Lung Malignancy Flashcards
When performing a CT-thorax what are the two major requirements for safe use of a contrast agent?
- Check her eGFR before giving contrast, since they are cleared by the kidneys.
- Keep the patient under observation for an extra 15 minutes after the imaging to ensure against any contrast reaction.
What is the brock calculator?
A brock university cancer prediction equation, it estimates the probability that a lung nodule will be diagnosed as cancer within a 2-4 year follow up period.
Variables: Age Sex Family hx of lung cancer Emphysema Nodule size Nodule type - nonsolid/partially solid/solid Nodule in upper lung Spiculation (spiky)
Online calculators works by handling the missing information and allows clinicians to explore the effect of extra tests on the final probability of disease.
Which is better: a cold or a hot lesion, as measured by PET?
A cold lesion is better since it is less metabolically active:
cold lesion - 20% risk that lesion is malignant
Hot lesion - 95% risk that lesion is malignant
Finding a lung nodule needs follow up, with a high probability of malignancy in the brock calculator and a positive PET scan, the probability of malignancy is 100%
Why is a PET scanner warm?
For the same reason that patients shouldn’t talk: the scanner shows up any areas using glucose, including brown fat when a patient is cold
How is diagnosis and staging of bronchial carcinoma carried out?
(Why do we diagnose AND stage….?)
- Clinical symptoms (sometimes silent/asymptomatic, or metastatic)
- Urgent CXR within 2 weeks if
- over 40 with two unexplained symptoms (A)
-Or over 40 and have smoked and have one unexplained symptom (A)
A= cough, fatigue, dyspnoea, chest pain, weight loss, appetite loss
- 2 week suspected cancer referral (Lung cancer MDT) if:
- over 40 with unexplained haemoptysis
- Or any age and CXR suggests lung cancer
4. CT lungs, liver and adrenal glands (before any biopsy) - NEED DIAGNOSTIC PATHOLOGY AND STAGING: BOTH ARE NECESSARY FOR TREATMENT-
5. Calculate probability (size of nodes) of mediastinal malignancy (I.e. how central are they)
- Probability and location - decide sampling:
Low and peripheral = PET-CT and guided transthoracic needle biopsy (percutaneous via skin)
Intermediate and peripheral/central = Fibreoptic bronchoscopy*, PET-CT TBNA (or EBUS TBNA, or EUS FNA
High and peripheral/central = Neck US and visible lymph node sampling
(*most common investigation, via nose or mouth)
(EBUS - endobronchial ultrasound)
(TBNA - transbronchial needle aspiration biopsy)
(EUS - endoscopic ultrasound)
(FNA - fine needle aspiration)
What would a T2 N1 M0 tumour be?
T2 - >2cm across
N1 - a single node
M0 - no metastases
What is thoracentesis?
Insertion of a needle in to the chest wall and to the pleural space for drainage of pleural effusion.
In the context of a bronchial cancer, what is the relevance of testing EGFR?
EGFR = presence or absence of endothelial growth factor receptor on the non small cell lung cancer
This is dependent on the person’s DNA: if they have a mutation in the EGFR they have a better prognosis.
Wild type EGFR has a worse prognosis.
Only a minority of people have it but it allows for targeted therapy (gefitinib etc) which prevent growth signals, and improves survival rates compared to standard chemotherapy.
If a patient presents with normal blood results except for:
Hyponatremia
High urinary sodium
Fatigue
Which type of cancer is this more likely to be;
Adenocarcinoma or small cell lung cancers?
Small cell lung cancer - SIADH, and ACTH secretion
Adenocarcinoma (non small cell) - PTH secretion
What is Anti-Hu?
Anti-Hu is the ANNA1 autoantibody, also known as a purkinje antibody, they are caused by antigens released by the tumour.
They also attack neurones.
The presence of these may indicate the presence of neurological manifestation of paraneoplastic syndromes.
