Lung Cancer Flashcards
What are the common risk factors for lung cancer?
Family History Smoking - active and passive Asbestos Chemical Agents - radon, nickel, chromate Chest radiotherapy
What are the different types of primary lung cancers?
Small Cell (15%)
Non Small Cell
- Squamous Cell (40%)
- Large Cell (10%)
- Adenocarcinoma (40%)
- Alveolar cell carcinoma
From what cells do Small Cell Lung Cancers originate?
Kulchitsky cells
What is the characteristic growth pattern of SCLC?
Centrally located
Rapid growing
Highly Malignant
How does squamous cell lung cancer commonly present?
Bronchial obstruction leading to recurrent infections
Finger clubbing
What can be seen on CXR with Squamous cell lung cancer?
Cavitations so a CT is needed to rule out TB
What paraneoplastic syndromes are associated with squamous cell lung cancer?
PTHrP = hypercalcaemia
Ectopic TSH = hyperthyroid
Hypertrophic osteoarthropathy
Which type of lung cancer is most common in non-smokers?
Adenocarcinomas
Why do adenocarcinoma’s tend to present with fewer symptoms?
They are more likely to be located in the peripheries
What is the growth pattern of lung adenocarcinomas
Peripherally located
Less differentiated
Metastasise early
Have a poor prognosis
What is a pancoast tumour? What does it present with/ what structures becomes involved?
An apical lung tumour (commonly squamous)
Horners Syndrome (sympathetic ganglion) Arm and hand pain (Brachial Plexus) Hoarse voice (Recurrently Laryngeal Nerve)
What signs does horners syndrome present with?
anhidrosis
miosis
ptosis
What is the pathophysiology behind horners syndrome?
Sympathetic ganglion are affected leading to decreased sympathetic input.
How can lung cancer present?
- symptoms
- examination
- bloods
Cough Dyspnoea Haemoptysis Chest Pain Recurrent chest infections Weight loss and reduced appetite
Clubbing
Pleural effusion
Fixed monophonic wheeze
Supraclavicular/ cervical lympadenopathy
Thrombocytosis
What are signs/symptoms of Superior Vena Cava Obstruction?
Early morning headache
Arm and Face Oedema
Jugular distention
What paraneoplastic syndromes can small cell lung cancer cause?
ACTH = HTN and high glucose (as opposed to classic cushingoid appearance)
ACTH = increased cortisol = hypokalaemic alkalosis
SIADH = hyponatraemia
Lambert Eaton Myasthenic Syndrome - proximal muscle weakness
What paraneoplastic syndromes are associated with adenocarcinomas?
Gynaecomastia
Hypertrophic osteoarthropathy (painful and stiff wrist and ankle)
What are the indications for an urgent CXR referral from GP for lung cancer?
When would you refer straight to 2ww?
> 40 yo and 2 suspicious symptoms
> 40yo + 1 suspicious symptom + smoker
2ww if >40 with unexplained haemoptysis
What investigations are used for diagnosing lung cancer?
Chest X-Ray - initial
CT - gold standard for ?lung cancer
Bronchoscopy - histological diagnosis
Transthoracic needle biopsy
PET-CT Scan - before treatment if potentially curable
Mediastinoscopy - assessment of mediastinal lymph nodes
What do you look for on CXR for lung cancer?
Opacities (or can be cavitating if squamous cell)
Hilar Enlargement
Pleural Effusion
Lung Collapse
Describe the staging system used for Non Small Cell Lung Cancers
TNM Staging 1 = single tumour <3cm 2 = ipsilateral lymph nodes 3 = contralateral lymph nodes or invasion of organs, nerves 4 = Metastatic spread
What is the mainstay of treatment for stage 1+2 lung cancers?
Surgical Resection with Hilar and Mediastinal Lymph Node sampling
What are the complications of a lobectomy?
Respiratory failure
Air leakage
AF
Broncho-pleural fistula
On examination, what would indicate someone had had a lobectomy?
Thoracotomy scar
Absent breath sounds
Reduced chest expansion
Dull to percuss
What is the mainstay of treatment for advanced NSCLC?
Chemo-radiotherapy as most are inoperable
What additional treatment is needed in lung cancer treatment?
Cranial radiation due to risk of brain metastasis
What defines whether a SCLC is limited or extensive?
Tumour in 1 hemithorax and regional lymph nodes. The area can be covered by a tolerable radiotherapy field.
Beyond this it is considered extensive
What is the mainstay of small cell lung cancer treatment?
chemo-radiotherapy
surgery can be used in very early stages with no nodal involvement
What paraneoplastic syndrome is associated with large cell lung cancers?
B-HCG
What specific symptom would suggest alveolar cell carcinoma?
+++ sputum
What are the contraindications to surgical management of lung cancer?
Peak flow <1.5L Pleural effusion Tumour located near the hilum Metastasis (i.e. late stage 3 or stage 4) SVCO Vocal cord paralysis
