- Nausea/vomiting - Myoclonus - Lethargy/confusion - Seizures/coma

1. Fluid restriction - 1.5L/day. 2. Demeclocycline. Treat underlying cause.

- Finger Clubbing - Bloated Face - Lymphadenopathy - Tracheal deviation - Dull percussion - Stridor - Enlarged liver

Lung Cancer Flashcards by Caitlin Caldwell

Symptoms of Lung Cancer

Prolonged cough & haemoptysis.
Dyspnoea (SOB)
Recurrent Chest infections/pneumonia.
Weight loss.
Chest/Shoulder pain.
Fatigue.
Hoarseness.

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Bronchial Carcinoma: Local Invasion

Recurrent laryngeal nerve, pericardium, oesophagus, brachial plexus, pleural cavity, superior vena cava.

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Symptom associated with local invasion of recurrent laryngeal nerve

Hoarse voice

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Symptoms associated with local invasion of pericardium

Dyspnoea, Atrial fibrillation & pericardial effusion.

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Symptom associated with local invasion of oesophagus

Dysphagia

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Symptom associated with local invasion of brachial plexus

Pancoast tumour.

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Common sites for metastases

Liver, Brain, Bone, Adrenal, Skin, Lung

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Symptoms of Cerebral metastases

Visual disturbances, weakness, headaches (worse in morning, not photophobic), fit.s.

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Symptoms of Paraneoplastic syndrome

Finger clubbing
Weight loss
Weakness

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Symptoms of Hypercalcaemia

Renal/Biliaru Calculi.
Bone pain.
Abdominal pain.
Constipation.
N&V.
Polyuria.
Depression, anxiety, reduced GCS, Coma.
Cardiac arrhythmias.

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Treatment of Hypercalcaemia

Rehydration.
IV biphosphonate.

Treat underlying cancer.

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Paraneoplastic Syndrome: associated conditions

Hypertrophic Pulmonary Osteroarthopathy (HPOA)
Thrombophlebitis.
Hypercalcaemia.
Hypernatraemia (SIADH).
Eaton Lambert Syndrome.

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Symptoms of (SIADH)

Nausea/vomiting
Myoclonus
Lethargy/confusion
Seizures/coma

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Treatment of SIADH

Fluid restriction - 1.5L/day.
Demeclocycline.

Treat underlying cause.

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Signs of Lung Cancer

Finger Clubbing
Bloated Face
Lymphadenopathy
Tracheal deviation
Dull percussion
Stridor
Enlarged liver

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Investigations for Lung Cancer

FBC, Coag screen, Na/K/Ca/Alk Phos,
Spirometry, CXR (abnormal), CT Thorax, PET, Bronchoscopy, EBUS, aspiration of pleural fluid, Thoracoscopy, Lymph node aspirate (Metastases).

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Differential diagnoses

TB, Vasculitis, PE, Lymphoma, Bronchiectasis.

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Types of Lung Neoplasms

Primary: Benign or malignant.

- Metastatic.

Risk Factors

Smoker.
Asbestos exposure.
Nickel.
Chromates.
Radiation.
Atmospheric pollution.
Genetics.

What causes haemoptysis?

Ulceration

What causes chest pain?

Invasion of chest wall

What causes pneumonia?

Obstruction of airway.

Lung tumours: Types

Smoking associated:

Adenocarcinoma
Squamous carcinoma
Small cell carcinoma
Large cell carcinoma

Bronchial gland tumours & neuroendocrine tumours.

Small Cell Lung Cancer

Worst prognosis.
Rapidly progressive.
Early metastases.

Treatment of Small Cell Lung Cancer

- More chemosensitive. | - Rarely suitable for surgery.

Adenocarcinoma

- Expresses TTF1

Squamous Carcinoma

- Expresses nuclear antigen p63 & height mwt. Cytokeratins.

Peripheral adenocarcinomas

Atypical adenomatous hyperplasia. - Spread of neoplastic cells along alveolar walls (bronchioloalveolar carcinoma) - Invasive carcinoma.

TNM Staging

Tumour, Nodes, Metastases. - Bronchoscopy: type (SCLC/NSCLC). - Mediastinoscopy/ EBUS. - CT (Brain&Thorax): Tumour size, local invasion, nodes, metastases. - PET scan.

What are Carcinoids?

Neuroendocrine neoplasms of low grade malignancy.

What are Bronchial gland neoplasms?

- Adenoid cystic carcinoma. | - Mucoepidermoid carcinoma.

Pleural Neoplasia

Primary malignant neoplasm => mesothelioma. Common site of invasion of lung carcinomas and metastatic cancers.

Treatment of non-small cell cancers

- Surgery or radical radiotherapy. | - Palliative chemotherapy & new targeted treatment.

Surgery

Pneumonectomy or lobectomy - Thoracotomy. - Minimal access VATS. Curative objective.

Cytotoxic Chemotherapy

- Rarely curative but prolonged survival. - Better response in SCLC. - Major side effects. - Whole body treatment targeting rapidly dividing cells, blood brain barrier.

Side effects of chemotherapy

Nausea, vomiting, tiredness, bone marrow suppression (opportunistic infection & anaemia), hair loss, pulmonary fibrosis.

New Targets

Genetic mutations: EGFR, ALK1. Immune Therapy: PD-L1.

Radiotherapy

- Ionising radiation (usually XR), external beam. - Radical: Curative intent. - Palliative: Delaying tactic, useful for metastases. - Well tolerated.

Disadvantages of Radiotherapy

- Max cumulative dose - Collateral damage: Spinal cord, oesophagus adjacent lung tissue. - Only goes where beam pointed.

SABR

Many more, less powerful beams => total dose delivered to tumour higher and more effective but less collateral damage.

Endobronchial therapy

- Stent insertion for stridor. - Photodynamic therapy. - Other laser therapy.

Co-morbidiities

Smoking related diseases: - COPD - Ischaemic heart disease.

Palliative Care

Treating: - Pain - Dyspnoea - Cough - Anxiety - Poor mobilitu

Causes of Lung Cancer

Tobacco Smoking, Asbestos, Radon