Lung cancer and pleural disease lecture Flashcards
How common is lung cancer?
- One of most common cancers in UK
- Commenest cause of cancer deaths
Assessing x-ray RIP
- Patient name and DOB
- AP/PA?
- Date
- Is it Rotated? - clavicles equidistant from spinous process
- Is there adequate Inspiration - 6 anterior ribs/8-10 posterior ribs?
- Is there adequate Penetration - can you see vertebrae through heart?
RIP
Areas which lung cancer metastasises to?
- Liver
- Brain
- Bones
- Adrenals (sometimes kidney)
- Skin mets
- Splenic
Language for CT interpretation
- Attenuation
- Lower attenuaton = darker
- Higher attenuation = brighter
Language for MRI interpretation
- High signal = bright
- Low signal = dark
Language for PET scan interpretation
- High FDG avidity - bright
- Low FDG avidity - dark
What time do lung cancers often present?
Late - tumours have to get quite large before causing symptoms
Tumour doubling time lung cancer
30-100 days - tumour sometimes doubles while waiting for diagnosis
Intrathoracic presentation symptoms/signs of lung cancer
- Peristent cough that has changed recently
- Haemoptysis
- Monophonic wheeze - one sound, partial blockage of one section of airway at one level
- Increasing breathlessness
- Infection - eg consolidation on CXR or sometimes lobar collapse
Extrapulmonary signs/symptoms of lung cancer
- Hoarseness voice - L RLN nerve compression
- SVCO - headache, faint, breathless
- Dysphagia
- Palpitations - pericardium involved?
- Shoulder/inner arm pain - brachial plexus impinged or bone mets
- Chest pain
- Poor appetite
- Weight loss
- Enlarged lymph nodes
- Clubbing
- Cushings syndrome?
What 2 things are important to ask about in history (apart from presenting complaint) for lung cancer?
- Smoking history
- Occupation history
How to ask smoking history?
- Do you smoke now?
- If yes, how much and for how long and has this changed recently?
- If no, have you ever smoked?
- Do you smoke anything else?
How to ask occupation history?
- What was the nature of exposure? (eg asbestos powder?)
- When were you exposed until when?
- Who was your employer?
- Was there protective gear provided?
Death certificates if mesothelioma or if someone has received a war pension?
Goes to coroner - they determine cause of death
Assessing suitability for management of lung cancer?
WHO performance status
How to deliver to someone that their scans may show cancer?
- I can’t be certain what this is yet
- Possibilities include infection, TB, inflammation and another possibility, something I need to make sure I rule out is a growth in the lung, possible even a lung cancer
- But all we can be sure of at the moment are the pictures of your scans
- Offer contact details of cancer nurse specialists
Inv for lung cancer - bloods
- U&E
- LFT
- Calcium
- FBC
- Clotting - esp if thinking of biopsy
Imaging for lung cancer suspect
- CXR
- Staging CT - contrast from neck to adrenals
- +/- CT head, PET-CT (with FDG radioactive glucose)
Special tests for suspected lung cancer
- Spirometry and transfer factor (DLCO diffusing capacity carbon monoxide)
- = Ability of lungs to transfer inhaled gas to bloodstream
- ECHO
What can areas of high avidity be on PET scan?
- Abscess
- Infection eg TB
- Cavitating tumour?
- Cancer
- General inflammation
When can we biopsy lung cancers?
If closer to pleura
Ways of biopsying lung cancers?
- bronchoscopy
- EBUS - endobronchial US - can use bronchoscope + US to see lymph node masses nearby just outside airway wall, can then biopsy these
- Image guided biopsy - eg from outside pt
Types of lung cancer
- Small cell - neuroendocrine, aggressive
- Non-small cell - squamous, large cell, adenocarcinoma
Squamous cell sub divisions
PD-L1
