Lung Cancers Flashcards
Anatomical Point of bifurcation of trachea?
carina
what is stridor?
inspiratory wheeze
why can you get hoarseness in lung cancer?
can get local invasion into recurrent laryngeal nerve
dysphagia for solids is often a pointer to a tumour where?
oesophagus
local invasion to the pericardium is one of the causes of?
atrial fibrilation
In lung cancer, wasting of the small mucsles in the hand is due to?
T1 root infiltration by a primary lung cancer in the apex of the lung
what happens when the tumour invades the pleural space
generates a large volume of pleural fluid
why would a patient with LC get puffy eyelids and a headache?
local invasion of the SVC obstructs drainage of the blood from the arms and the head
why would you get distended veins visible on the abdomen and thorax?
the blood flow is bypassing the obstructed SVC by opening up the anastomosis with the IVC tributaries
when will the patient often describe pain which is worse at night?
when there is bone erosion
when would you get localised chest wall pain, worse with movement?
when there is chest wall invasion
primary sites of metastases for a primary lung cancer?
brain, liver, bone, lung, adrenal, skin
how could liver mets present as obstructive jaundice?
mets can obstruct biliary drainage
common presentation of bone mets?
localised pain which is worse at night, pathological fracture
what type of scan can demonstrate skeletal mets?
isotope bone scan
what are paraneoplastic symptoms?
features result from the effects of biochemically active products from the primary tumour. They are NOT indicative of metastatic disease.
features result from the effects of biochemically active products from the primary tumour. They are NOT indicative of metastatic disease.
why can you get hypercalcaemia?
the tumour can produce a substance which mimics the effects of parathyroid hormone
features of hypercalcaemia?
bones, stones, groans, psychiatric moans
headaches, confusion, thirst and constipation
calcium can cause confusion in an older person, mimic dementia
y
why would you get low sodium ?
1y tumour can produce a substance which mimics ADH, causing a low plasma sodium
syndrome that mimics myasthenia gravis and causes weakness?
eaton lambert syndrome
anyone with a new presentation of finger clubbing must have ?
a chest x ray
why is thrombophlebitis common in patients with lung cancer?
It is a reminder of the increased coagulability of blood in cancer patients
hypercalcaemia pneumonic/
stones (renal/biliary calculi)
bones (bone pain)
groans (abdo pain, nausea, constipation)
thrones(polyuria)
psychiatric overtones ( depression, anxiety, reduced GCS, coma)
ALSO CARDIAC ARRYTHMIAS
treatment of high calcium?
rehydration
if very high on admission, can use IV biphosphonate
SIADH associated with which kind of lung cancer?
small cell
how does SIADH result in low sodium?
there is a diltution of solutes, resulting in low sodium
what does coughing in a cancer patient feel like?
tying to cough something up but it won’t come
almost all smokers cough something up in the morning. what does this look like
clear sputum
when do you get haemoptysis?
when tumour invades through mucosa and causes bleeding
why is localised chest wall pain worrying?
it indicates local chest wall invasion
how does Positron Emission Tomography work?
scan to assess the function of the lungs
analysis of uptake of radio labelled glucose
tissues with high metabolic activity light up
what do you need to make the diagnosis with certainty?
tissue biopsy
how can you get a biopsy?
bronchoscopy (biopsy and brush cytology)
what is medical thorascopy?
Under sedation and with local anaesthetic the semi-rigid scope is inserted between the rib spaces. The lung is deflated to allow visualisation of the pleural surfaces. Biopsies can be taken from the pleura
risk factors for lung cancer?
smoking asbestos - increases risk of lung ca by a factor of 5 arsenic radon nickel chromate aromatic hydrocarbon cryptogenic fibrosing alveolitis
smoking and asbestos are synergistic i.e. a smoker with long term asbestos exposure has a 10*5 risk = 50x risk
what is often the first investigation done in patients with suspected lung cancer?
chest x ray (in patients who are diagnosed, 10% had a normal chest x ray)
what is the investigation of choice for suspected lung cancers?
CT
when would you do a PET scan?
non SCLC. aw my. are you eligible for curative treatment
which lung cancer can cause gynaecomastia?
adeno (TT)
which lung cancer associated with small cell lung cancer?
lambert eaton syndrome
the two lung cancers seen exclusively in smokers?
scc and small cell
adenocarcinoma, where is it seen in the lungs?
peripherally (arden)
squamous cell (strap) where is it seen?
centrally
which one secretes ACTH? which hormone does this cancer also secrete?
small cell lung cancer
A C T H
also secretes ADH
which do you get high calcium in?
squamous cell (due to PTH)
