Lung Cancer - Clinical Features Flashcards
What exposures increase your risk of lung canceR?
- Smoking
- Asbestos
- Radon
- Air pollution
- Diesel Exhaust
What are the top 10 signs/symptoms of lung cancer?
- Chronic Cough
- Wheeze
- Chest & Bone Pain
- Repeated chest infections
- Swallowing problems
- Raspy hoarse voice
- SOB
- Weight Loss
- Nail Clubbing
What other symptoms arise in advanced lung canceR?
Metastatic & paraneoplastic symptoms
What would horners syndrome, SVC obstruction, hepatomegaly or skin nodules indicate in lung canceR?
It has invaded/metastasised to other tissues
What is Horners Syndrome?
Lung cancer invades the cervical sympathetic ganglion.
Nerve damage causes small pupil, drooping eyelid and loss of sweat in one side of the face
What is a pancoast tumour?
A tumour of lung cancer found at the very apex of the lung.
How do we rank a patients performance?
0-4
0 = fully active
1 = Symptoms but ambulatory
2 = ‘up & about’ for >50% of the day but unable to work
3 = ‘up & about’ <50% and limited in caring for themselves
4 = Bed or chair bound
What initial investigations would be done if lung cancer was suspected?
- CXR
- Full Blood Count (FBC)
- Renal/Liver function
- Calcium level
- Clotting screen
- Spirometry
Why do a calcium test in suspected lung canceR?
Some lung cancers can affect calcium levels hwich in turn affects liver function
Once cancer is confirmed what test would we use to locate it prior to tissue diagnosis?
CTs of the thorax and abdomen
What method of tissue dianosis would we use for a central tumour?
Bronchoscopy
Allows visual and biopsy info
What method of tissue diagnosis would we use for tumour spread to mediastinal nodes?
An EBUS guided procedure (endobronchial ultrasound).
Using a -ve pressure syringe to aspirate cells form the tumour for study
How would we diagnose a peripheral lung tumour?
With an image guided lung biopsy
What would we do if the CT showed a liver tumour?
An image guided liver biopsy
What are the parts of staging?
Staing of a tumour is made up of ‘T’, ‘N’ & ‘M’.
T = Size & evidence of invasion
N = Level of nodal involvement (& which nodes)
M = Presence of metastasis
If there is metastasis what stage of cancer is it?
Always a stage 4 when theres metastasis
If considering surgical treatment what further staging must be done first?
A full body PET scan to map other tumours
Why do we remove a large margin (or even whole lobe/lung) when doing surgery on a lung tumour?
To ensure the entire tumour and nearby micrometastases have been removed
What factors come into lung cancer treatment descisions?
- Performance Status
- Patient Wishes
- Histological type
- Stage
- Aims e.g. radical or palliative
What treatments are available for lung cancer?
- Surgery (18% of patients)
- Radiotherapy
- Chemotherapy
- Best supportive care
What is ‘best supportive care’?
Care designed to treat symptoms, calm any fears and generally improve the patients quality of life.
But not treat the cancer
What are the aspects of pallaiative management?
- Symptom control
- Quality of Life care
- Community support
- Planning for the End
