Lung Cancer - Clinical Features and Staging Flashcards
What are RFs for developing lung cancer?
Smoking Passive smoking Exposure to asbestos Air pollution Diesel exhaust
What are signs and symptoms of lung cancer?
Chronic cough Haemoptysis Wheeze SoB Chest pain Wt loss, anorexia Hoarseness SVC syndrome Lymphadenopathy (cervical/supraclavicular) Clubbing
What patients with lung cancer will get hoarseness?
Pancoast tumours pressing the recurrent laryngeal nerve
What are symptoms of advanced/metastatic lung cancer?
Bone pain
Spinal cord compression –> limb weakness, paraesthesia, bladder/bowel dysfunction
Cerebral mets –> headache, vomiting, dizziness, ataxia, focal weakness
Thrombosis
What are symptoms someone with a paraneoplastic syndrome might get?
Hyponatraemia (SIADH) Anaemia Hypercalcaemia (PTHrP) Dermatomyositis/polymyositis Eaton-Lambert syndrome (proximal muscle weakness) Cerebellar ataxia Sensorimotor neuropathy
What cancers is Lambert-Eaton syndrome associated with?
Mostly associated with small cell lung cancer
(Less so with breast + ovarian cancer)
May occur independently as an autoimmune condition
What causes Lambert-Eaton syndrome?
Antibodies directed against presynaptic voltage gated calcium channels in the peripheral nervous system
What are features of Lambert-Eaton syndrome?
Repeated muscle contractions leads to increased muscle strength
Limb girdle weakness (lower limbs first)
Hyporeflexia
Autonomic symptoms - dry mouth, impotence, difficulty micturating
What do you see on EMG in Lambert-Eaton syndrome?
Incremental response to repetitive electrical stimulation
How is Lambert-Eaton syndrome managed?
Treat underlying cancer
Immunosupression, e.g. prednisolone +/- azathioprine
3, 4-diaminopyridine
IV Ig therapy + plasma exchange
What is SIADH?
Syndrome of inappropriate ADH secretion is characterised by hyponatraemia secondary to dilutional effects of excessive water retention
What are causes of SIADH?
Small cell lung cancer, pancreatic + prostate cancer
Stroke, SAH, subdural haemorrhage, meningitis/encephalitis/abscess
TB, pneumonia
Drugs - SUs, SSRIs, TCAs, carbamazepine, vincristine, cyclophosphamide
Others - positive end expiratory pressure, porphyrias
How is SIADH managed?
Correct slowly
Fluid restrict
Demeclocycline
ADH receptor antagonists
Why must you correctly SIADH slowly?
To avoid precipitating central pontine myelinolysis
How does demeclocycline work?
Reduces responsiveness of collecting tubule cells to ADH
What initial investigations are useful to do in someone who has just been diagnosed with lung cancer?
CXR, FBC, LFTs, U&E, calcium, clotting screen, spirometry
Which of NSCLC and SCLC carries a worse prognosis?
SCLC
What kind of tumour do you usually get with bronchial adenoma?
Carcinoid
What is important to remember about alveolar cell carcinomas?
++ sputum
NOT related to smoking
How is lung cancer staged?
TNM
What is T1 lung cancer?
<=3cm surrounded by lung/visceral pleura, not involving main bronchus
1a <=1cm
1b 1-2cm
1c 2-3cm
What is T2 lung cancer?
3-5cm or involves main bronchus, visceral pleura or aletectasis or post-obstructive pneumonitis extending to hilum
What is T3 lung cancer?
5-7cm or tumour involving chest wall, pericardium, phrenic nerve or satellite nodules in same lobe
What is T4 lung cancer?
> 7cm or invades mediastinum, diaphragm, heart, great vessels, recurrent laryngeal nerve, carcina, trachea, esophagus, spine or separate tumour in different lobe of ipsilateral lung
What is N0 in lung cancer staging?
No regional LN involvemetn
What is N1 in lung cancer staging?
Involvement of ipsilateral hilar/ipsilateral peribronchial nodes
What is N2 in lung cancer staging?
Involvement of mediastinal/subcarcinal nodes
What is N3 in lung cancer staging?
Involvement of contralateral mediastinal/hilar or ipsilateral scalene/supraclavicular
What is M0?
No distant mets
What is M1?
Distant mets present
What are the performance statuses?
0 = fully active 1 = symptoms but ambulatory 2 = up and about >50% of time, unable to work 3 = up and about <50% of the time, limited self care 4 = wheelchair/bed bound
What surgeries may be offered for lung cancer?
Wedge resection
Lobectomy
Pneumonectomy
What kind of radiotherapies may be offered for some patients with lung cancer?
Radical
Palliative
Stereotactic
What targeted therapies may be used in treating lung cancer?
TKIs
Monoclonal antibodies, e.g. enotinib, getitinib
What chemotherapies may be used in treating lung cancer?
Small cell, e.g. cisplatin/etoposide
Adenocarcinoma, e.g. cisplatin/pemetrexed
Squamous, e.g. cisplatin/gemcitabine
What may be involved in managing palliative lung cancer?
Symptom control - chemo/radio, opiates, bisphosphonates, benzos
Treat hypercalcaema, dehydration, hyponatraemia
