lung cancer lms Flashcards
other risk factors for lung cancer
pulmonary fibrosis
exposure to environmental tobacco smoke
HIV infection
genetic factors: arsenic, radon gas
non small cell lung cancer
85% of cases
- adenocarcinoma (50%)
- squamous cell (30%)
- large cell (undifferentiated)
small cell carcinoma
15% of cases
adenocarcinoma.
further subdivided into moldecular phenotypes
drugs targeted to specific phenotypes being developed
EGFR is the mot common and can be treated with tyrosine kinase inhibitors
common presentations
- new perisstant cough +/- haemoptysis
most patients with haemoptysis have something other than lung cancer, but the presence is still a red flag
breathlessness - cancer may be causing pleural effusion, obstruction or lobar collapse
weight loss, fatigue, non specific symptoms
bone pain
incidental CXR
increasingly patients are picked upp on incidental CXR or CT
follow up incidental lung nodules
classical presenting syndromes
pancoasts tumour - tumour in the apex of the lung erodes into the brachial plexus and patient presents with horner syndrome due to loss of sympathetic innervation, pain and muscle wasting in the arm or hand
superior vena cava obstruction - central tumour in the mediastinum eroding into venous return from the head and neck
left recurrent leryngeal nerve palsy - tumour at left hilum causes hoarseness of the voice
bone mets - causes hypercalcaemia, poor prognostic faeture
pancoasts tumour
tumour in the apex of the lung erodes into the brachial plexus and patient presents with horner syndrome due to loss of sympathetic innervation, pain and muscle wasting in the arm or hand
SIADH
syndrome of innappropriate ADH
leads to hyponatraemia
tumour in the apex of the lung
might cause pancoasts syndrome
at left hilum
lobal collapse of left upper or lower lobe
or
left laryngeal nerve palsy causing hoarse voice
at right hilum
lobar collapse
superior mediastinum
super vena cava obstruction
a peripheral tumour might cause
chest wall pain if it erodes into the pleura
a tumour in the middle of the lung may be
completely asymptomatic because there are no pain receptors in the lung
investigation
FBC, calcium, renal function (because youre going to need to use contrast), LFTs
CXR
CT chest and abdomen - with contrast for anatomical localisation and staging
lung function tests
involve respiratory physician for histology and staging
biopsy required for histology
PET scan
assess involvement of regional lymph nodes/presence of mets
PET and CT simultaneous scan used to find mets - shows areas of increased metabolic uptake likely to be due to cancer activity
how to stage the tumour
biopsy required for histology
bronchoscopy for central tumours - combine with endobronchial USS for mediastinal lymph node sampling
sputum cytology
not first line
only recommended in extremely frail patients with central tumours in whom any other type of investigation would be innapprpriate
staging for non small cell lung cancer
stages 1-4 depending on size, site, LN involevment
metastasses (distant mets = automatic staage 4 cancer)
staging for small cell lung cancer
‘limited stage’ = within thorax
‘extensive stage’ = outside the thorax
surgery not offered as treatment for small cell lung cancer
common sites of. mets
liver, adrenal glands, bones, spine, brain
can also metastasis to other lobes of the same lung or to the other lung
treatment for non small cell lung cancer
surgery is the only chance for cure (only 11-12% of cases are operable)
for everyone else care is applaitive: chemotherapy and radiotherapy
chemotherapy for non small cell lung cancer
palliative
tyrosine kinase inhibitors for EGFR positive
drugs are expensive and improve quality of life but not length of life
radiotherapy for non small cell cancer
high dose is localised and innoperable (attempt for cure)
palliative for symptom control
treatment for small cell lung cancer
chemotherapy is first line
most therapy will have a good remission
when the tumour recurs further treatment is available but treatment is not curative
prognosis
poor
5 year survival overall is 15%
screening for lung cancer
numerous trials for cancer screening
for high risk groups
annual low dose non contrast CT scans
major implications for resources due to follow up of numerous nodules/abnormalities