Lung cancer Flashcards
Classifications of lung cancer
Small cell carcinoma
- Highly malignant
- Associated with smoking
- Accounts for around 15%
Non-small cell carcinoma
- Adenocarcinoma (most common type)
- Squamous cell (SCC)
- Large cell carcinoma
Small cell carcinoma
- Epidemiology
Accounts for 15-20% of all lung cancers
Associated with smoking
Adenocarcinoma
- Epidemiology
- Associations
Most common type of lung cancer
- Around 40%
- F>M
- Far east ethnicity have higher risk.
Most common type in non-smokers.
Squamous cell carcinoma
- Epidemiology
- Associations
Next most common type of cancer
(25%)
- Strongly associated with smoking
Large cell carcinoma
- Epidemiology
Accounts for 10% of NSCLC
Hamartoma
- Definition
- Epidemiology
- Pathology
- Treatment
Benign tumour, most common type is from the lung.
- Originates from connective tissues: fat, cartilage, CT.
Epidemiology
- F>M
Treatment
- Surgical resection, excellent prognosis.
Complications of lung cancer
Paraneoplastic syndromes
- Horner’s syndrome (Pancoast tumour)
Phrenic nerve palsy
Recurrent laryngeal n palsy
SVC obstruction
AF
Paraneoplastic presentations of lung cancer
- Endocrinology
Endocrinology
- SIADH ( SCLC producing ADH)= hypoNa+
- Cushings (SCLC producing ACTH)
- Serotonin syndrome–> carcinoid
- SCC producing PTHrP= hyperCa2+
Paraneoplastic presentations of lung cancer
- Rheumatology
- Neurology
- Dermatology
Rheumatology
- Dermatomyositis/ polymyositis
Neurology
- Cerebellar degeneration
- Peripheral neuropathy.
Dermatology
- Acanthosis nigricans
- Trousseau syndrome
Small cell carcinoma
- Pathology: location, histology, behaviour
Location
- Central, near bronchi
Histology
- Small, poorly differentiated cells
- “Oat cells” appearance, flat, low cytoplasm
- Neuroendocrine origins= Feyrter cells
Behaviour
- Highly malignancy, mainly present in later stage
- Poor prognosis, but highly sensitive to chemo
- Ectopic hormone secretion due to neuroendocrine origin.
Adenocarcinoma
- Pathology: location, histology, behaviour
Location
- Peripheral
Histology
- Differentiated, glandular (poorly differentiated if advanced)
- Mucin positive
Behaviour
- Mets are extrathoracic
- Most present with mets.
SCC
- Pathology: location, histology, behaviour
Location
- Central
Histology
- Squamous cell differentiation
- May show keratinisation
Behaviour
- Locally invasive
- Late mets, via lymph
- HyperCa2+ due to PTHrP
Large cell carcinoma
- Pathology: location, histology, behaviour
Location
- Central/ peripheral
Histology
- large, undifferentiated cells
Behaviour
- Poor prognosis
Symptoms of lung cancer
General
- Fatigue
- Weight loss/ anorexia
Resp
- Dyspnoea
- Cough w/ haemoptysis
- Chest pain
Signs of lung cancer
-
Peripheral
- Clubbing
- Lymphadenopathy: supraclavicular, axillary
- Horner’s syndrome; miosis, ptosis, anhydrosis
- Anaemia signs
Chest
- Dull percussion
Mets sign
Signs of mets in lung cancer
- Bone pain
- Confusion
- Seizures
- Cerebellar dysfunction
- Peripheral neuropathy
Blood tests for Lung Ca
FBC
- May show anaemia
U+E
- HypoNa+
Hypercalcaemia
LFT
- May show ALP if bone mets
Imaging for lung Ca
CXR
- Pleural effusion
- Peripheral circular opacity
- Hilar enlargement
- Consolidation
- Lung collapse
CT
- Lower neck, thorax, upper abdomen.
Bronchoscopy
Special investigations for lung ca
Thoracentesis of pleural effusion/ pleural biopsy
- Shows malignant cells
Fine needle aspiration
- If lymphadenopathy present
Sputum cytology
- Malignant cells may be present
SCLC
- treatment
Tends to present at late stage
If caught earlier:
- Chemotherapy
- with radiotherapy
- Prophylactic cranial irradiation
Surgery
If extensive, surgery not an option
Later stages= palliation
Palliation for SCLC
Analgesia
Radiotherapy
- Bronchial obstruction
- Haemoptysis
- Bone/ CNS mets
Stenting/ dexamathasone/ RT
- SVC obstruction
Endobronchial therapy
Pleural draining
NSCLC treatment
- Stage 1, 2
- Surgical resection, requires good cardioresp reserve
- Preoperative chemo
- Post-op radiotherapy/chemo
- Later stages
- Radio/ Chemo
