Lung Carcinoma Flashcards
Which organs typically metastasise to the lungs?
- Kidney
- Prostate
- Breast
- Bone
- GI
- Cervix
- Ovary
How are lung carcinomas differentiated?
SMALL CELL CARCINOMA (SCC) - 15%
NON-SMALL CELL CARCINOMA (NSCC) - 85%
- Squamous - 42%
- Adenocarcinoma - 40%
- Large cell - 10%
Which lung carcinoma are non-smokers most likely to get?
Adenocarcinoma
What are the risk factors of lung cancer?
> Smoking (MAIN)
increases risk of lung ca by a factor of 10
Other factors >asbestos - increases risk of lung ca by a factor of 5 >arsenic >nickel >aromatic hydrocarbon >cryptogenic fibrosing alveolitis
What are the symptoms of lung cancer?
>Weight loss >SOB >Persistent Cough >Haemoptysis >Chest pain >Fatigue
Define small cell carcinoma
> Cancer growth rising from APUD endocrine system and secrete substances that act as hormones or neurotransmitters.
> Fast growing, highly malignant, poor prognosis
What is a pancoast tumour?
Usually NSCLC in apex of lung surrounding nearby tissue
What are common symptoms of pancoast tumour?
Brachial plexus Invasion
- Small muscle wasting
- Weakness in arm and hand
- Pain down arm
Sympathetic ganglion invasion (HORNER’S)
- Miosis (pupil constriction)
- Anhidrosis (Inability to sweat)
- Ptosis (drooping of eyelid)
What are some common signs of lung cancer?
- Clubbing
- Supraclavicular abnormality
- Bone pain/fracture
- Seizures
- Dilated neck/chest veins
What is meant by paraneoplastic syndrome?
- These are the non-metastatic distant effects of a cancer
- Due to the excretion of hormones and cytokines form a tumour
- OR the body’s own immune response to the tumour
Usually seen in SMALL CELL
What are paraneoplastic features of small cell?
- Syndrome of inappropriate antidiuretic hormone secretion (SiADH)
- Excess ADH from posterior pituitary =
- Hyponatraemia
- Fluid overload - Inappropriate ACTH secretion
- Leads to Cushing Syndrome features
- Mainly HTN, hyperglycaemia, hypokalaemia, alkalosis, muscle weakness - Lambert-Eaton syndrome
- Myasthenia due to antibodies affecting the NMJ causing peripheral weakness
What are paraneoplastic features of squamous cell (NSCLC)?
- Parathyroid hormone-related protein release leading to hypercalcaemia
- Hypertrophic pulmonary osteoarthropathy
- Clubbing
- Wrist and ankle joint pain due to inflammation of the periosteum of long bones - Hyperthyroidism
- Due to ectopic TSH
What is the paraneoplastic feature of adenocarcinoma?
Gynaecomastia
What neurological deficits can any type of lung cancer cause?
- Encephalopathies
- Myelopathies
- Neuropathies
- Muscular disorders - proximal myopathy
What are the main investigations for lung cancer?
Bloods
- FBC = anaemia
- Other biochemistry = liver involvement, hypercalcaemia, hyponatraemia
Imaging
- CXR/CT for staging
- PET for staging/mets
- Bone scan for metastatic involvement
Scope
-Bronchoscopy and biopsy = cytology
What are CXR features of lung cancer?
Central mass Hilar lymphadenopathy Pleural effusions -Lung collapse -Mediastinal/hilar fullness
How is non-small cell lung carcinoma generally managed?
Surgery
- Only 20% suitable for surgery
- Mediastinoscopy performed prior to surgery as CT does not always show mediastinal lymph node involvement
- Contraindicated if stage IIIb or IV (mets present)
Radiotherapy
-curative or palliative radiotherapy
Chemotherapy
-poor response
How is small cell lung carcinoma generally managed?
-Usually metastatic disease by time of diagnosis
Surgery
-Patients with very early stage disease (T1-2a, N0, M0) are now considered for surgery.
Limited disease
-Chemotherapy and radiotherapy
Extensive disease
-Palliative chemotherapy
