Lung Cancer Flashcards
Cancer Features
malignant growth uncontrolled replication local invasion metastasis - secondary cancer =lymphatic spread =blood stream =serous cavities non-metastatic systemic effects
Lung cancer presentation
primary tumour local invasion metastases non-metastatic (paraneoplastic)
detect cancer early
cough 3 weeks or more breathless no reason chest infection = doesn't clear up haemoptysis chest or shoulder pains unexplained tiredness/ lack of energy hoarse voice
haemoptysis
fresh haemorrhage from tumour –> ulcerating through surface
direct consequence of primary tumour
is the smaller or larger lung normally the diseased one?
smaller
stridor
distressing symptom
difficulty breathing in
accompanied = coarse audible wheeze during inspiration
short of breath
tumour blocking carina
local invasion
recurrent laryngeal nerve pericardium oesophagus brachial plexus pleural cavity superior vena cava
hoarse voice
contact with vocal cord/ pharynx
local invasion pericardium
breathless
atrial fibrillation
pericardial effusion
local invasion oesophagus
dysphagia
pancoast tumour can cause
brachial plexus invasion
pleural effusion
large volume of pleural fluid accumulates
local invasion of superior vena cave =
obstructs drainage of blood from arm + head
puffy eye lids + headache
local invasion of superior vena cava symptoms palliated
insertion of a stent to open occluded vein
must be done before vein = permanently occluded by thrombosis
chest wall invasion by lung cancer
localised chest wall pain
worse with movement
bone erosion
pain = worse at night
result of tumour eroding artery + into major bronchus =
sudden death due to massive haemoptysis
common sites for metastases
liver brain bone adrenal skin lung
cerebral metastases
insidious onset weakness visual disturbance headaches -worse in morning -not photophobic fits
short term cerebal metastases treatment
high dose corticosteroid therapy
e.g. dexamethasone = improve short term symptoms by removing oedema
high dose corticosteroid therapy disadvantage
benefit = shortlived
liver metasases
liver function tests = usually abnormal (particularly Alkaline phosphatase)
bone metastases
localised pain worse at night
pathological fracture - bone fracture = follows mechanical stress
non-metastatic: paaneoplastic
finger clubbing hypertrophic pulmonary osteoarthropathy - HPOA weight loss thrombophlebitis hypercalcaemia hyponatraemia - SIADH weakness - eaton lambert syndrome
new finger clubbing
chest X ray = . must
diseases causing finger clubbing
lung cancer liver disease, especially chronic hepatitis C congenital cyanotic heart disease bacterial endocarditis bronchiectasis
thrombophelbitis
an inflammatory process that causes a blood clot to form and block one or more veins, usually in your legs
hypercalcaemia
stones (renal/biliary calculi)
bones (bone pain)
groans (abdominal pain, constipation, N +V)
thrones (polyuria)
psychiatric overtones (depression, anxiety, reduced GCS, coma)
cardiac arrhythmias
hypercalcaemia treatment
initial = rehydration
calcium = very high on admission (>4)/ not correct with fluid —–> IV bisphosphonate
treat underlying cancer = usually squamous
SIADH
syndrome of inappropriate antidiuretic hormone
small cell complex low Na concn non specific symptoms -nausea -myoclonus -lethargy/confusion -seizures/coma
SIADH Treatment
treat underlying cause
fluid restriction - 1.5L/day
sometimes = demecloycline
lung cancer history
cough haemoptysis cigarette smoker breathless weight loss chest wall pain tiredness recurrent infection other smoking related disease anything else = worried about
chronic bronchitis
clear sputum every morning
lung cancer cough
distortion of normal bronchial mucosa by tumour
cannot get sputum out
breathlessness in lung cancer
obstruction of major branch of bronchial tree by tumour
causes of SOB
pleural effusion
pulmonary emboli
pericardial invasion
lung cancer examination
finger clubbing breathless cough weight loss bloated face hoarse voice lymphadenopathy tracheal deviation dull percussion stridor enlarged liver
lung cancer investigations
full blood count coagulation screen Na, K, Ca, Alk Phos spirometry FEV1 chest X ray CT scan of thorax PET scan bronchoscopy endobronchial ultrasound NOT sputum cytology
positron emission tomography
scan = assess function not structure
tissue uptake of radiolabelled glucose
tissues = high metabolic activity = light up
lung cancer tissue diagnosis
bronchoscopy CT guided biopsy lymph node aspirate aspiration of pleural fluid endobronchial ultrasound thoracoscopy
lung cancer differential diagnosis
clinical picture
- smoker
- haemoptysis
- abnormal chest X-ray
differential diagnosis possible causes
lung cancer Tb vasculitis pulmonary embolism secondary cancer lymphoma bronchiectasis
