Lung Cancer Flashcards
What is the most common type of lung cancer?
Bronchial Carcinoma 90%
Adenocarcinoma
Squamous cell
Small cell
Large cell
What are features of adenocarcinoma?
Central Frothy pink sputum Peripheral lesions Most common in non-smokers Often presents with Pleural effusion
What are features of Small cell carcinoma?
Presents late, high aggressive
Associated with smoking
Arises from endocrine cells - ECTOPIC ACTH production
What are features of squamous cell carcinoma?
Local spread common, mets late
Central or peripheral mass that can be cavitating
Production of PTH - hypercalcaemia
What are common sites of local spread of Lung Ca?
Axillary lymph nodes and Supraclavicular LN
Chest wall - BP damage
What are non-metastatic manifestations of bronchial carcinoma?
Inappropriate ADH secretion - Hyponatremia
Ectopic ACTH - Cushings
Hypercalcaima - Ectopic PTH
What is paraneoplastic syndrome?
Presentation resulting from tumour secretion of hormones, peptides or cytokines.
What are neurological presentations of paraneoplastic syndrome?
Lambert Eaton - autoimmune distruction of Neuromuscular junction. Improves with use
Polyneuropathy
What is the presentation of lung cancer?
Cough - particularly change in character of smokers cough Weightloss Haemoptysis Malaise Chest pain Clubbing
What is the 2WW cancer referral criteria?
> 40 with unexplained Haemoptysis OR CXR with findings suggestive of Ca
What is the 2WW referral criteria for urgent CXR?
> 40 with 1 (if Hx smoking) or 2 (no smoking Hx) of WL, Fatigue, Chest pain, SOB or cough
> 40 with chest signs, persistent chest infection or thrombocytosis
What CXR findings would be suggestive of Lung Ca?
Symptomatic tumours tend to be visible on CXR Hilar enlargement Lung collapse Pleural effusion Consolidation
Other than CXR what Ix would you want to do?
FBC - Anaemia? Infection?
U&E - Na+?
Bone profile - ? Ca2+
CT - Staging
Bronchoscopy with Fine needle aspiration OR percutaneous biopsy
What is the management of a non-small cell carcinoma?
Lobectomy and radiotherapy for stages 1,2,3,
What is the management of small cell carcinoma?
For patients with limited disease = Chemotherapy. 90% response. Palliative as presents late and often mets at presentation
What are common sites of metastasis?
Liver
Bone
Adrenal gland
Brain
What cancers commonly met TO lung?
Breast GI Prostate Kidney Melanoma
Which form of lung cancer is most common in non-smokers?
Adenocarcinoma
What is mesothelioma?
Aggressive Tumour of mesothelial cells of the lung pleura. Related to asbestos exposure
What are typical CXR findings for mesothelioma?
Pleural effusion
Lobulated or nodular pleural thickening
Pleural mass
What is the management of mesothelioma?
Symptomatic - cure only possible with very localised mesothelioma.
Poor prognosis around 1 year
What is the presentation of local invasion of the sympathetic ganglion and which type of tumour is associated with this presentation?
Pancoast Tumours - apex Horners syndrome - E MAP Enopthalmous Miosis Anhydrosis Ptosis
Why may Lung Ca present with voice hoarseness?
Invasion of the recurrent laryngeal nerve
Which subtype is most commonly associated with lambert eaton syndrome?
Small cell lung cancer
Within the lung where are adenocarcinomas located and where do they most commonly metastasis too?
Peripheral
Bone
Where do squamous cell carcinomas metastasis too and where are they located within the lung?
Centrally located
Locally invasive
What is superior vena cava outlet obstruction and how does it present?
Acute onset
Dyspnoea
Neck and face plethora
Neck vein distension
What sign would be positive in superior vena cava outlet obstruction?
Pemberton Sign - raising hands above your head produces facial congestion, cyanosis and transient respiratory distress
What are surgery CI>
Disseminated disease
SVCO
FEV1 <1.5L
Vocal cord paralysis
