Lung cancer Flashcards
5yr survival
7% still alive 5 years after diagnosis
more people are diagnosed every year than there are people with lung cancer due to the high number of patients that don’t survive 12 months
invasion
hoarse voice suggest involvement of the recurrent laryngeal nerve.
this means that the patient is now inoperable
T1 nerve
pancoast tumours will lead to pain in the T1 dermatome - in the forearm
T1 is the level if the thoracic vertebra at which the sympathetic nerve leaves the spinal cord, which can lead to horner’s syndrome
horner’s
T1 is a favoured site of mets in NSCLC
pancoast tumours can also grow upwards
pleural effusion
investigation of drained fluid
ie cytology
breast cancer can cause pleural effusion
skin lesions
indicate stage IV disease
investigations
sputum cytology
bronchoscopy
transthoracic needle biopsy
try and use investigations that also allow for a biopsy
squamous cell cancer
much more commonly associated with finger clubbing
more likely in smokers vs non smokers
small cell
neuroendocrine tumour
very short doubling time
image the upper abdomen due to metastasis to liver and adrenal glands
mesothelioma
arises from the pleura
possibly involving mediastinal structures or the heart
NSCLC
other considerations eg pulmonary function tests, MRI etc to determine how far the cancer has spread, and whether surgical excision will be effective
LDH
intracellular enzyme
released after necrosis of cells, haemolysis of RBCs
high LDH indicates cell death
suggest empyema rather than simple effusion
acts as cardiac enzyme if cell death is around heart
elevated in SCLC
indicative if large tumour bulk, and at risk of tumour lysis syndrome
if raised in NSC:C indicates the tumour is growing rapidly and has a worse prognosis
adenocarcinoma
much more common than squamous cell cancer in non smokers
complications
SVC obstruction - JVP waveform absent
pleural effusion - inflammatory process after involvement of the pleura.
exudate - inflammation
transudate - (organ) failure
distant mets - brain, liver, bone
non-metastatic effects:
hypercalcaemia
cushing syndrome
SIADH
SVC obstruction
blocks drainage back to right atrium
demarcated below the nipple line
needs stenting, or treatment of the underlying cause
Sx: most common: dyspnoea facial swelling less common: head fullness cough arm swelling chest pain
CXR:
widening if mediastinum
pleural effusion
may be normal (16%)
melanoma
heavily haemorrhagic brain mets
brain mets
50% are due to lung cancer
present:
headaches
seizures (most common)
Tx:
supportive - steroids, anticonvulsants (valproate)
surgery -solitary vs multiple sites
radiotherapy
chemo - doesn’t cross BBB unless it is disrupted by mets. more of a role in germ cell and small cell tumours
patients with minimal involvement outside of the bran have much better outcomes
resection of brain tumour much more effective than just biopsy
hypercalcaemia
can have insidious presentation
PTH-rP is way stringer than PTH
more associated with squamous cell lung cancer
Tx is to rehydrate the patient with IV saline - dehydration will kill the patient first
follow with a bisphosphonate
therefore IV saline is the most appropriate initial intervention
ectopic ACTH
50% due to SCLC
leads to cushing’s syndrome
7% of SCLC patients will have ectopic ACTH production
SIAD
most common endocrine paraneoplastic syndrome
SCLC
many chemotherapy drugs cause it
fluid restrict patient, then assess serum/plasma osmolarity as well as urine
need to have:
hyponatraemia
normal albumin/glucose
serum hypo-osmolality
gynaecomastia
gonadotrophins can be released from SCLCs, or lung mets after a gonadal primary
b-hCG will be raised
can lead to thyrotoxicosis - b-hCG increased thyroxine production
lambert-eaton myasthenic syndrome
non-metastatic manifestation of SCLC (60-70%)
often confused for myasthenia gravis
ABx in chemo patients
a small delay can massively increase mortality
eg if no ABx after 48h mortality is 80%
