Non-small cell lung cancer Flashcards
what is the definition of NSCLC?
Lung cancer comprises a group of malignant epithelial tumours arising from cells lining the lower respiratory tract
There are three main types of NSCLC (adenocarcinoma, squamous cell carcinoma, and large cell carcinoma) and these are grouped into further subtypes.
what is the epidemiology of NSCLC?
NSCLC accounts for more than 80% of all lung cancers.
More common in men
Up to 90% caused by smoking
what is the aetiology of NSCLC?
Lung fibrosis
Cigarettes
Occupation (asbestos, nickel)
what is the risk factors for NSCLC?
Cigarette smoking Occupational (asbestos etc) COPD Passive smoking family history Radon gas exposure Older age
what is the pathophysiology of NSCLC?
Adenocarcinoma - 45%, located in periphery of lung
Large cell carcinoma - 10%, undifferentiated no histological features, arise centrally
Squamous cell carcinoma - 30%, involve central airways
what are the key presentations of NSCLC?
local: Dyspnoea Chest pain Shoulder pain Persistent cough (>6 weeks) Hemoptysis Recurrent chest infections Systemic: Weight loss Fatigue SADH ACTH, PTH secretion HPOA Eaton-lambert Thrombophlebitis Non-infective endocarditis DIC
what are the first line and gold standard investigations for NSCLC?
History:
Duration of cough
Duration of horde vice
Weight loss intentional or unintentional
Fatigue
Worrying the patient?
CXR - variable; may detect single or multiple pulmonary nodule(s), mass, pleural effusion, lung collapse, or mediastinal or hilar fullness
Contrast enhanced CT of lower neck, thorax, upper abdomen - shows size, location and extent of primary tumour; evaluates for hilar and/or mediastinal lymphadenopathy and distant metastases
FBC - may be anaemic
Biopsy - obtained via bronchoscopy, fine needle aspiration (CT guided)
Histology on biopsy sample - H&E and immunohistochemistry
Molecular testing on biopsy sample
what are the differential diagnoses for NSCLC?
Small cell lung cancer
Metastatic cancer
Pneumonia / bronchitis
how is NSCLC managed?
Resection +/- chemotherapy
Palliative care
nintedanib
how is NSCLC monitored?
After potentially curative treatment for lung cancer, patients should be followed regularly to assess for disease recurrence and treatment-related toxicity
what are the complications of NSCLC?
Post obstructive pneumonia
SVCS
Paraneoplastic syndromes
what is the prognosis of NSCLC?
Patients with adverse prognostic factors, including poor performance status and pretreatment weight loss, have a worse prognosis irrespective of treatment. Male sex and age are also independent predictors of lower survival.
what are the paraneoplastic features for squamous cell carcinoma?
parathyroid hormone-related protein (PTH-rp) secretion causing hypercalcaemia
clubbing
hypertrophic pulmonary osteoarthropathy (HPOA)
hyperthyroidism due to ectopic TSH
what are the paraneoplastic features of andeocarcinomas?
gynaecomastia
hypertrophic pulmonary osteoarthropathy (HPOA)
