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