Lung Cancer Flashcards
Bronchial Carcinoma Context
Most common malignant tumour worldwide, causing around 1.4 million deaths annually
3rd most common cause of death in UK
Who Gets Bronchial Carcinoma
Recently the incidence in men is decreasing but increasing in women, but the ratio of incidence is men:women = 1:2
Smoking accounts for 90% of lung cancers
Other factors include: pollution, asbestos, radon exposure, polycyclic aromatic hydrocarbons, ionising radiation, occupational exposure to toxins, preexisting lung disease, HIV infection, genetic predisposition
Usually presents in older age
Pathophysiology of Small Cell Bronchial Carcinoma
20-25% of lung tumours
Arise from neuroendocrine cells (APUD cells)
Express TT1 mutations
Grow centrally and metastasise early
Associated with paraneoplastic syndromes: Lambert-Eaton Myasthenic Syndrome (muscle weakness), Syndrome of Inappropriate Antidiuretic Hormone Secretion, and Cushing syndrome (fat deposits)
Pathophysiology of Adenocarcinoma
27-30% of lung tumours, most common in non smokers, incidence on the rise
Originates from mucous secreting glandular cells
Most often arise in the peripheries
Express TTF1 mutations
Metastasis common, reaching the pleura, lymph nodes, brain, bones, adrenal glands
Pathophysiology of Squamous Cell Carcinoma
35% of lung tumours
Keratinised tumour originating from epithelial cells
Arise centrally and sometimes cavitate
Associated with bronchus obstruction, local spread common, and metastasise late
Associated with hypercalcemia (PTH like hormone secretion)
Pathophysiology of Large Cell Bronchial Carcinoma
10-15% of lung tumours
Any non small cell carcinoma that doesn’t fit the criteria of any other carcinoma
Poorly differentiated
Metastasise early
Symptoms of Bronchial Carcinoma
Cough (>3 weeks), Haemoptysis (fresh or old), SOB, chest pain (peripheral infiltration will cause pleuritic pain, mediastinal infiltration will cause dull central pain), wheeze (monophonic), hoarse voice (compression of the left recurrent laryngeal nerve), small muscle of the hand waisting and arm pain (pancoast tumour causes C8/T1 palsy), recurrent infections, superior vena cava obstruction
Symptoms of Metastasis of Bronchial Cell Carcinoma
Liver = anorexia, nausea, weight loss, RUQ pain
Bone = bone pain, pathological fracture, spinal chord compression
Adrenal glands = asymptomatic
Brain = raised intra-cranial pressure, head ache, confusion, carcinomatous meningitis
Investigations for Bronchial Carcinoma
Bloods = FBC (anaemia), U/E, LFT
CXR = first line, shows mass, pleural effusion, hilar lymphadenopathy
CT + PET = important for staging
Bone scan and head CT = if metastasis is suspected
Cytology = sputum culture, bronchoscopy, pleural tap, biopsy
Management of Bronchial Carcinoma
Small cell = chemotherapy +/- radiotherapy (?immunotherapy)
Non-small cell operable (stageI,II,IIIA) = surgical lobectomy +/- adjuvant chemotherapy
Non-small cell inoperable = radiotherapy +/- chemotherapy
Mesothelioma Overview
Causes about 2300 deaths per year and is thought to have peaked in 2020
Mesothelioma Pathophysiology
Malignant tumour arising from the mesothelial cells of the pleura as a result of asbestos exposure/close contact with asbestos workers
Usually takes 30-40 years to develop
Presentation of Mesothelioma
Initial presentation is usually with a pleural effusion accompanied by persistent chest wall pain
Weight loss, SOB, fever, sweating, and cough may present
Investigations for Mesothelioma
CT: pleural nodularity, circumferential thickening, local invasion, lung entrapment
Pleural fluid aspiration: low cytological yield
Biopsy
Treatment of Mesothelioma
Poor outlook Pleurodesis will eliminate effusions Radio/chemo have limited use, alongside surgery Ease symptoms Report all deaths to public health
