Lung Cancer Flashcards
Where does most of the cancer arise from?
Bronchi
Symptoms:
List some respiratory symptoms
Cancer symptoms - 2
Persistent cough SOB Haemoptysis Chest pain Recurrent infection (pneumonia)
Weight loss
Lethargy
Loss of appetite
Symptoms:
What may compression on oesophagus cause?
Why may they get a hoarse voice?
Dysphagia
Compression of the recurrent laryngeal nerve in the mediastinum
Signs:
Hands
What may be felt around the clavicle and axilla?
Why may they have hepatomegaly?
Why may the have distended neck veins?
Cachexia:
- What is it?
- Why do cancer patients get it?
Clubbing
Lymphadenopathy
Spread to liver
SVC obstruction
Weakness and wasting away of the body
Increased breakdown and depletion of skeletal muscle proteins are the main cause of cachexia in patients with malignant tumours.
Signs:
They may also get HPOA which stands for Hypertrophic pulmonary osteoarthropathy. What is it?
They may also get Pancoast syndrome which begins causing them shoulder and arm pain. What is a Pancoast tumour?
HPOA is a syndrome characterized by the triad of periostitis, digital clubbing and painful arthropathy of the large joints, especially involving the lower limbs. HPOA without clubbing of the digits is considered an incomplete form of HPOA and has been rarely reported.
A Pancoast tumour is a tumour of the pulmonary apex. It is a type of lung cancer defined primarily by its location situated at the top end of either the right or left lung. It typically spreads to nearby tissues such as the ribs and vertebrae.
Metastases sign:
Signs of brain mets?
Sign of bone mets?
Sign of liver mets?
Confusion
Fits
CNS signs
Bone pain
Hepatomegaly
Risk factors:
Obvious main risk factor
What else may contribute to the development of LC?
Passive smoking
Asbestos
Radiation exposure (e.g. X-ray)
Investigations:
Initial imaging:
- How long should a cough last before a CXR is indicated?
- What other type of cough may they have before a CXR is indicated?
CXR findings:
- Why do they get pleural effusions?
- What do they get lung collapse?
- Why do they get hilar enlargement or hilar/mediastinal lymphadenopathy?
- Why do they consolidation?
> 3 wk cough
Haemoptysis
Lung cancer or another type of cancer spread to the pleural space. These cancer cells increase the production of pleural fluid and cause decreased absorption of the fluid.
A lung tumour may also cause fluid to build up in the lung or space around the lung or push the air out of the lungs and cause the lung to collapse. If this happens, you may feel short of breath. This is because enough oxygen is not getting in the body and carbon dioxide is not leaving the body quickly enough.
Spread to lymph nodes or tumour moving into the hilar or mediastinal region.
Any pathologic process that fills the alveoli with fluid, pus, blood, cells (including tumour cells) or other substances resulting in lobar, diffuse or multifocal ill-defined opacities.
This appearance can be due to either infection or cancer - an X-ray cannot determine the difference
Investigations:
What type of imaging can be used to help distinguish blood vessels from lymph nodes, and highlight vascularised tumours as well as looking for mets in the lower neck and upper abdomen?
A contrast-enhanced CT
Also used long term as follow up and monitoring
Investigations - Pathological confirmation:
Why is a bronchoscopy done? - 2
What can be done if CT shows bronchoscopy will not able to reach lesion?
What can be done for pleural effusion?
To biopsy
To see if operable or not
Transthoracic CT/US-guided needle biopsy
Thoracentesis - a procedure in which a needle is inserted into the pleural space between the lungs and the chest wall. This procedure is done to remove excess fluid, known as a pleural effusion, from the pleural space to help you breathe easier.
Staging investigations:
What type of imaging is used to stage proximal cancer?
What type of imaging is used to look for mets?
Why are lung function tests done before surgery or radiotherapy?
PET or CT
A contrast-enhanced CT of neck and abdomen
CT/MRI for brain
To check there is sufficiency reserve
Management:
Main types of management
Lobectomy
Radio +/- chemotherapy
Complications:
Why may they get a hoarse voice?
Why may they get phrenic nerve palsy? What is a serious complication of this?
Why may the have distended neck veins?
Why may they get Horners syndrome?
Compression of the recurrent laryngeal nerve in the mediastinum
Compression of the phrenic nerve due to tumour or lymphadenopathy - Diaphragmatic palsy
SVC obstruction due to tumour
Compression of sympathetic ganglion
