Lung cancer: clinical features and staging Flashcards
What is the risk factors for lung cancers
• Smoking (more than 85%)
• Passive smoking
• Exposure to Asbestos, Radon, air pollution,
and diesel exhaust
What is the leading cause of cancer death in men and women
Lung cancer
What is the clinical signs of lung cancer
• Chest signs • Clubbing • Horner’s syndrome • Pancoast tumour • Superior vena cava obstruction • Lymphadenopathy • Hepatomegaly • Skin nodules (metastases) 
What is the symptoms of lung cancer
Chronic cough coughing up blood wheezing Chest and bone pain Chest infection Difficulty swalloing Raspy horse voice Shortness of breath Unexplained weight loss
What is advanced metastatic lung cancer symptoms - when the lung cancer spreads
Bone pain
Spinal chord compression
Cerebral metastases
Thrombosis
What symptoms can a cerebral metastases cause
– Headache – Vomiting – Dizziness – Ataxia – Focal weakness
What is the initial investigations for lung cancer
Chest ray - most common CT scan - thorax + abdomen Kidney function test Full blood count - Check calcium Spirometry - asses lung function Clotting screen - abnormal/normal
What is the best screening tool for lung cancer
chest X ray
What is examples of tissue diagnnosis
• Bronchoscopy - • Fine needle aspiration/biopsy • FNA of neck node or skin metastasis • Mediastinoscopy/otomy - EBUS
How does a bronchoscopy work
Tube passed into airway while patient is under anesthetic
When do we do bronchoscopy
Tumour on the CT scan
What is the different histological types of lung cancerr
Small cell carcinoma
adenocarcinoma - non smoker
Squamous cell carcinoma
Large cell carcinoma
What type of cell type is non smokers and has a good prognosis
adenocaricinoma
How many stages of lung cancer is there
4
What is staging categories based on
Nodes and metastasis
What does the prognosis depend on
staging and cell type
Curative treatment can only be offered to what staging
1 + 2
What cell type has the worst prognosis
small cell carcinoma
What is mandatory to determine if there is further staging (or patients going for surgery)
CT
PET scan
What is treatment decisions based on?
• Performance status • Patient wishes • Histological type and stage • Multi disciplinary team • Aims of treatment e.g. radical or palliative
What is the performance statement ranking?
- 0 = fully active
- 1 = symptoms but ambulatory
- 2 = “up and about” > 50%, unable to work
- 3 = “up and about” < 50%, limited self care
- 4 = bed or chair bound
What is the treatment for lung cancer
Surgery
radio therapy
chemotherapy
best supportive care - just treat symptoms
Co-ordination - lung cancer specialist nurse
palliative care
What is palliative management
symptom control - chemotherapy/radiotherapy, opiates
improve quality of life
offer community support
If the X-ray is abnormal where do you refer
respiratory clinical for CT scan
What is the different surgical treatments of lung cancer
Wedge resection
Lobectomy
Pneumonectomy
