Lung Cancer Flashcards
What are risk factors for lung cancer?
Cigarette smoking Passive smoking Asbestos exposure Chromium Arsenic Iron oxides Radon gas
What are the classification of lung cancer?
Non-small cell lung cancer: Squamous cell carcinoma (35%) Adenocarcinoma (30%) Large cell 10% Adenocarcinoma in situ
Small cell carcinoma 20%
Arise from endocrine cells often secreting polypeptide hormones
Carries a worse prognosis
What are symptoms of lung cancer?
Cough Haemoptysis Dyspnoea Chest pain Recurrent or slowly resolving pneumonia Lethargy Anorexia Weight loss
What are signs of lung cancer?
Fixed monophonic wheeze Clubbing Cachexia Anaemia Supraclavicular or axillary nodes
Mets: Bone tenerness HEpatomegaly Confusion Fits Focal CNS Peripheral neuroapthy
What paraneoplastic features of small cell lung cancer? Location?
Usually central
ADH -> hyponatraemia
ACTH -> Cushing’s syndrome, can cause bialteral adrenal hyperplasia, high cortisol can cause hypokalaemic alkalosis
Lambert Eaton Syndrome: antibodies to voltage gated calcium channels causing muscle weakness
What paraneoplastic features of squamous cell cancer?
PTHrP secretion -> hypercalcaemia
Hypertrophic pulmonary oesteoarthropathy
Clubbing
Hyperthyroidism due to TSH ectopic
What paraneoplastic features of adenocarinoma?
Gynaecomastia
Hypertrophic pulmonary osteoarthropathy
Where are squamous cell carcinoma, adenocaricnoma and large cell cancer located?
Squamous cell carcinoma - central, near large airways - PTHrP,
Adenocarcinoma - peripheral - most common in non-smokers
large cell cancer - peripheral
What are local complications of lung cancers?
Recurrent laryngeal nerve palsy - hoarseness Phrenic nerve palsy SVC obstruction Horner's sydnrome - Pancoast's tumour Pericariditis AF
What are metastatic complications of lung cancer?
Brain
Bone - bone pain, anaemia, hypercalcaeia
Liver
Adrenals - Addison’s
What investigations in lung cancer?
CXR: Peripheral nodule Hilar enlargement Consolidation Lung collapse Pleural effusion Bony secondaries
Cytology:
Sputum and pleural fluid
FNA or biopsy (peripheral lesions /lymph nodes)
CT for staging
Bronchoscopy:
Histology and assess operability
+ Endobronchial US for assessment and biopsy
Radionucleotide bone scan if mets suspected
Lung function test to assess suitability for lobectomy
PET-CT before treatment to show distant mets and local ones
What staging in lung cancer?
TNM using CT CAP
What treatment for NSCLC? What are contraindications to surgery?
Lobectomy (open or thorascopic) if medically fit
Radical radiotherapy for patients with stage early stage disease
Chemotherapy and radiotherapy for more advanced disease
CI: Stage IIIb (T1-4mN3M0) or stage IV (M1) FEV1<1.5L Malignant pleural effusion Tumour near hilum Vocal cord paralysis SVCO
What treatment for SCLC?
Consider surgery in early stage disease
Chemotherapy + radiotherapy
Palliative radiotherapy for bronchialobstruction, SCVO, haemoptysis, bone pain and cerebral mets
SVC stent + radiotherapy and dexamethasone for SVCO
Endobronchial therapy - tracheal stenting
Pleural tdrainage
Analgesia Steroids Anti-emetics Antidepressants Bronchodilators
What are 2WW referral criteria for lung cancer?
CXR findings that suggest lung cancer
>40 years with unexplained haemoptysis
Offer urgent chest C-ray in over 40s who have 2 or more of (or smoker + 1 of):
cough, fatigue, SOB, chest pain,w eight loss, appetite loss
