Lung Cancer Flashcards
What are the two main categories of lung cancer?
Small Cell Lung Cancer
Non small Cell Lung Cancer
What is the most aggressive type of lung cancer?
Small Cell Lung Cancer is more aggressive, cells divide quickly and it is more prone to metastasise early
What are the different types of non-small cell lung cancer?
Adenocarcinoma (most common type of lung cancer)
Squamous cell carcinoma
Carcinoid tumour
Large cell tumours (haven’t differentiated to either of above)
What are some of the symptoms of lung cancer?
Haemoptysis Chronic cough Chest pain Breathlessness Fatigue Weight loss Recurrent lobar pneumonia (due to reduced ventilation distally)
Symptoms due to compression of other tumours:
Pancoast’s Tumour- Horner’s, Upper limb weakness, SVC obstruction
Hoarse voice- laryngeal nerve compression
Paraneoplastic symptoms (more common with SCLC)-
Cushings features
PTH release- hyperparathyroid features
Lambert eaton myasthenic syndrome
What are some differentials for haemoptysis?
Lung malignancy Tuberculosis Pulmonary infarct Pulmonary oedema (pink frothy sputum) Bleeding from elsewhere- e.g. pharynx
Why could an apical lung tumour cause upper limb weakness?
Invasion or compression of the brachial plexus. This could also cause sensory abnormalities.
What are some risk factors for lung cancer?
Smoking
Radon exposure
Radiation exposure- e.g. previous radiotherapy
Genetics
What initial investigations should be done for lung cancer?
CXR
Bloods- FBC, U&Es, Ca, PTH, ALP, CRP, ESr,
TB?- Sputum culture, TBT, AFB staining, HIV check too
Sputum cytology- if effusion send for analysis
What further investigations should be done for lung cancer after basic ones?
CT Scanning- can assess the extent of spread, local invasion, or be used to guide a biopsy
Bronchoscopy- Can be used to visualize the tumour, take a biopsy but is limited by anatomical location of the tumour. EBUS can be used to sample mediastinal lymph nodes as well.
If any bony metastases are suspected radio-isotope bone scanning should be done.
If considering surgery lung function tests need to be done to assess suitability.
PET scanning (marked glucose) will also show up metastases and the primary tumour
How is lung cancer staged?
TNM staging system like every other cancer
What is a Pancoast’s tumour?
This is an apical lung tumour, due to its location it causes additional symptoms:
- Compression of brachial plexus = Upper limb weakness
- Compression of SVC= SVC obstruction
- Compression of cervical sympathetic chain = Horner’s Syndrome (Ptosis, Meiosis, Anhidrosis)
What is Lambert Eaton Myasthenic Syndrome?
This occurs due to lung cancers which stimulate production of autoantibodies which target the calcium channels of presynaptic neurons. Unlike myasthenia repetitive action causes increasing strength (myasthenia demonstrates fatigability)
What are the treatment option for lung cancer?
Depends upon the TNM stage
Surgery if localised
Chemotherapy
Radiotherapy
Targeted therapies for specific mutations
What should you always remember to ask about in a lung cancer history?
Smoking status Passive smoking (i.e. did parents or anyone in your home smoke)
What are some differentials for nodules on a CXR?
Malignancy Granuloma TB Abscess Hamartoma Foreign body Cysts Tumour not in the lung- e.g skin, breast
What is the prognosis for lung cancer?
It’s not great.
NSCL- 50% at 2 years without spread, 10% with spread
SCLC- Medical survival is 3 months if untreated, 1-1.5 years if treated.
Where does lung cancer often metastasis to?
Brain
Bone
Liver
Adrenal Glands
What type of lung cancer causes elevated PTH?
Squamous cell lung cancer
What type of lung cancer secretes Beta HCG? What features does this cause?
Large cell carcinoma
Causes galactorrhoea in females or gynaecomastia in males
What might carcinoid tumours secrete? What symptoms can this cause?
Carcinoid tumours can cause carcinoid syndrome where they secrete serotonin. This can cause flushing, nausea and diarrhoea. 5-HIAA can be detected in the urine if serotonin elevated.
What might be seen on a CXR for lung cancer?
Nodule/ Lesion
Hilar lymphadenopathy
Pleural effusion- do a pleural tap if seen
Collapse or consolidation (due to poor ventilation distally)
How does CT how biopsies are obtained?
If within the lumen of the airway- transbronchial biopsy can be done
If within the parenchyma- endobronchial ultrasound can be used to obtain a biopsy, can also sample lymph nodes
If located peripherally- CT guided biopsy or VATS
When is surgery suitable for lung cancer?
For a localised solitary nodule that has not metastasised. Metastatic disease can only be treated with chemotherapy.
What scans can help to identify metastatic disease?
CT scan
PET Scan
Isotope Bone Scanning
