Lung cancers Flashcards
How many lobes are in the R vs L lobe of the lung?
Which fissures divide these?
Right: 3 lobes divided by the oblique and horizontal fissure
Left: 2 lobes divided by the oblique fissure
How can can the histological types of lung cancer can be broadly divided?
Which is more common?
Small cell lung cancer (20%)
Non-small cell lung cancer (80%)
List the 4 types of non-small cell lung cancer
Incl how common each is among total lung cancers
Adenocarcinoma (40%)
Squamous cell carcinoma (20%)
Large-cell carcinoma (10%)
Other types (10%)
Which type of lung cancers are responsible for paraneoplastic syndromes?
Small cell lung cancer
Contain neurosecretory granules that can release neuroendocrine hormones
List 4 histological features of Squamous cell Carcinomas
(CAKE under a bridge)
- Central
- Angulate cells
- Keratin pearls and Keratinisation
- Eosinophiliic cytoplasm
- Intercellular bridges (prickles)
List 4 histological features of an Adenocarcinoma
- Peripheral
- Columnar/cuboidal cells
- Glands (acini) -
- Papillary structures
- May line alveoli
- Some produce mucin
List 4 histological features of Small cell carcinoma
- “oat cell carcinoma”
- Very cellular
- Small nuclei
- Little cytoplasm
- Nuclear moulding
- Necrosis and lots of mitoses
What is a Mesothelioma?
Malignancy affecting the mesothelial cells of the pleura
Mesotheliomas are highly linked with what?
History of Asbestos inhalation
List 4 symptoms of lung cancer
- Haemoptysis
- Finger clubbing
- SOB
- Cough
- Weight loss
- Recurrent pneumonia
- Lymphadenopathy
Which lymph node is most commonly the first to be found on examination?
supraclavicular
What extra-pulmonary manifestation of lung cancer is associated with horse voice?
Recurrent laryngeal nerve palsy
Due to tumour pressing on the RLN as it passes through the mediastinum
If a tumour affects the phrenic nerve how may the patient present and why?
SOB due to diaphragm weakness
Superior vena cava obstruction is a complication of lung cancer, how does it present?
Facial swelling, difficulty breathing and distended veins in the neck and upper chest
What sign associated with SVC obstruction can be elicited on examination?
“Pemberton’s sign” - medical emergency
When raising the hands over the head causes facial congestion and cyanosis
What tumour is associated with Horners syndrome?
Pancoast tumour pressing on the sympathetic ganglion
What is the triad of Horner’s syndrome?
Ptosis, anhidrosis and miosis
Which lung cancer may present with hyponatraemia and why?
Small cell lung cancer
Secrete ectopic ADH causing SIADH
Which lung cancer may present with Cushings Syndrome and why?
Small cell lung cancer which secrete ectopic ACTH
Which lung cancer may present with Hypercalcaemia?
Squamous cell carcinoma which secretes ectopic PTH
What is Limbic encephalitis?
Paraneoplastic syndrome associated with small cell lung cancer
Causes immune system to make antibodies against tissues in the brain, specifically the limbic system, causing inflammation
List 4 symptoms of Limbic encephalitis?
- Short term memory impairment
- Hallucinations
- Confusion
- Seizures
What antibody is associated with Limbic encephalitis?
Anti-Hu antibodies
What is Lambert-Eaton myasthenic syndrome?
Antibodies produced against small cell lung cancer
These antibodies also target VOCC on presynaptic motor neurones
List 4 symptoms of Lambert-Eaton myasthenic syndrome
- Proximal muscle weakness
- Diplopia (intraoccular muscles)
- Ptosis (levator muscles)
- Slurred speech and dysphagia (pharyngeal muscles).
Patients may also experience dry mouth, blurred vision, impotence and dizziness due to autonomic dysfunction
What is the NICE Referral Criteria for suspected lung cancer?
Offer a chest x-ray, carried out within 2 weeks, to patients >40 with:
- Clubbing
- Lymphadenopathy
- Recurrent or persistent chest infections
- Raised platelet count (thrombocytosis)
- Chest signs of lung cancer
List 2 other two instances when we should consider a chest x-ray
Patients over 40 years old who have:
- ≥ 2 unexplained symptoms and never smoked
- ≥ 1 unexplained symptoms in patients that have smoked
Investigations for suspected lung cancer?
Highlight the first line
- Chest x-ray
- Staging CT scan
- PET-CT
- Bronchoscopy with endobronchial ultrasound (EBUS)
- Biospy
List 4 x-ray findings suggestive of lung cancer
- Hilar enlargement
- Peripheral opacity
- Pleural effusion - usually unilateral
- Collapse
What are the 2 ways a biopsy is obtained for suspected lung cancer?
Bronchoscopy or percutaneous biopsy
Management of non-small cell lung cancer?
- Surgery offered first-line if disease is isolated (curative)
- Radiotherapy (curative) if diagnosed early
- Adjuvant chemotherapy
- Palliative chemotherapy
Management of small cell lung cancer?
- Chemotherapy and radiotherapy
- Endobronchial treatment (stents , debulking) for palliative treatment
Is prognosis better for small cell or non-small cell cancer?
Non-small cell lung cancer
List the 3 types of surgery for lung cancer
- Thoracotomy
- Video-assisted thoracoscopic surgery (VATS) – minimally invasive “keyhole” surgery
- Robotic surgery
