Lung Cancer Flashcards
Signs and symptoms of lung cancer
- Shortness of breath
- Cough
- Haemoptysis (coughing up blood)
- Finger clubbing
- Recurrent pneumonia
- Weight loss
- Lymphadenopathy – often supraclavicular nodes are the first to be found on examination
What Ix to do in suspected lung ca?
- CXR - 1st line -> characteristic findings
- CT scans -> staging
- PET-CT -> to identify metastasis
- Endoscopy with endobronchial ultrasound (EBUS) -> USS at the end of scope + biopsy
- histological diagnosis
Principles of PET-CT (how does it work)
PET-CT (positron emission tomography) scans
- injecting a radioactive tracer (usually attached to glucose molecules) and taking images using a combination of a CT scanner and a gamma ray detector
- to visualise how metabolically active various tissues are
- useful in identifying areas that the cancer has spread to by showing areas of increased metabolic activity suggestive of cancer
What type of lung cancer is surgery offered for?
- Non- small cell ca -> if a patient has a disease limited to a single area (intention to cure the ca)
Types of surgeries used in lung cancer?
*surgeries used in non-small cell lung ca (if limited to the single area)
Types:
- Lobectomy (removing the lung lobe containing the tumour) is first line
- Segmentectomy or wedge resection (taking a segment or wedge of lung to remove the tumour) is also an option
Other than surgeries Rx for non-small lung ca
- radiotherapy (may be curative in early stages)
- chemotherapy (in addition to surgery and radiotherapy, or as palliative)
Treatment of small-cell lung cancer
- chemotherapy
- radiotherapy
*but worse prognosis than in non-small cell lung ca
Palliative treatment surgeries
Endobronchial treatment with stents or debulking
Aim: to reduce symptoms due to obstruction
Recurrent pharyngeal n palsy in lung ca
- present with hoarse voice
- cancer presses on recurrent pharyngeal n.
Phrenic n. palsy in lung ca
- presents with SOB due to weakness of diaphragm
- cancer compressing phrenic n.
Superior vena cava obstruction in lung cancer
- cause
- presentation
- direct compression of the tumour on the superior vena cava
- presents with facial swelling, difficulty breathing and distended veins in the neck and upper chest
“Pemberton’s sign” is where raising the hands over the head causes facial congestion and cyanosis. This is a medical emergency.
What is Pemberton’s sign?
Caused by direct compression of the tumour on superior vena cava
Pemberton’s sign - raising the hands over the head causes facial congestion and cyanosis. This is a medical emergency!
What is Horner’s syndrome?
- triad
- cause
- Triad of: ptosis, anhidrosis and miosis
- Cause: Pancoast tumour (lung apex) pressing on sympathetic ganglion
SIADH
- cause (type of lung ca)
- presentation
- ectopic ADH secretion
- in small cell lung ca
- presentaiton: hyponatraemia
Cushing’s syndrome in lung ca
- type of lung ca
- cause
- ACTH ectopic secretion
- small cell lung ca
Hypercalcaemia in lung ca
- cause
- type of cancer
- ectopic PTH secretion
- squamous cell carcinoma
Limbic encephalitis in lung ca
- type of cancer
- what happens
- presentation
- detection
- Small cell lung cancer
- cancer -> immune system produce antibodies against parts of the brain
- presentation: short term memory loss, hallucinations, seizures and confusion
- anti-Hu antibodies
What to consider in a smoker with symptoms of Lambert-Eaton Syndrome?
Small- cell lung cancer
Lambert-Eaton syndrome in lung cancer
- cause
-
antibodies produced by the immune system against small cell lung cancer cells
Mesothelioma
- parts of the lung affected
- association
- mesothelial cells of the pleura affected
- associated with asbestos exposure
*
When does mesothelioma present?
There is a huge latent period between exposure to asbestos and the development of mesothelioma of up to 45 years
Prognosis and treatment of mesothelioma
- very poor prognosis
- chemotherapy use is mainly paillative
Common sites of lung cancer metastasis
brain, liver, adrenal glands and bone
What further tests to perform on a patient with lung adenocarcinoma?
- mutation is present in eGFR -> we have specific treatments that may target it; same for ALK
- PDL -1 -> tests for anything that is not small-cell cancer (e.g. adenocarcinoma and squamous cell) -> specific immunotherapies available
