Lung cancer Flashcards
refer along 2 week suspected cancer pathway if:
- CXR finding suggest lung cancer
- aged over 40 with unexplained haemoptysis
offer urgent CXR within 2 weeks to assess for lung cancer in people aged 40 and over if they have 2 or more of the following unexplained symptoms or have ever smoked and have 1 of following
- cough
- fatigue
- SoB
- chest pain
- weight loss
- apetite loss
consider urgent CXR to assess for lung cancer in people aged 40 and over with any of the following
- persistent/recurrent chest infections
- finger clubbing
- supraclavicular lymphadenopathy
- chest signs consistent with lung cancer
- thrombocytosis
staging system for lung cancer
TNM
T - tumour
N - nodes
M - metastases
T1 tumour
less than 3 cm
T2 tumour
3-7 cm
or
involves main bronchus > 2cm from trache
T3 tumour
> 7 cm OR invades chest wall OR separate nodule same lobe
T4 tumour
invades local structures e.g. mediastinum, heart, trachea
inoperable
Nodal staging
N0 - no nodes
N1 - local ipsilateral node
N2 - ipsilateral mediastinal nodes
N3 - contralateral mediastinal nodes
brain metastases and lung cancer
1/3 those with lung cancers are thought to develop brain metastases
investigation of choice for Brain metastases
contrast enhanced brain MRI
management of brain mets w/ oedema
Dexamethasone 8mg BD PO
what should be checked prior to starting steroids
blood glucose
because steroids can exacerbate diabetes
what is the 1 year survival or patients diagnosed with lung cancer in the UK
30%
symptoms of SVC obstruction and how can they be relived instantly?
- dilated veins on upper chest
- red suffused eyes
- SoB: worse on lying down
- swelling of an arm
SVC stent
which lung cancer is more chemosensitive
small cell lung cancer
possible curative treatments for small cell lung cancers (4)
- chemotherapy followed by radiotherapy
- radiotherapy alone
- surgery alone
- surgery followed by radiotherapy
red flags for lung cancer (5)
- dry/productive cough
- haemoptysis
- hoarse voice
- chest pain
- constitutional symptoms: apetite/weight loss, fatigue
what are paraneoplastic syndromes
rare disorders caused by an immune response to cancer
3 paraneoplastic syndromes linked to small cell lung cancer
SiADH
ACTH
Lambert Eaton syndrome
what is SiADH + the management
ADH caused excessive retention causing hyponatraemia
manage: fluid restriction, vasopressin, demeclocycline
vasopressin
ADH receptor antagonist
effect of ACTH
bilateral adrenal hyperplasia –> high levels of cortisol –> hypokalaemic alkalosis
- muscle weakness
- hypertension
- hypokalaemia
- alkalosis
what is Lambert eaton syndrome
when an antibody is directed against pre synaptic voltage gated calcium channels in the peripheral nervous system resulting in repeated muscle contractions, limb girdle weakness, hyporeflexia and autonomic symptoms
