lung cancer Flashcards
Investigation of lung cancer: explain the modalities by which lung cancer can be diagnosed
what 4 things are done after detecting cancer
confirm diagnosis, determine histological type of tumour, determine tumour stage, molecular pathology
4 cytology (cell) techniques to identify cells which may be cancerous
sputum, bronchial washings and brushings, pleural fluid, EBUS (endobronchial ultrasound and bronchoscopy)
3 histology (stage - see if in situ) biopsy techniques
bronchoscopy (central); CT-guided biopsy through skin (peripheral); bone scan; PET scan; surgical (lymph node for staging)
signs of lung cancer
haemoptysis (coughing up blood due to invasion of large/small vessels), unexplained/persistent: cough, chest/shoulder pain, chest signs, dysphagia and dyspnoea (bronchial obstruction from tumour - partial lung collapse), hoarsness, finger clubbing, weight loss (cancer uses glucose), chest infection (impaired bronchus drainage), Horner’s syndrome, superior vena cava syndrome
describe finger clubbing
nail bed becomes more boggy and angle becomes more obtuse
2 clinical objectives
establish diagnosis, establish staging
use of FDG-PET-CT to establish diagnosis and staging
radio-labelled glucose actively taken up by rapidly dividing cancer cells - lung and lymph node tissue should not be taken up; used to see spread; additional collection required to confirm (e.g. sample lymph node)
advantages of trans-thoracic CT biopsy (needle to lung tissue inserted under CT guidance)
real time, highly sensitive
disadvantages of trans-thoracic CT biopsy
risk of pneumothorax, small sample size, in case of bleeding no immediate intrabronchial treatment possible
scanning brain
MRI as PET monitors glucose and brain uses a lot of glucose in metabolism
establishing treatment plan
multi-disciplinary team to determine best treatment plan (x-ray → CT, pulmonary, exercise tests)
