Lung Cancer: Clinical Features and Staging Flashcards
What are the risk factors for lung cancer?
Smoking
Passive smoking
Exposure to asbestos, radon, air pollution and diesel exhaust
What are the signs of lung cancer?
Chronic coughing, Haemoptysis, wheezing, chest pain, chest infections, difficulty swallowing, hoarse voice, shortness of breath, unexplained weight loss, nail clubbing
What are the metastatic symptoms in advanced disease?
- Bone pain
- Spinal cord weakness (limb weakness, paraesthesia, bladder/bowel dysfunction)
- Cerebral metastases (Headache, Vomiting, Dizzieness, Ataxia, Focal weakness)
- Thrombosis
What are the paraneoplastic symptoms of advanced disease?
- Hyponatraemia
- Anaemia
- Hypercalcaemia: Parathyroid hormone related protein and Bone metastases
- Dermatomyitis/Polymyositis: Proximal muscle weakness
- Eaton Lambert Syndrome: Upper limb weakness
- Cerebellar ataxia
Sensorimotor neuropathy
What are the clinical signs of lung cancer?
- Chest signs
- Clubbing
- Lymphadenopathy
- Horners Syndrome
- Pancoast tumour
- Superior vena cava obstruction
- Lymphadenopathy
- Hepatomegaly
- Skin nodules
What are the inital investigations in lung cancer?
Chest X-ray Full Blood Count Renal, Liver functions and calcium Clotting screen Spirometry
What are the investigations to get tissue diagnosis for lung cancer?
Bronchoscopy
- EBUS
- Image guided lung biopsy
- FNA of neck node or skin metastasis
- Excision of cerebral metastasis
- Bone biopsy
- Mediastinoscopy/otopy
- Surgical exicision
What are treatment decisions for lung cancer?
- Performance status
- Patient wishes
- Histological type and stage
- Multidisciplinary team
- Aims of treatment
What is the performance status?
0 - fully active 1 - symtoms but not ambulatory 2 - "up and about" > 50%, unable to work 3 - "up and about" < 50%, limited self care 4 - bed or chair bound
what are various treatments of lung cancer?
- Surgery (wedge section, lobectomy, pneumonectomy)
- Radiotherapy (radical, palliative, stereotactic)
- Chemotherapy
- Best supportive care
- Co-ordination - Lung cancer specilaist nurse
What is palliative management during lung cancer?
- Symptom control (chemo, radiotherapy,
- Quality of life
- Community support
- Decisions and planning, resuscitation status, end of life care
Which types of lung cancer have high associations with smoking?
Squamous cell and small cell carcinoma
What does prognosis depend on?
Staging and cell type
What is prognosis like for small cell carsinoma and adenocarcinoma?
Small cell = bad
Adenocarcinoma = good
What is the point in a PET scan?
To determine micrometastasis in all parts of the body
