarinomas often have?
PDL1
EGFRr
ALK
ROS1
What is the treatment pathway if a GP suspects lung cancer?
What does this mean?
2 week urgent referral
Time from GP referral to first hospital admission should be done in 2weeks
Why can you get voice hoarseness with lung cancer?
Lung cancer can compress teh recurrent laryngeal nerve
What type of lung cancer typically has paraneoplastic syndromes?
Small cell lung cancer
What are some syndromes that can be cause by a small cell lung cancer secreting hormones or substances?
SIADH
Cushings
What does the small cell carcinoma produce leading to Cushing’s syndrome?
ACTH
What electrolyte imbalance is caused by a small cell lung cancer secreting ADH leading to SIADH?
Hyponatraemia
What type of lung cancer can cause Hypercalcaemia?
Why can this happen?
Squamous cell carcinoma
Ectopic PTH secretion by the. Tumour
What syndrome can rarely be caused by a small cell lung cancer which can lead to damage to Autonomics, vision, voice and swallowing?
Lambert Eaton myasthenic syndrome
What is the pathophysiology of lambert Eaton myasthenic syndrome?
Antibodies set up against cancer damage voltage gated calcium channels at presynaptic membrane of motor neurones
What is the treatment options for lung cancer?
Surgical resection/ablation
Radiotherapy (radical or palliative)
Systemic anti cancer therapy (chemo + immunotherapy)
What is a bright area called on a CT image?
What is a dark area called on a CT image?
Bright = highly attenuated
Dark = low attenuation
What are bright areas on a PET scan called?
What are dark areas on a PET scan called?
Bright = has high FDG Avidity (highly avid)
Dark = low avidity
What are fluffy opacities on a CXR. Called?
Alveolar shadowing
What are dots and lines called on a CXR?
Nodular or reticular shadowing
What are the bright areas called on an MRI?
What are the dark areas called on an MRI?
Bright = hyper intense
Dark = hypointense
What is the NICE. Guidelines criteria for referral for an urgent 2 week CXR with ?lung cancer?
Patients over 40 with:
-clubbing
-lymphadenopathy
-persistence / recurrent chest infections
-raised platelets (Thrombocytosis)
-chets signs of lung cancer
