Lung Cancer Flashcards
Types of lung cancer?
Small cell
Non-small cell - squamous, adeno, large cell
What is the most common type of lung cancer?
Squamous currently, but adeno increasing
Squamous cell carcinoma?
Epithelial cells associated with keratin production
Occasionally cavitate with central necrosis
Obstructing lesions with post-obstructive infection
Local spread, rarely metastasise
Adenocarcinoma?
Originates from mucus secreting glandular cells
Most common type in non-smokers
Peripheral lesions
Mets common
Large cell carcinoma?
Poorly differentiated
Mets early
Small cell carcinoma?
Arises from neuroendocrine cells
Secretes hormones
Arises centrally
Metastasise early
Presenting symptoms?
Cough Breathlessness Haemoptysis Wheeze + stridor Weight loss Fever Clubbing
What is a pancoast tumour?
Apical lung tumour - often non-small cell
How do pancoast tumours present?
Hoarseness
Horner’s syndrome
Thoracic outlet syndrome
Bovine cough
What is Horner’s syndrome?
Damage to sympathetic trunk - mitosis, partial ptosis, anhydrosis and enophthalmos on ipsilateral side
Mitosis? Why?
Constricted pupil
Loss of sympathetic drive of iris dilator muscle
Ptosis? Why?
Weak, droopy eyelid
Loss of sympathetic control of Muller muscle that elevated eyelid
Anhydrosis? Why?
Decreased sweating
Impingement of sweat gland fibres from cervical sympathetic ganglion
Enophthalmos?
Inset eyeball
Thoracic outlet syndrome?
Compression of brachial plexus - pain and weakness of muscles of the arm and hand
Superior vena cava syndrome?
Small-cell lung cancer Obstruction of SVC by tumour Facial + upper limb oedema Headache Dyspnoea Stridor Swollen collaterals on chest wall Pemberton's sign
What is pemberton’s sign?
Demonstrate presence of latent pressure in thoracic inlet - elevate both arms to side of face - +ve sign is marked by the presence of facial congestion and cyanosis
Other symptoms of lung cancer?
Pericardial effusion
Pleural effusion
Dysphagia
Para-neoplastic syndromes?
Ectopic Cushing’s
SIADH
Hypercalcemia
Hypertrophic osteoarthropathy
Ectopic Cushing’s?
ACTH secretion Weight gain Hypertension Hypokalemia Muscle weakness Small cell lung cancer
SIADH?
ADH secretion
Euvolmic hyponatremia
Headache, weakness, altered mental state, seizures, respiratory depression
Small cell lung cancer
Why hypercalcemia in some lung cancers?
Increased PTHrP - increased bone resorption and renal calcium absorption - hypercalcemia
Squamous cell carcinoma
Symptoms of hypercalcemia?
Abdominal pain Bone pain Confusion Depression Weakness Kidney stones Abnormal heart rhythm
Hypertrophic osteoarthropathy?
Periosteal proliferation of tubular bones
Painful symmetrical arthritis of ankles, knees, wrists and elbows
Clubbing
Adenocarcinoma
What is Lambert-Eaton myasthenic syndrome?
Autoantibodies against the presynaptic voltage-gated calcium channels
Muscle weakness of limbs
Small-cell lung cancer
Investigations for suspected lung cancer?
Bloods CXR Contrast CT PET scan Bronchoscopy Neck ultrasound LFTs Cytology
NSCLC treatment?
Surgery (I, II)
Radiotherapy (I - III)
Chemotherapy (III, IV)
SCLC treatment?
Chemotherapy
TNM staging NSCLC?
T1 <3cm
T2 <7cm
T3 >7cm with invasion
T4 invasion of mediastinum, vessels, trachea
N1 - ipsilateral hilar nodes
N2 - ipsilateral mediastinal/subcarinal nodes
N3 - contralateral nodes
M1 - metastases
Paraneoplastic features of small cell?
ADH
ACTH
Lambert-Eaton syndrome
Paraneoplastic features squamous cell?
Parathyroid related protein
Hyperthyroidism
Hypertrophic pulmonary osteoarthropathy
Paraneoplastic features of adenocarcinoma?
Gynaecomastia
Hypertrophic pulmonary osteoarthropathy
What is Lambert-Eaton syndrome?
Weakness in the muscles of proximal arms and legs
Legs are worse
Improves with muscle use
