Lung cancer Flashcards
What are some of the presentations and signs that would require urgent referral for query lung cancer?
Unexplained haemoptysis Persistent/recurrent chest infections Finger clubbing supraclavicular/cervical lymphadonopathy thrombocytosis (increased platelets) Two of: -SOB -cough -weight loss -smoker -asbestos -chest pain -fatigue
What type of cancer are almost all primary lung tumours?
Bronchial carcinomas
What are the two main types of lung cancer, what are the main differences?
Small cell (oat cell) - Derived from APUD endocrine cells, causes a poorly differentiated, highly malignant tumour Non-small cell - a group of cancers that are less aggressive and have later metastases
What are the types of non small cell cancers?
Squamous cell carcinoma Adenocarcinoma Large cell carcinoma Carcinoid tumours Bronchoalveolar cell tumours
What is the difference between adenoma and adenocarcinoma?
Adenoma is the benign type and adenocarcinoma is the malignant counterpart
What are the main differences between squamous cell carcinoma and adenocarcinoma?
Squamous cell carcinoma tend to be more central and obstructive and commonly have local spread. They show keratin formation.
Adenocarcinomas tend to be more peripheral, common in non-smokers and invade the pleura and mediastinal nodes.
What are the TNM stages for non small cell lung cancer?
T1 - less than 3cm, confined to the lung and not involving the main bronchus
T2 - >3cm but <7cm, involves the pleura, in main bronchus >2cm from carina, causes collapse or obstructive pneumonitis extending to the hilum
T3 - >7cm, invading larger areas, in main bronchus <2cm from carina, collapse or obstructive pneumonitis in whole lung, seperate nodules in same lung lobe
T4 - invades mediastinum, heart, great vessels etc, has seperate nodules within different lobes of same lung
N1 is involvement of nodes within or close to the affected lung, N2 is involvement of mediastinal or subcarinal nodes, and N3 is more distant spread
What are the common sites of spread of lung cancer?
Brain, bone, liver, contralateral lung, adrenal glands and kidney
What hormones are commonly secreted by small cell lung tumours and what symptoms do these cause?
PTHrp and ADH are commonly secreted. This causes patients to often have pathological fractures due to weakened bones, it causes hypercalcaemia. The ADH causes hyponatraemia ausing nausea and cramps.
How is small cell lung cancer staged?
Limited-stage disease - limited to one hemithorax and ipsilateral lymph nodes
Extensive-stage disease - contralateral lung and distant metastases
What is the most common form of pleural malignancy and what causes?
Mesothelioma and it can be caused by asbestos exposure
What are some signs you may see on examination of a patient with lung cancer?
Clubbing, horners syndrome, cervical or supraclavicular lymphadenopathy, signs of SVC obstruction (dilated chest veins, rubour of the face, arm swelling)
What scans are typically done following a CXR indicative of malignancy?
CT thorax with IV contrast will give a detailed view of the lung fields
Pet scanning can be used in staging the disease
What is typical treatment of lung cancer?
Typically lobectomy
What are the chemotherapy agents used in SCLC and NSCLC?
In non small cell platinum agents are commonly used combined with gemcitabine
In small cell cisplatin or carboplatin is recommended
