Lung Cancer Flashcards
What is the third most common cancer in the UK?
Lung cancer
Lung cancer is a significant health concern in the UK.
From which cells does lung cancer arise?
Malignant epithelial cells in the lungs.
List the clinical features of small cell lung cancer (SCLC).
- More common in older smokers
- Metastasises early
- Secretes ACTH (Cushing’s syndrome)
- Secretes ADH (SIADH)
- Associated with Lambert-Eaton syndrome
What are the subtypes of non-small cell lung cancer?
- Adenocarcinoma
- Squamous cell carcinoma
- Large cell carcinoma
Where is adenocarcinoma typically located?
Peripherally (in smaller airways)
What are the clinical features of adenocarcinoma?
- More common in non-smokers
- Metastasises early
- Responds well to immunotherapy
Where is squamous cell carcinoma typically located?
Centrally (in bronchi)
What are the clinical features of squamous cell carcinoma?
- More common in smokers
- Secretes PTHrP (hypercalcaemia)
- Metastasises late (via lymph nodes)
Where is large cell carcinoma typically located?
Peripheral and central
What are the clinical features of large cell carcinoma?
- More common in smokers
- Metastasises early
List some risk factors for lung cancer.
- Tobacco smoking
- Air pollution
- Family history
- Male sex
- Radon gas (typically in miners)
What are typical symptoms of lung cancer?
- New-onset dyspnoea
- Unexplained cough for ≥3 weeks
- Haemoptysis
- Unintended weight loss
- Bone pain (due to metastasis)
- Fatigue
What are typical signs of lung cancer?
- Cachexia
- Finger clubbing
- Dullness to percussion
- Cervical lymphadenopathy
- Wheeze on auscultation
What is recurrent laryngeal nerve palsy and its symptom?
Lung tumour compresses laryngeal nerve
Hoarse voice
What does phrenic nerve palsy cause?
Shortness of breath, diaphragm weakness
What are the symptoms of superior vena cava obstruction?
- Facial swelling
- Difficulty breathing
- Distended neck veins
- Pemberton’s sign (facial congestion and cyanosis on raised hands above head)
What is Horner’s syndrome characterized by?
- Ptosis
- Anhidrosis
- Miosis
What causes syndrome of inappropriate ADH secretion in lung cancer?
Ectopic ADH
What is Cushing’s syndrome caused by in lung cancer?
Ectopic ACTH
What causes hypercalcaemia in lung cancer?
Ectopic parathyroid hormone
What is Lambert-Eaton myasthenic syndrome caused by?
Antibodies against small cell lung cancer
What are the symptoms of Lambert-Eaton myasthenic syndrome?
- Muscle weakness (especially proximal)
- Diplopia
- Ptosis
- Slurred speech
- Dysphagia
- Dry mouth
- Blurred vision
- Impotence
- Dizziness (autonomic dysfunction)
What are the NICE suspected lung cancer guidelines for x-ray referral?
- Within 2 weeks for patients >40 with:
- Clubbing
- Lymphadenopathy (supraclavicular)
- Recurrent or persistent chest infections
- Thrombocytosis (raised platelets)
- Chest signs of lung cancer
What are the considerations for x-ray in patients >40?
- 2+ unexplained symptoms in patients who have never smoked
- 1+ unexplained symptoms in patients who have ever smoked
List some unexplained symptoms of lung cancer.
- Fatigue
- Dyspnoea
- Cough
- Chest pain
- Weight loss
- Loss of appetite
What findings can be seen on a chest x-ray for lung cancer?
- Hilar enlargement
- Peripheral enlargement (visible lesion in lung field)
- Pleural effusion
- Collapse
What is the purpose of a CT scan in lung cancer management?
Staging
What is the role of bronchoscopy with endobronchial ultrasound?
Detailed assessment of tumour and ultrasound guided biopsy
What is the first line of management for non-small cell lung cancer?
Surgery
List the management options for non-small cell lung cancer.
- Surgery
- Radiotherapy (curative if early disease)
- Chemotherapy
- Targeted therapies
What is the management for small cell lung cancer?
Chemotherapy + radiotherapy
What is palliation in lung cancer management?
Endobronchial treatment with stents or debulking to relieve bronchial obstructions
