Lung Cancer Flashcards
How do you classify lung cancer?
Where do they tend to present?
- small cell (central)
- non small cell -
- adenocarcinoma (non smokers) (peripheral),
- squamous cell carcinoma (central),
- large cell lung carcinoma (peripheral)
What are the signs and symptoms of lung cancer?
- SOB
- cough
- haemoptysis
- finger clubbing
- recurrent pneumonias
- weight loss
- lymphadenopathy (supraclavicular)
- hoarse voice (pancoast tumour pressing on recurrent laryngeal nerve)
- superior vena cava syndrome
What investigations should you conduct for suspected lung cancer?
- CXR
- CT - contrast enhanced (must be done in suspected and confirmed cancer and before bronchoscopy/biopsy)
- Bronchoscopy
- PET- CT scanning (preferentially taken up by neoplastic cells, typically used for non small cell to establish eligibility for curative tx)
- Bloods
- Histology
What might you see in cxr in lung cancer?
- Hilar enlargement
- Peripheral lung opacity
- Pleural effusion
- Collapse
What are the treatment options in Lung Cancer?
NSCLC
- surgery is first line (only 20% eligible) - lobectomy or segmentectomy. mediastonoscopy performed as CT does not always show mediastinal lymph node involvement
- Radiotherapy can also be curative
- Chemotherapy can be given as adjuvant or palliative
What are contraindications to surgery in NSCLC?
assess general health
stage IIIb or IV (i.e. metastases present)
FEV1 < 1.5 litres is considered a general cut-off point*
malignant pleural effusion
tumour near hilum
vocal cord paralysis
SVC obstruction
What are extra-pulmonary features of lung cancer not specific to a particular type?
- superior vena cava obstruction
- Recurrent laryngeal nerve palsy
- Phrenic nerve palsy
- Horner’s syndrome (due to pancoast tumour)
How does superior vena cava obstruction present?
What sign should you look out for?
- facial swelling
- difficulty breathing
- distended veins in the neck and upper chest
Pemberton’s sign
raising the hands over the head causes facial congestion and cyanosis. EMERGENCY
What does phrenic nerve palsy lead to and how does it present in lung cancer?
nerve compression causes diaphragm weakness
presents as SOB
What is the Horner’s syndrome triad?
What causes it?
- ptosis
- meiosis
- anhidrosis (on half the face)
caused by tumour in the pulmonary apex (PANCOASTS tumour) pressing on sympathetic ganglion
What are paraneoplastic syndromes associated with Small cell lung cancer? (4)
- Syndrome of inappropriate ADH (SIADH) caused by ectopic ADH secretion - presents with hyponatraemia
- Cushing’s syndrome can be caused by ectopic ACTH secretion
- Limbic encephalitis - antibodies (anti-Hu) to limbic system –> short term memory impairment, hallucinations, confusion, seizures
- Lambert eaton myasthenic syndrome
What paraneoplastic features is squamous cell lung cancer associated with? (4)
- hypercalcaemia due to ectopic Parathyroid hormone secretion
- hyperthyroidism due to ectopic TSH
- hypertrophic pulmonary osteoarthropathy (HPOA)
- CLUBBING
What paraneoplatic features is Adenocarcinoma associated with?
- gynaecomastia
2. hypertrophic pulmonary osteoarthropathy (HPOA)
How is Large cell lung carcinoma defined?
What can it secrete?
Anaplastic, poorly differentiated, with poor prognosis
β-hCG
What is the management of SCLC?
usually metastatic disease by time of diagnosis
patients with very early stage disease (T1-2a, N0, M0) are now considered for surgery.
most patients with limited disease receive a combination of chemotherapy and radiotherapy
patients with extensive disease offered palliative chemo
What is Lambert Eaton Myasthenic Syndrome?
What type of cancer causes it?
antibodies against presynaptic voltage gated calcium channels in the PNS
small cell lung cancer. less commonly breast and ovarian
How does Lambert Eaton Myesthenic Syndrome present?
- repeated muscle contractions lead to increased muscle strength (in contrast to myasthenia gravis) (only seen in 50%, after prolonged use muscle strength will generally decrease)
- limb-girdle weakness (affects lower limbs first)
- hyporeflexia
- . autonomic symptoms: dry mouth, impotence, difficulty micturating
- . ophthalmoplegia and ptosis not commonly a feature (unlike in myasthenia gravis)
What investigation would you do for LEMS and what would you expect to see?
EMG: incremental response to repetitive electrical stimulation
How do you manage LEMS?
- treat underlying cancer
- immunosuppression with azathioprine or prednisolone
- 3,4 diaminopyridine, IVig
What is mesothelemia?
What is it associated with?
Prognosis and management?
malignancy of mesothelial cells of pleura
storngly associated with asbestos, huge latent period of up to 45 yrs
poor prognosis, mainly palliative chemo
