Lung cancer Flashcards
Types of lung cancer
- Small cell
2. Non small-cell (adenocarcinoma, squamous cell carcinoma, large-cell carcinoma)
Features of small-cell lung cancer (SCC)
- Percentage of lung cancers accounted for
- Cells of origin
- Cellular morphology
- Location of tumours
- Categorisation
- Sensitivity to chemotherapy
- Other sites of small-cell cancers
- Major risk factor
- 20%
- Neuroendocrine
- Small with large nuclei
- Central and nodal tumours
- Limited (chest) and extensive (incurable)
- Exquisitely sensitive (but high recurrence rate)
- Ileum and appendix
- Smoking is most strongly associated with small-cell
Features of adenocarcinoma
- Percentage of lung cancers accounted for
- Location of tumours
- Population affected
- 40%
- Peripheral lung
- Non-smokers
Features of squamous cell carcinoma (SCLC)
- Percentage of lung cancers accounted for
- Location of tumours
- 30%
2. Large airways
Risk factors for lung cancer
- Smoking/marijuana/second-hand smoke
- Genetics (8%)
- Environment (radon gas, asbestos, pollution, radiation)
Symptoms of lung cancer (7)
10% asymptomatic at diagnosis.
- Cough, haemoptysis (obstruction, obstructive pneumonia)
- Wheeze, stridor (obstruction)
- Dyspnoea (obstruction, phrenic n. impingement, pleural effusion)
- Chest pain (invasion of chest wall or rib)
- Hoarse voice (left recurrent laryngeal n. impingement)
- Fever, fatigue, weight loss
- Ulnar neuropathy/Horner’s syndrome (Pancoast tumour compressing T1 nerve root and sympathetics)
Signs of lung cancer (3)
May be none.
- Pemberton’s sign (SVC obstruction)
- Clubbing + HPO
- Other paraneoplastic features: hyponatraemia, Cushings, Lambert-Eaton myasthenic syndrome, hypercalcaemia
Possible signs of lung cancer on CXR (5)
- Mass
- Widening of mediastinum
- Atelectasis
- Consolidation
- Pleural effusion
Classification of non-small-cell lung cancers
TNM staging
1. Confined to lung
2. Confined to lung and N1 nodes (lobar, interlobar, hilar)
3. Confined to lung and N2 nodes (mediastinal)
A: ipsilateral
B: contralateral
4. Spread beyond N2 nodes
Treatment of lung cancer according to TNM staging
Stage 1-2 = surgery to cure
Stage 3a = surgery with chemo to cure
Stage 3b = chemo to cure
Stage 4 = palliative
Common sites of metastasis (7)
- Intrapulmonary
- Adrenal glands
- Brain
- Liver
- Bone
- Pericardium
- Kidneys
3 cancers that most often metastasise to bone
Prostate, renal and lung