Lung - presenting symptoms and investigations

Question 1

What is the typical presentation of lung cancer?

Answer 1

• shortness of breath
• coughing
• chest pain
  (these are the main ones)
• less common are: chest infection, hoarseness, malaise, weight loss

Question 2

What causes finger clubbing?

Answer 2

• change in shape at the end of fingers
• NSCLC, caused by fluid collecting at end of fingers
• Thought to be due to hormone production

Question 3

What is pancoasts syndrome?

**

Answer 3

• Pain caused by local tumour spread

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Question 4

What is horner syndrome?

Answer 4

• Sympathetic ganglion is involved and damaged
• results from damage to the sympathetic nervous system
• drooping of one eyelid/smaller pupil#
• reduced or absent sweating on one side of face

Question 5

What is Superior vena cava syndrome?

Answer 5

• Tumours press on SVC
• blood can back up in veins
• swelling in face, neck, arms, upper chest
• can cause headaches and distension of jugular veins on chest
• can be gradual or life threatening

Question 6

What are paraneoplastic syndromes?

Answer 6

• non-endocrine, non-metastatic complications
• rare
• thought to occur when white blood cells attack normal cells in the nervous system
• often associated with small cell
• often will be diagnosed before the cancer

Question 7

What is HPOA?

Answer 7

• hypertrophic pulmonary osteoarthropathy (mostly small cell)
• Joint stiffness sometimes severe pain
• End of long bones will have onion skin appearance
• associated with finger clubbing
• often caused by a blood borne tumour releasing a hormone

Question 8

What will metastatic disease present with?

Answer 8

• bone pain
• nervous system changes
• jaundice
• lumps near the surface of the body

Question 9

What are some of the challenges associated with lung cancer diagnosis?

Answer 9

• late presentation!

Question 10

What are the aims of investiagtions?

Answer 10

• to establish an accurate diagnosis
• to determine the stage of the cancer
• to determine the patient’s overall fitness
• to inform the patients overall management plan

Question 11

Are chest x-rays effective?

Answer 11

• No, lung tissue does not absorb enough radiaiton, little difference between tumour and tissue
• Will detec advnced cancer
• lacks sensitivity to detect mediastinal node mets and chest wall/mediastinal metastasis
• low cost

Question 12

How is sputum cytology used?

Answer 12

• examines the presence of abnormal cells
• detects more cancers and in particular resectable cancers
• showed improved survival in screened groups but overall mortality compared with control did not change
• not to be used in isolation

Question 13

How is CT scanning used

Answer 13

• can detect lymph nodes better
• decetion of invasion into cardi and vascular structures
• tumour immobilisation
• overall allows for more accurate size measurement and earlier detection
• unreliable on own
• to be used before biopsy

Question 14

Percutaneous FNA biopsy?

Answer 14

• Needle passed through skin and muscle of chest under local anaesthetic
• acquire cells of tumour itself
• patholodical confirmation
• uncomfortable
• may require a hospital stay

Question 15

What is pleural aspiration cytology?

Answer 15

• FNA cytologic technique
• Via airway or chest wall
• if not candidate for surgery, may be only available method for obtaining a diagnostic specimen
• risks include spread through pleural space although new technologies make less likely

Question 16

What is an EBUS?

Answer 16

• Bronchoscopy with ultrasound
• under GA
• Bronchoscope passed through trachea, pass into smaller areas
• probe end of bronchoscope creates u/s
• assess tumour size and nodes

Question 17

The liverpool lung project?

Answer 17

• aim to reduce cancer mortality by enabling early detection usng molecular and epidermal risk