Lung Cancer Flashcards
What are the symptoms of lung cancer?
Persistent cough Haemopytsis Dyspnoea Chest pain Weight loss and anorexia Hoarseness Superior vena cava syndrome
What sort of tumours cause horseness?
Pancoast tumours pressing on the recurrent laryngeal nerve
What are the examination findings of lung cancer?
A fixed, monophonic wheeze
Supraclaicular lymphadenopathy or persistent cervical lymphadenopathy
Clubbing
What are the paraneoplastic features of lung cancer?
Small cell - ADH, ACTH, Lambert-Eaton Syndrome
Squamous Cell - PTH-rp secretion causing hypercalcaemia,
Clubbing,
Hypertrophic pulmonary osteoarthropathy,
Hyperthyroidism due to ectopic TSH
Adenocarcinoma -
Gynaecomastia
Hypertrophic pulmonary osteoarthropathy
That are the complications of lung cancer?
Hoarseness
Stridor
Death
What are the investigations of lung cancer?
Chest x-ray: often 1st line, 10% normal x-ray have cancer.
CT: Investigation of choice in suspected lung cancer.
Bronchoscopy: Biopsy to obtain histological diagnosis.
PET scanning: Typically done in non-small cell lung cancer to establish eligibility for curative treatment
Bloods: Raised platelets/thrombocytosis
What is the management of non-small cell lung cancer?
Management:
Only 20% suitable for surgery
Curative or palliative radiotherapy
Poor response to chemotherapy
What are contraindications to surgery in non-small cell lung cancer?
Assess general health Metastases FEV1 <1.5 L Malignant pleural effusion Tumour near hilum Vocal cord paralysis SVC obstruction
What are the criteria to refer to suspected cancer pathway referral (appt in 2 weeks)?
Chest x-ray findings that suggest lung cancer
Aged 40 and over with unexplained haemoptysis
What are the criteria for ordering an urgent chest x-ray (2 weeks) to assess for lung cancer?
40 + and over if 2 of, or ever smoked and 1 of: UNEXPLAINED Cough Fatigue SOB Chest pain Weight loss Appetite loss
or 40 + and 1 of: Persistent or recurrent chest infection Finger clubbing Lymphadenopathy Chest signs consistent with lung cancer Thrombocytosis
What are the features of small cell lung cancer?
Usually central
Arise from APUD cells
Associated with ectopic ADH, ACTH secretion.
If a paraneoplasm releases ACH, what results?
Hyponatraemia
If a paraneoplasm releases ACTH, what results?
Cushing’s syndrome
can also cause bilateral adrenal hyperplasia, the high levels of cortisol can lead to hypokalaemic alkalosis
What is Lambert-Eaton Syndrome?
Antibodies to voltage gated calcium channels causing myasthenic like syndrome
What is the management of small cell lung cancer?
Usually metastatic disease by time of diagnosis.
Very early stage: consider surgery.
Chemotherapy and radiotherapy.
