Lung Cancer Flashcards
what are early signs of lung cancer?
- a cough for more than 3 weeks
- feeling breathless for no reason
- a chest infection that doesn’t clear up
- coughing up blood
- unexplained weight loss
- chest or shoulder pains
- unexplained tiredness or lack of energy
- a hoarse voice
what is haemoptysis?
coughing up blood
why might recurrent pneumonia suggest lung cancer?
A tumour may cause a partial obstruction of the upper lobe bronchus causing recurrent episodes of pneumonia which obscure the tumour on an X-ray
what is stridor?
difficulty breathing in leading to a coarse audible wheeze (unique as other diseases cause distress when breathing out)
where is likely to be affected by local invasion in lung cancers?
- recurrent laryngeal nerve (causing hoarse voice)
- pericardium
- oesophagus
- pleural cavity
- superior vena cava
what can local invasion of the pericardium cause?
- breathlessness
- atrial fibrillation
- pericardial effusion
what can pancoast tumour cause?
(brachial plexus invasion)
The tumour has eroded through the ribs and into the lower part of the brachial plexus (T1root infiltration) which leads to the wasting of small muscles of the hand
how is pleural effusion often dealt with?
when the primary tumour invades the pleural space it generates a large volume of pleural fluid and so this must be drained.
what symptoms may be shown when the superior vena cava is invaded?
blood drainage from the arms and head is obstructed so the patient may present with puffy eyelids and a headache. there may be distension of the superficial veins especially on the abdomen and normal pulsation is lost. There is also a raised JVN
what symptoms will lung cancer with chest wall invasion have?
localised chest wall pain, worse with movement and at night.
what are common sites for metastases in lung cancer?
liver, brain, bone, adrenal glands, skin, other areas of lungs
Describe cerebral metastases
- insidious onset (slow and progressive)
- weakness, visual disturbances, headaches which are worse in the morning but not photophobic (light sensitive)
- can have fits
what are the symptoms of bone metastases?
localised pain which is worse at night or pathological fractures
what are non-metastatic consequences of lung cancer?
finger clubbing, hypertrophic pulmonary osteoarthropathy (HPOA), weight loss, thrombophlebitis, hypercalcaemia, hyponatraemia (SIADH), weakness
what is HPOA?
(hypertrophic pulmonary osteoarthropathy)
symptoms of pain and tenderness of the long bones near adjacent joints are due to the elevation of the periosteum away from the bone surface.
what are the features of hypercalaemia?
(too much calcium in the blood)
stones = in the renal, gal stones
bones = bone pain
groans = abdominal pain, constipation, thirst
thrones = polyuria
psychiatric overtones (depression, anxiety, reduced GCS, coma)
cardiac arrhythmias
what is the treatment for hypercalcaemia?
- initially rehydration
- if calcium is >4 or does not correct with fluid then IV bisphosphonate should also be given
- treat underlying cancer
what is SIADH?
(symptom of inappropriate antidiuretic hormone)
- usually small cell lung cancer
- complex
- results in low sodium concentration
- nausea, myoclonus (muscle twitching), lethargy/confusion, seizures, coma
what is the treatment for SIADH?
- treat underlying cause
- fluid restriction (<1.5L a day)
- sometimes need demeclocycline
what investigations would you always do for suspected lung cancer?
- full blood count
- coagulation screen
- Na, K,Ca, Alk Phos
- spirometry, FEV1
what investigations would you only do sometimes for lung cancers?
chest X-ray, CT of thorax, PET scan, bronchoscopy, endobronchial ultrasound, Not sputum cytology
what is a PET scan?
- scan to asses function rather than structure
- analysis of tissue uptake of radiolabelled glucose
- tissues with high metabolic activity ‘light up’
how can we make diagnosis of lung cancer?
- bronchoscopy
- CT guided biopsy
- lymph node aspirate
- aspiration of pleural fluid
- endobroncial ultrasound
- thoracoscopy
what things should you do when giving a cancer diagnosis?
- prepare the ground
- bring a relative
- make sure they understand
- prepare for obvious questions
- tell their GP
- arrange follow up
