Lung Cancer Flashcards
Percentage of types of lung tumours
87% non small cell
12-15% small cell
<1% neuroendocrine and mesothelioma
Presentation specific to non small cell tumours
Pancoast = horners syndrome - meiosis, anhydrosis, partial ptosis
Hypercalcaemia
Presentation specific to small cell tumours
SVCO
SIADH - dilutional hyponatraemia
Paraneoplastic syndrome (up to 50%)
Symptoms from mets e.g bone pain
General symptoms of lung cancer
Cough Haemoptysis (likely central tumour as invaded mediastinal BVs) Dyspnoea Chest pain Weight loss Anorexia
General signs of lung cancer
Anaemia Clubbing Cachexia Lymphadenopathy Chest signs e.g dull on percussion (effusion or consolidation) SVCO Horners syndrome
Signs of SVCO
Facial and neck oedema
Facial redness
Dilated chest veins
Dyspnoea
Blood tests for lung cancer
FBC U&Es LFTs Bone profile CRP Tumour markers
Who is referred via 2 week wait
40 or over with unexplained haemoptysis
CXR suggestive of lung cancer
Age criteria for urgent CXR
40 or over
Symptoms on their own which meet criteria for urgent CXR
Persistent or recurrent chest infection Persistent supraclavicular or cervical lymphadenopathy Clubbing Chest signs of lung cancer Thrombocytosis
Symptoms which you need 2 of or smoker with 1 to meet criteria for urgent CXR
Cough Fatigue SOB Chest pain Anorexia Weight loss
When can surgery be a treatment for SCLC
Tumour 5cm or less
Treatment for SCLC if not suitable for surgery
Consider cranial radiotherapy for prophylaxis of brain metastasis
Chemotherapy +/- thoracic radiotherapy
Treatment for SCLC relapse
Second line chemotherapy (no 3rd line!)
Or
Palliative supportive care
Criteria for prophylactic cranial radiotherapy in SCLC
Limited disease AND complete/good partial response to primary treatment
Criteria for thoracic radiotherapy in SCLC
Limited disease:
Alongside cycle of chemo OR after chemo if good partial response within thorax
Extensive disease:
After chemo if complete response at distant sites and good partial response within thorax
Prognosis of SCLC limited vs extensive disease
Limited: 18-30 months
Extensive: 7-12 months
How to stage NSCLC
TNM staging to convert into stage 1-4
Describe stage 1A NSCLC
Tumour 3cm or less
No spread to LN
Describe stage 1B NSCLC
Tumour 3-5cm
No spread to LN
Describe stage 2 NSCLC
Tumour up to 7cm
+/- spread to peribronchial or hilar LN
Describe stage 3A NSCLC
Tumour extends into surrounding tissue
Spread to ipsilateral LNs
Describe stage 3B NSCLC
Spread to contralateral LNs
Or
Subcarinal or mediastinal LN spread with >1 tumour
Describe stage 4 NSCLC
Metastatic spread i.e palliative
