Lung cancer, sarcoids Flashcards
Most common lung cancer type
SCC (35%)
Most common lung cancer type in non-smokers and more common in M/F
Adenocarcinoma (25%)
SCC behaviour
Locally invasive Metastasise late PTHrP --> raised calcium Hyperthyroiditis HPOA +clubbing
Adenocarcinoma pathology and behaviour
Peripherally located
Gynaecomastia
Glandular differentiation
Extrathoracic mets common + elderly
Large cell pathology and behaviour
Peripheral/central
Large, poorly differentiated cells
Poor prognosis
Small cell pathology
Central location, near bronchi
Small, poorly differentiated cells
Small cell behaviour
80% present late
Very chemosensitive but poor prognosis
SIADH (reduced Na)
Ectopic ACTH (Cushing’s syndrome), lamberton-Eaton
Complications of lung cancer
Recurrent laryngeal and phrenic nerve palsy
SVC obstruction, AF
Horner’s
Other paraneoplastic features in lung cancer
DERN
Derm - acanthosis nigricans, trousseau syndrome
Endo: serotonin - carcinoid (flushing, diarrhoea, wheeze, pulmonary stenosis, telangiectasis)
Rheum - Dermatomyositis/polymyositis
Neuro - Purkinje cells, peripheral neuropathy
Imaging for lung cancer
CXR, contract enhanced volumetric CT, PET-CT, radionucleotide bone scan
Biopsy in lung cancer for peripheral lesions and normal lesions
Peripheral - percutaneous FNA
Bronchoscopy/endoscopic bronchial ultrasound biopsy
Mx lung cancer
MDT
NSCLC - surgical resect, radio, chemo (platinum based)
SCLC - may respond to chemo
Epidemiology of lung cancer
19% of all cancers
27% of cancer deaths - commonest
ARDS pathogenesis and CXR image
Direct pulmonary insult
2ndry to severe systemic illness
CXR - bilateral perihilar infiltrates
Pulmonary causes of ARDS
pneumonia, aspiration, contusion, inhalation injury
Systemic causes of ARDS
Shock, sepsis, trauma, haemorrhage
Acute liver failure, pancreatitis, DIC
Lung cancer referral if:
CXR findings suggestive
Aged >40 with unexplained haemoptysis
Lung mets to
Breast, kidney, GI tract
Age, sex, ethnicity seen in sarcoidosis
Age: 20-40
Sex: F>M
Geo - Afro caribbean
Acute sarcodosis features
Erythema nodosum, fever, BHL (bi-hilar lymphadenopathy), polyarthralgia
General sarcoidosis features
fever, anorexia + weight loss
fatigue, lymphadenopathy + HSM
Resp stages in sarcoidosis
Upper - otitis + sinusitis Lower - Dry cough, SOB, chest pain 1 - BHL 2 - BHL + peripheral infiltrates 3 - Peripheral infiltrates alone 4 - Progressive mid-zone fibrosis
Derm, arthralgia and abdo features in sarcoidosis
Derm - erythema nodosum, lupus pernio
Abdo - hepatomegaly + cholestatic LFTS, spenomegaly
Arthralgia - polyarthralgia, dactylitis
Neuro, renal + hormonal, sarcodosis features
Neuro - peripheral/cranial polyneuropathy, meningitis, transverse myelitis
Renal - raised Ca–>stones, nephrocalcinosis, DI
Low hormones - pituitary dysfunction
Ophthal and myocardial sarcodosis features
Ophthal - uveitis, keratoconjunctivitis, sicc
Myocardial - pericardial effusion, restrictive cardiomyopathy
BHL differential
Sarcoidosis
Infection - TB, mycoplasma
Malignancy - lymphoma, carcinoma
Interstitial disease - EAA, silicosis
Blood results
Raised - ESR, Ca, serum ACE, Ig, LFTs
Lymphopenia
Other Ix in sarcoidosis
CXR, CT, MRI
Tuberculin skin test - negative in 2/3
Tissue biopsy
Rx sarcoidosis acute and chronic
Acute - bed rest and NSAIDs, spontaneous resolution
Chronic - steroids 40mg, immunosuppression
