Lung Cancer Flashcards
Causes
SMOKING asbestos radiation arsenic chromium coal tar and oils iron oxides pollution
Smoking when already diagnosed
Increases LE
Does not lower risk back
2 Types
Small cell (oat cell) (10%) Non small cell
Types of non small cell
Squamous cell carcinoma >
Adenocarcinoma!!
Large cell carcinoma
Small cell features
aggressive
early spread
chemo response
endocrine cells produce hormones
Squamous cell features
Cavitates
Smokers
Large cell features
Early metastasis
undifferentiated
Bronchoalveolar cell features (adenocarcinoma in situ)
resembles pneumonia
Indications for urgent CXR
haemoptysis >3 weeks of = cough weight loss chest signs dyspnoea chest/shoulder pain hoarseness clubbing features of mets supraclavicular/cervical lymphadenopathy
Chest signs
Visible swelling Facial swelling distended veins reduced expansion Dullness = reduced TV and RV Wheeze reduced breath sounds
Paraneoplastic syndromes in Small cell
Cushings = ectopic ACTH SIADH Lambert Eaten myasthenic syndrome limbic encephalitis cerebellar syndrome
Paraneoplastic syndrome in squamous cell carcinoma
Hypercalcaemia
When is the 2 week wait
- if CXR or CT suggests cancer with pleural effusion or slowly resolving consolidation
- if CXR or CT normal but high clinical suspicion
When should there be an urgent referral
- persistent haemoptysis in smokers/ex older than 40 years
- SVC obstruction signs
- stridor
Ix for diagnosis and staging
- bronchoscopy
- CT guided biopsy
- PET scan
- MRI for Pancoast tumours
- bloods
- bone scan
- brain CT/MRI
- mediastinoscopy
- FNA
TNM Staging
T = size and location (T1 = small, peripheral, surgical removal T4 advanced large invading) N = which lymph nodes involved (1 = hilar, 2 = mediastinal, 3 = contralateral) M = if metastases present
Common sites of metastases
brain, liver, lungs, adrenals, bones
Surgical treatment
- for localised non invading
- no spread
- only chance of cure
Radical Radiotherapy
- squamous cell carcinoma
- not possible for surgery as lymph nodes involved or patient not fit
- complication = early post radiation pneumonitis and later fibrosis
Palliative radiotherapy
- relieves pain, haemoptysis, neurological problems
Chemotherapy
- cisplatin, docetaxel, gemcitabine
- ORAL = EGFR ant (gefitinib, erlotinib)
- ALK = certiib, alectinib, crizotinib
- NEW = atezolizumab, durvalumab
- immunotherapy = pembrolizumab (PD-L1 positive tumours)
Adjuvant chemo
- after surgery to reduce recurrence chance
- if disease in hilar LN
Neo-adjuvant chemo
- before surgery to make sure cancer well controlled
Palliative
Endobronchial laser Stenting = relieves breathlessness Endobronchial radiotherapy (brachytherapy) - painkillers - antitussives - oxygen - steroids
