Lung Cancer Flashcards
What type of lung cancer do the non-metastatic manifestations of malignant disease usually occur in?
Small cell lung cancer
What are the non-metastatic manifestations of malignant disease?
- Hypertrophic arthropathy
- Eaton Lambert Syndrome and Myasthenia gravis - autoantibodies that affect muscle synapses
- SIADH
- Hypertrophic osteoarthropathy
- Ectopic adrenocorticotrophic hormone secretion
- Hypercalcaemia due to secretion of parathyroid hormone-
related peptides
What is SIADH?
An endogenous source of ADH (either cerebral or tumour-derived) promotes water retention by the kidney in the absence of an appropriate physiological stimulus. The clinical diagnosis requires the patient to be euvolaemic, with no evidence of cardiac, renal or hepatic disease potentially associated with hyponatraemia.
What is hypertrophic osteoarthropathy?
This is a painful periostitis of the distal tibia, fibula, radius and ulna, with local tenderness and sometimes pitting oedema over the anterior shin. X-rays reveal subperiosteal new bone formation. While most frequently associated with bronchial carcinoma, HPOA can occur with other tumours
What are important causes of lung cancer?
Tobacco smoke, ionising radiation, asbestos
What are the types of lung cancer?
Lung - primary/secondary
Pleura - Mesothelioma
Other cell types e.g. sarcoma, lymphoma
What are the types of primary lung cancer?
Small cell (24%) Non-small cell (76%) - squamous, adenocarcinoma, large cell
What are the symptoms of lung cancer?
Cough, haemoptysis, chest pain, breathlessness, stridor, hoarse voice (damage to recurrent laryngeal nerve), weight loss, facial swelling, Intercostal nerve involvement causes pain in the distribution of a thoracic dermatome.
What are the signs of lung cancer?
Weight loss, finger clubbing, lymphadenopathy, chest asymmetry, focal chest signs (consolidation, fluid), hepatomegaly, neuropathy, bronchial obstruction (collapse of a lobe or lung, with breathlessness, mediastinal displacement and dullness to percussion with reduced breath sounds)
What are the associated conditions?
Pancoast tumour - filled in supraclavicular fossa from apical tumour and grows into brachial plexus.
Horner’s syndrome – sympathetic nervous supply to the eye comes out at T1. Causes ptosis, dilation of pupil, dry skin and sunken eye.
Superior vena cava obstruction - facial/hand swelling which is worst in mornings and headaches
Brain mets –> stroke
Liver mets –> Jaundice
cutaneous mets
How is lung cancer investigated?
- CXR/CT scan
- Bloods (FBC, LFTs, Calcium)
- Bronchoscopy + endobronchial ultrasound (EBUS)
- Percutaneous needle biopsy
- Node biopsy
- Mediastinoscopy
- thoracotomy
How is lung cancer staged?
CT scan
FDG-PET scan
(Tumour, node, metastasis) TNM staging
What is a FDG-PET scan?
Patient is injected with radiolabelled fluorodeoxyglucose and scanned to see which cells take up FDG. Picks up areas of cancer and infection.
How is small cell cancer managed?
Chemotherapy, Palliation
How is non-small cell cancer managed?
Surgery, radical radiotherapy, palliation
What is EGFR?
Epidermal growth factor receptor (EGFR) is a protein found in abnormally high levels on the surface of many types of cancer cells, particularly non-small cell lung cancer (NSCLC) cells and adenocarcinoma.
What is the treatment for EGFR positive patients?
Gefitinib
What are the signs and symptoms of hypercalcaemia?
o Anxiety o Depression o Cognitive changes o Lethargy o Coma o Muscle weakness o Cramping o N&V o Anaemia o Arrhythmia
What type of lung cancer sometimes releases Parathyroid related protein
Squamous cell carcinoma
How is hypercalcaemia managed?
Furosemide + Fluid, treat underlying causes, Bisphosphonates ± calcitonin
What does asbestos exposure increase risk of?
mesothelioma
What is asbestosis?
Chronic lung condition associated with lung fibrosis that follows chronic exposure to asbestos. There is extensive thickening and plaque formation in the pleura.
What is the commonest type of bronchial carcinoma?
Squamous cell carcinoma
What are the signs of SVC obstruction?
suffusion and swelling of the neck and face, conjunctival oedema, headache and dilated veins on the chest wall,
How are the upper mediastinal lymph nodes biopsied?
EBUS or mediastinoscopy
How are lower mediastinal lymph nodes biopsied?
through the oesophageal wall using endoscopic ultrasound.
A 54-year-old man is investigated for a chronic cough. A chest x-ray arranged by his GP shows a suspicious lesion in the right lung. He has no past history of note and is a life-long non-smoker. An urgent bronchoscopy is arranged which is normal. What is the most likely diagnosis?
Lung Adenocarcinoma (Non-smoker, peripheral lesion)
What are the clinical features of squamous cell carcinoma?
- typically central
- associated with parathyroid hormone-related protein (PTHrP) secretion → hypercalcaemia
- strongly associated with finger clubbing
- hypertrophic pulmonary osteoarthropathy (HPOA)
