Lung Cancer Flashcards
What percentage of lung cancer is incurable at time of diagnosis?
90%.
What can lung cancer present by (symptoms/signs)?
Haemoptysis (tumour blood supply chaotic and often breaks down), recurrent pneumonia (x-ray 6 weeks after pneumonia), stridor, shortness of breath (due to tumour taking up alveolar space or blocking airway).
Where can a lung cancer locally invade?
Recurrent laryngeal nerve (gives hoarse voice), pericardium (breathless, atrial fibrillation, pericardial infusion), oesophagus (dysphagia [cant swallow]), pancoast tumour invades branchial plexus (causes muscle wasting and heavy weak arm), pleural effusion, superior vena cava obstruction (veins pop out and dilate, treated with stent), chest wall (causes pain [mix between pleuritic and MSK] and lump), encasing left pulmonary artery (sometimes tumour erodes into artery and major bronchus, causing sudden death due to massive haemoptysis).
Where are the most common sites for metastases in bronchial carcinoma?
Liver, brain, bone, adrenal, skin and other parts of lung.
What kind of onset of cerebral metastases, what are some of the symptoms or cerebral metastases and how long does it take to develop?
Insidious onset. Weakness, visual disturbance, headaches that are worse when intra-cranial pressure is greater [worse in the morning, not photophobic], fits). Some weeks.
When do liver metastases cause symptoms and what sort of pain do they cause and where?
When they are quite large, stretching pain, in right upper quadrant.
What can bone metastases cause symptoms wise and where are they really bad to occur?
Pain. In spine as they can damage the spinal cord.
Is it understood why lung cancer metastases are common in the adrenal gland and what symptoms or functional changes do they cause?
No, and none.
What paraneoplastic (non-metastatic) changes can lung cancer cause?
Finger clubbing, hypertrophic pulmonary osteoarthropathy - HPOA (relatively rare, expansion of periosteum on long bones, causes pain and finger clubbing).
What is thrombophlebitis?
Inflammation of a vein where there is a blood clot at the site of inflammation. Common manifestation of many cancers and is not confined to lung cancer.
What other than cancer is weight loss a symptom of?
Advanced COPD.
What ‘ones’ does hypercalcaemia cause?
Stones (renal/biliary calculi), bones (bone pain), groans (abdominal pain, constipation, N+V), thrones (polyuria [needs to pee a lot]), psychiatric overtones (depression, anxiety, reduced GCS [glasgow coma scale], coma).
How does lung cancer cause hypercalcaemia and what can hypercalcaemia do to the heart?
Due to hormone release from the tumour. Can cause cardiac arrhythmias.
What are the treatments for hypercalcaemia?
Initial treatment is rehydration. If very high calcium or does not correct with fluid then IV biphosphate. Treat underlying cancer - usually squamous cell.
What does SIADH stand for and what type of lung cancer usually causes it?
Symptom of inappropriate antidiuretic hormone. Small cell.
What does SIADH result in and what are the symptoms?
Low sodium concentration. Generalised non-specific symptoms (nausea/vomiting, myoclonus [shock-like contractions of part of a muscle], lethargy/confusion, seizures/comas)
What is the treatment for SIADH?
Treat underlying cause, fluid restriction - 1.5L/day, sometimes need demeclocycline.
What should you ask about when you’re taking a history for lung cancer?
Cough, haemoptysis, cigarette smoker (uncommon to have lung cancer without having smoked), breathless, weight loss, chest wall pain, tiredness, recurrent infection, other smoking related disease, “is there anything you are worried about?”
What are you looking for in an examination that could show lung cancer?
Finger clubbing, breathless, cough, weight loss, bloated face, hoarse voice, lymphadenopathy, tracheal deviation, dull percussion, stridor, enlarged liver.
What investigations should you order when looking for lung cancer?
Full blood count, coagulation screens, Na K C Alk phosphates, spirometry and FEV1, CXR, CT scan or thorax PET scan, bronchoscopy, endobronchial ultrasound, NOT sputum cytology (bronchoscopy is done regardless of result).
How does positron emission tomography (PET) work?
Scan assesses function rather than structure, analysis of tissue uptake of radiolabelled glucose, tissues with high metabolic activity light up.
What techniques can we use to get a sample of tissue?
Bronchoscopy, CT guided biopsy, lymph node aspirate, pleural fluid aspirate, endobronchial ultrasound (bronchoscope with ultrasound tip to target and sample lymph nodes), thoracoscopy (looks into pleural space).
What are the other possible differential diagnoses for people with lung cancer?
TB, vasculitis, PE, secondary cancer, lymphoma, bronchiectasis.
What in tobacco smoke causes lung cancer?
Polycyclic hydrocarbons, aromatic amines, phenols, nickel, cyanates.
What other cancers can smoking cause?
Laryngeal, cervical, bladder, mouth, oesophagus, colon.
What other risk factors are there for lung cancer?
Asbestos, nickel, chromates, radiation, atmospheric pollution, genetics.
What ectopic hormones (hormones not native to organ in which they arise) can lung cancers produce?
Squamous cancer: parathyroid hormone (PTH). Small cell: adrenocorticotropic hormone (ACTH).
What types of lung cancer are there (from highest to lowest prevalence)?
Adenocarcinoma, squamous carcinoma, small cell carcinoma, large cell carcinoma.
A quarter of people who get what type of lung cancer are non-smokers?
Adenocarcinoma.
Give the histological characteristics of each type of lung cancer.
Squamous: defined by keratin formation. Adenocarcinoma: gland-forming epithelium, mucus also produced. Small cells: lots of tightly packed undifferentiated cells with not much cytoplasm. Large cell: very large undifferentiated cells.
