Lung cancer Flashcards
Referral guidelines for lung cancer: symptoms that require immediate referral
Immediate referral – SVCO, stridor
Referral guidelines for lung cancer: symptoms that require urgent referral
• Urgent referral: – CXR abnormality – Normal CXR but high suspicion – Persistent haemoptysis – History of asbestos exposure and SOB, chest pain
Referral guidelines for lung cancer: symptoms that require 2 week wait
• Refer for CXR
– Haemoptysis
– Persistent (>3wks)
• cough, chest or shoulder pain, weight loss, hoarseness, clubbing, LNA, chest signs, SOB, ?mets
– Chronic respiratory disease with unexplained deterioration
Risk factos for lung cancer
Cigarrete smoke • Uranium • Radon (granite) • Asbestos • Certain types of nickel exposure • Familial risk doubled in 1st degree relatives of lung cancer patients
NSCLC: Symptoms at diagnosis
Clubbing •Lymphadenopathy •Cachexia •SVCO •Hoarse voice
Investigations for lung cancer
- CXR:
- CXR detect >90% of 1-2cm nodules
- CT: chance of malignancy with size
- PET Scan:
- Reduces open shut thoracotomies from 41% to 20%
- Reduced 1 year post surgery mortality by 19% vs 10% • PPV less than NPV
What stage of lung cancer is operable?
Operability proven (stage T2N1)
Definitions of chemotherapy: Induction chemotherapy
A general term that includes neo-adjuvant chemotherapy and primary chemotherapy.
Definitions of chemotherapy: Adjuvantchemotherapy
Treatment given after potential curative surgery or radiotherapy, in an attempt to improve the cure rate.
Definitions of chemotherapy: Neo-adjuvant chemotherapy
Chemotherapy given before planned surgery or radiotherapy
Definitions of chemotherapy: Combined chemoradiotherapy
Treatment given to patients eligible for potential curative radiotherapy at
presentation and the treatments are either given sequentially or concurrently.
Definitions of chemotherapy: Primary chemotherapy
Chemotherapy given to patients who at the time of presentation are not considered suitable for curative surgery or radiotherapy because the tumour is too large or appears unresectable. Chemotherapy is given with the aim to down-stage the tumour to enable them to then proceed to treatment with curative intent. The response rates and survival are much lower in this setting.
What is the function of palliative chemotherapy?
- increases duration of survival
- reduces symptoms from the disease
- improves quality of life
- (the last two not necessarily synonymous)
What us Performance Status?
Performance status is an attempt to quantify cancer patients’ general well-being and activities of daily life.
0 – Asymptomatic (Fully active, able to carry on all pre disease activities without restriction)
1 – Symptomatic but completely ambulatory (Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature. For example, light housework, office work)
2 – Symptomatic, <50% in bed during the day (Ambulatory and capable of all self care but unable to carry out any work activities. Up and about more than 50% of waking hours)
3 – Symptomatic, >50% in bed, but not bedbound (Capable of only limited self-care, confined to bed or chair 50% or more of waking hours)
4 – Bedbound (Completely disabled. Cannot carry on any self- care. Totally confined to bed or chair)
5 - Dead
64 female Malaysian non-smoker • SOB-3 months
• Cough
• Examination
• Not clubbed, no LNA
• Diffuse bilateral crackles
• Previous treatment Gemcitabine Carboplatin achieved SD
• CXR and CT
What is the diagnosis?
- Bronchioalveolar carcinoma
- Type of adenocarcinoma
- Malignant transformation of type II pneumocytes
