Lung Cancer Flashcards
How common is cancer of the bronchus?
Second most common cancer in the UK
What are the risk factors for bronchial cancer?
Smoking Passive smoking Asbestos Chromium Arsenic Iron oxides Radiation (radon gas)
What types of bronchial cancer are there?
Small cell (oat cell) (20%) – typically central arise from Kulchitsky cells often polypeptide hormones resulting in paraneoplastic symptoms e.g. ACTH, SIADH and Lambert Eaton syndrome.
Non-small cell (80%)
• Squamous (45%) – typically central, cavitating, PTHrP, clubbing and hypertrophic pulmonary osteoarthropathy (HPO) – wrist pain
• Adenocarcinoma (20%) – typically peripheral, most common in non-smokers but majority with adenocarcinoma are smokers, HPO and gynaecomastia
• Large cell (15%) – typically peripheral, poorly differentiated and poor prognosis – metastasise early and may secret BhCG
What are the clinical features of bronchial cancer?
Cough Haemoptysis Dyspnoea Chest pain – indicating localised invasion Recurring or slowly resolving pneumonia Lethargy Anorexia Weight loss Clubbing Thrombocytopenia
What complications can occur from bronchus cancer?
Anaemia Wrist pain Lymphadenopathy (cervical) Consolidation, pleural effusion or collapse Recurrent laryngeal nerve palsy – hoarse voice and stridor Phrenic nerve palsy SVC obstruction Horner’s syndrome (Pancoast’s tumour) Lamber Eaton Syndrome
What is Lambert Eaton syndrome?
Lambert Eaton Syndrome – antibody to voltage gated calcium channels causing muscular weakness (walking in treacle), autonomic features and improves with exercise. Diagnosis by presence of Antibodies to VGCC, treat by curing cancer, giving steroids or plasma electrophoresis.
Where does lung cancer spread to?
Spread to bone, liver brain and adrenals
What differentials should be considered alongside lung cancer?
Abscess Granuloma Cyst Foreign Body TB
What investigations should be done in a patient with suspected lung cancer?
FBC, UE, LFT, CRP and bone profile
CXR – can show pleural effusion, nodules, hilar enlargement, consolidation, lung collapse, bony secondaries.
CT for staging and guiding bronchoscopy for histological and assessment of surgical options
Sputum cytology or pleural fluid (can get histological diagnosis from this)
Fine need aspiration biopsy sometimes USS guided
PET for staging in NSCLC
Bone scan
What are the criteria for an urgent CXR?
Urgent CXR referral if:
>40 with 2 or more unexplained symptoms or ever smoked and 1 unexplained symptom
What are the criteria for referral to the urgent cancer pathway?
Urgent Cancer pathway if
X-ray findings suggestive of cancer
>40yrs with unexplained haemoptysis
What is the TNM staging for lung cancer?
T1 < 3cm
T2 >3cm and/or collapse extending to hilum, invading pleura
T3 Any size extending to chest wall but not involving mediastinal structure
T4 Any size invading mediastinum, malignant pleural effusion
How is lung cancer managed?
Small cell – Chemo and Radio, 10% cure and 90% relapse after which palliative care
Non-Small cell – staging CT-PET, 0-3a can be considered for surgery (lobectomy) with adjuvant chemo/radio.
Stage 3b+, chemo and radiotherapy. From this 30% cure and 70% relapse after which palliative care.
What are the contraindications for surgery in lung cancer?
Surgery contraindications: FEV1<1.5l, malignant pleural effusion, tumour near hilum, vocal cord paralysis and SVC obstruction.
What is mesothelioma?
Tumour of the mesothelial cells usually in the pleura of the lungs. Very rarely other mesothelial layers may develop the cancer.
What are the risk factors for mesothelioma?
Asbestos exposure (but only 20% have asbestosis)
What are the clinical features of mesothelioma?
Latent period between exposure and diagnosis can be up to 45 years
Chest pain
Dyspnoea
Weight loss
Clubbing
Recurrent pleural effusions – can be asymptomatic
Where does mesothelioma metastasise to and what features does this present?
Metastasis – usually to lymph nodes, contralateral lung and bone causing lymphadenopathy, hepatomegaly, bone pain/tenderness, abdominal pain/tenderness and obstruction
What investigations should be done is suspected mesothelioma?
CXR
CT scan – pleural thickening
Send off any pleural fluid
Thoracoscopy and biopsy
What is the management for mesothelioma?
Cisplatin based chemotherapy improves survival
Little evidence for surgery or radiotherapy
Palliation with pleurodesis and indwelling intra-pleural drains
What conditions does asbestos cause in the lungs?
Plaques – benign and do not undergo malignant change
Pleural thickening – diffuse thickening caused by asbestos exposure
Asbestosis – lower lobe fibrosis related to length of exposure – presents with shortness of breath and reduced exercise tolerance
Mesothelioma – only requires limited exposure
