Lung Cancer: clinical features, staging and diagnosis Flashcards
Metastatic symptoms (4)
Bone pain
Spinal cord compression
Cerebral metastases
Thrombosis
Paraneoplastic Symptoms (3)
Hyponatraemia
Anaemia
Hypercalcaemia
Clinical signs
Chest signs Clibbing Lymphadenopathy Horner's syndrome Pancoast tumour SVC obstruction Hepatomegaly Skin nodules
What is horner’s syndrome
a condition marked by a contracted pupil, drooping upper eyelid, and local inability to sweat on one side of the face, caused by damage to sympathetic nerves on that side of the neck.
What is a pancoast tumour
Tumour of the pulmonary apex
Initial investigations done by GP
CXR FBC Renal, liver functions and calcium Clotting screen Spirometry
Investigations- Tissue Diagnosis
Bronchoscopy EBUS Image guided lung/liver biopsy FNA of neck node or skin metastases Bone biopsy Mediastinoscopy Surgical excision biopsy
Treatment
Surgery (wedge resection, lobectomy, pneumonectomy)
Radiotherapy (radical or palliative or stereoactive)
Chemotherapy
Targeted agents
What are examples of target agents
Tyrosine kinase inhibitors and monoclonal antibodies (erlotinib, geftinib and crizotinib)
Small cell carcinoma treatment
Cisplatin/etoposide
Adenocarcinoma treatment
Cisplatin/pemetrexed
Squamous cell carcinoma treatment
Cisplatin/gemcitabine
TNM
T: how big it is and the spread
N: Lymph node involvement
M: Metastases
What can be used to investigate T
CT
PET-CT
Bronchoscopy
What can be used to investigate N
PET-CT
Mediastinoscopy
CT
EBUS/EUS
What can be used to investigate M
PET-CT
CT
Bone scan
What is the half life post injection of FDG in PET scan
60 minutes
Tx/T0/Tis
Primary tumour can’t be assessed
No evidence of primary tumour
Carcinoma in situ
T1
< or equal to 3cm in dimension
T2
Tumour is between 3-5cm and involves main bronchos but not carina and invades visceral pleura
T3
Tumour between 5-7cm and invades chest wall, phrenic nerve
T4
Tumour greater then 7cm and invades: Diaphragm Mediatinum Heart Great vessels Trachea Recurrent laryngeal nerve Oesophagus Vertebral body Carina
N0
No regional LN metastases
N1
Ipsilateral peribronchial, hilar or intrapulmonary nodes
