Lung Cancer Flashcards
Whats the pathogenesis of LC?
Arises from bronchial epethilial mucosa + can also come from lung parenchyma.
Histological divisions: SCLCs or NSCLCs
Current or prev smokers:90% of cases.
Risk: dose dependent +’tar cntnt.
What are the 3 types of NSCLcs?
78%
Squamous cell,32% (⬆️ Ca2+ secretions)
Large cell + NOS (not otherwise specified)-35%
Adenocarcinoma 26%
RF of LC?
Smoking, passive Asbestos, nickel, chromium Arsenic IPF Radon
CF of LC?
Haemoptysis, wt loss, poor ️apetite, imcreasing breathlessness and cough esp > 50 .
May: diffuse chest pain caused by mediastinal displacement
Localalised pain: pleural or bony metastaisis.
Metastatic disease
Bone pain
Epilepsy or focal neurological signs- brain metastasis
Non metastatic manifestations
Finger clubbing
Malaise, lethargy and wt loss
O/E chest-
Lymphadenopathy, pleural effusion,
Lobar collapse,
Unresolved pneumonia.
What countries have high LC incidence?
Developing, where they smoke…….
LCancer is the most common cause of cancer death in the UK.
Low socioeconomic status: poor survival.
Why do lung cancer patients die early?
There is a late onset presentation. When it already has metastised.
4deaths per hour. 114 new cases every day.
Pain : late stage- when might reach viscera lets say.
In 1 year 1/3 survive.
Women respond to tx better.
3rd cancer death : after breast (85%), colorectal (55%) and lung (5%) 5Y survival.
What happens in SCLC?
12%
Grows rapidly
Very closely linked to cigarettes smoking
How do you stage NSCLC?
Stage1- small 7cm, involves lymph nodes or other parts of chest or lung.
Stage 4 - spread to both lungs, other parts of the body or within a pleural effusion.
How is SCLC staged?
Limited- within one lung field
Extensive- outside one lung field
Whats an MDT for lung cancer?
Radiologist Pallative Medical oncologist Respiratoty oncologist Surgeon
How would you treat NSCLC?
Surgery for stage 1+2
How is small cell lung cancer treated?
Surgery- very selected cases- cant usually tx w/ surgery
CT head - prophylactic
Radiotherapy
-Radical for limited stage - combined with chemo
- Pallative prophylactic for extensive stage
Chemo ❗️
-radical for limited stage w/ radiotherapy
-pallative for extensive stage
How do you go about -lung cancer tx- surgery?
NSCLC
PET-CT- pre-op
- metastised? Where, how extensive, reoccurrence in other lymph nodes
Specialist lung cancer surgeons
Video assisted thoracic surgery- VATS lobectomy
Adjuvant chemo
SCLC
- only if very localised- surgery.
Otherwise not usually.
How is a PET scan used?
Cells that divide rapidly and consume ⬆️⬆️ glucose
BUT-
In inflammation and infx - highly metabolic cells- metabolically active.
So low sensitivity for
Infx
Infl
Malignancy
Whatbare the advantages of VATS lobectomy?
Its like key-hole surgery-
3 probes in- faster recovery
⬇️ post op pain
In what age do you have to stop smoking to only have a small chance of death?
When is SCLC usually presented?
Higher incidence in winter and spring due to ⬆️ prevalences of pneumonia s well.
So do CXR to see.
What are the s+S of lung cancer?
Depends on location–> usually late finding
Only found on routine XR
Same sx might be caused by other conditions
1. Size
2. Location
3. Degree of obstruction
4. Existance of metastasis.
Pain- near pleura
Haemoptysis- bleeding
>3w + smoker chronic cough --> CXR 1. Localised- in lung, 2. Generalised- metastasised PE-- SOB Tirdness, fatigue, Fractures( bone m) Stroke (brain metasti) Stridor Repeated lung infx despite Antibiotics New onset hoarseness- Left Laryngeal nerve implicated - near bronchus Persistsent Hiccups- phrenic nerve implicated.
What are the localised S+S of LC?
Cough Breathing probs- stridor and SOB Change in phlegm Lung infx, haemoptysis Hoarsness, hiccups, Wt loss Chest pain and tightness Pancoats syndrome. Horners syndrome Pleural effusion SVC syndrome Fatigue-- anaemia?
Whats Pancoast syndrome? What complications could this have? What other syndrome is associated?
/ pulm sulcus tumor/ superior sulcus tumor- pulm apex- most are NSCLC-nusually squamous cells
Brachial plexus involved- pt holds arm.
Severe pain in shoulder refiom radiating toward axilla and scapula and ulnar aspect of hand muscles
Atrophy of hand and arm muscles - compression of- phrenic nerve, recurrent laryngeal nerve, vagus nerve
Compression of the blood vessles (brachiocephalic vein, subclavian artery) leading to oedema.
- Caviating mass on CxR
- Paratracheal nodes?
- 2nd rib destruction?
- calcified nodes? Silicosis
Compression of the sympathetic ganglion –> Horners syndrome
(Ptosis e.g. Left upper eyelid drops, meiosis e.g left pupil constrictes, hemianhydrosis, enopthalmos.
Would also expect to observe abscence of sweating, dilation of blood vessles in face.
Extension of tumour in- parietal pleura, endothoracic fascia, 1+2nd ribs, or vertebral bodies.
Usually these pts receive tx for presumed cervical osteaoarthritis or shoulder brusitis, resulting in the delay of diagnosis of 5-10M.
Whats superior vena cava syndrome?
SVC obstrtuction.
Medical emergency
Lumg cancer particularly adenocarcinomas are a common underlying cause. 70%
40% of cases not attributable to malignancies tho.
CF
Dyspnoea most common
Facial swelling
Head fullness. Cough, arm swelling, chest pain, headache, nausea, pleural effusiom, nausea, nasal stuffness, disorted vision, orthopnoea, dysphagia.
What are some generalised S+S?
Bone pain,
Headaches, mental status changes, or neurological findings
Abdo pain, elevated liver FTs, enlatged liver, GI disturbances (anorexia, cachexia-wasting syndrome- loss of wt
Hypercalcaemia
Paraneoplastic syndrome.
Jaundice, hepatomegaly, r/t liver involvment
Wt loss.
Whats paraneoplastic syndrome?
- altered immune response to neoplasm. CF - They are defined as non,etastatic systemic effects accompyining malignant disease. Result of substances produced by tumour.
Sx may be endocrine, neuromascular, MSK, CVS, cutaneous, GI, hematologic, renal
What are some eaely signs of LC?
Cough/chronic cough Dyspnoea Hemoptysis Chest/shoulder pain Recurring temperature Recurring resp infx
