Lung cancer Flashcards

1
Q

RF for bronchial carcinoma

A
  • Cigarettes inc passive exposure, esp large no pack years (cig per day*no years smoked divided by 20)
  • Toxins like radon, asbestos, polycyclic aromatic hydrocarbons, arsenic
  • Pre-existing lung disease like pulmonary fibrosis
  • Immunosuppression
  • Age
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2
Q

Small cell lung cancer

A

12% of bronchial carcinomas

Mostly caused by smoking

Often a/w paraneoplastic syndromes due to hormone secretions

Metastasise early

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3
Q

Non-small cell lung cancer

A
  • Adenocarcinoma: commonest type in UK, a/w smoking (but is also the commonest type in non-smokers), typically a peripheral lesion
  • Squamous cell carcinoma: also a/w smoking, typically central lesions, metastasises fairly late compared to others, a/w hypercalcaemia from PTHrp release + finger clubbing + hypertrophic pulmonary osteoarthropahty
  • Large cell carcinoma: large round cells, poorly-differentiated, early mets, typically peripheral, may secrete beta-hCG
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4
Q

Local effects of lung cancer

A
  • Persistent cough
  • Breathlessness
  • Haemoptysis
  • Chest pain from chest wall/pleura (sharp pain) or mediastinal nodes (dull central ache)
  • Wheeze from partial obstruction
  • Hoarseness - compression of LRLN
  • Brachial plexus invasion in Pancoast tumours causing C8/T1 palsy (wasting + pain of small muscles in hand)
  • Horner syndrome in Pancoast tumours if invades sympathetic chain (ptosis, miosis and anhidrosis)
  • Recurrent infection
  • Invasion of phrenic nerve causing hemidiaphragm paralysis
  • SVCO
  • Tracheal tumours-dyspnoea, stridor
  • Atelectasis
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5
Q

Metastasis of lung cancer

A
  • Liver: anorexia, nausea, WL, RUQ pain
  • Bone: pain, #, SC compression
  • Adrenals: asymptoamtic
  • Brain: RICP, carcinomatous meningitis, N+V, focal signs, headache, vision
  • Malignant pleural effusion
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6
Q

Extra-pulmonary non-metastatic manifestations

A
  • Metabolic: WL, anorexia, anaemia
  • Endocrine (mostly SCLC): ectopic ACTH, SIADH, hypercalcaemia (squamous cell usually), hypoglycaemia, hyperthyroidism, gynaecomastia
  • Neuro: encephalopathies, myelopathies, neuropathies
  • Vascular (uncommon): thrombophlebitis migrans, thrombotic endocarditis, DIC, TTP
  • Skeletal: clubbing, hypertrophic osteoarthropathy (causing wrist pain)
  • Cutaneous (uncommon): acanthosis nigricans, dermatomyositis
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7
Q

Signs on CXR

A

Mass lesion, large u/l pleural effusion, mediastinal widening, slow-resolving consolidation, collapse, reticular shadowing

or

normal!

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8
Q

Staging of lung cancer

A

TNM

  • T1 not in main bronchus, T2 in bronchus/pleura, T3 big, T4 mediastinal invasion
  • N: N0 none, N1 + N2 ipsilateral, N3 C/L or supraclavicular or mediastinal
  • M: M- none, M1a in c/l lung, M1b distant
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9
Q

Management of lung cancer

A
  • NSCLC: small number are suitable for resection which can cure in early stages, radiotherapy can help (but poor lung function is a common CI), usually some chemo to improve QoL
  • SCLC: stage 1 or neuroendocrine tumours may benefit from surgery but usually is a palliative scenario with chemo or radio if deemed appropriate; may do prophylactic brain radiation to prevent cerebral mets
  • Majority advanced disease so symptomatic v important esp for breathless + pain. E.g. radiotherapy for some bone pains or SVCO
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10
Q

Where do mets in the lungs often originate from?

A

Kidney, prostate, breast, bone, GIT, cervix or ovary

Present as parenchymal round shadows and are asymptomatic unless in the bronchi

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11
Q

Lymphangitis carcinomatosis

A

When spread occurs along lymphatics of the lungs

Usually from stomach, pancreas or breast

Causes progressive dyspnoea, CXR shows b/l lymphadenopathy + streaky basal shadowing

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12
Q

What are cannonball mets?

A

A solitary round shadow

Due to renal cell carcinoma

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13
Q

Mesothelioma

A

Asbestos-related

Presents late with pleural effusion or chest wall pain

Poor prognosis

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14
Q

CF

A
  • Symptoms do not predict diagnosis as often asymptomatic but may have the typical things like sob, persisting cough, dysphagia, hoarse voice
  • Possible signs include clubbing, Horner’s, swelling of face/arms/engorged veins, anaemia, hypercalcaemia, SIADH, Lambert-Eaton myasthenic syndrome
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15
Q

Imaging

A
  • staging CT from neck to lower abdomen (continuous scan so doesn’t miss stuff)
  • HRCT + CT thorax take slices every 1cm so not good for cancer as miss areas
  • use to work out TNM stage
  • May do PET scan if intended surgery to see mets not detected on CT - uses radio labelled glucose, look at uptake, higher areas of uptake in rapidly dividing cells
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16
Q

Why is lung cancer not screened for despite it being very common?

A
  • Cost
  • Unsure how you would capsule all at risk pts
  • Not enough radiologists to sport CT
  • Incidental findings of pulmonary nodules would increase burden more
  • Radiation effects
17
Q

What is a pulmonary nodule and what are the causes?

A
  • A nodule <3cm
  • C: granulomatosis w polyangiitis, rheumatoid nodule, carcinoid tumour, primary bronchial carcinoma, TB/fungal infection, mets
  • If <7mm don’t need FU unless Sx, otherwise need sequential CT surveillance for 2y