Non small cell lung cancer (NSCLC) Flashcards
What are the red flag symptoms suggesting a disease underlying a chest infection?
Haemoptysis Weight loss Persistent cough Breathlessness Pain Changes in fingers suggesting clubbing Pain in the limbs indicating Hypertrophic osteoarthropathy.
What do you understand by Skill mix?
This is the use of different grades of staff trying to use skilled personnel at the right level.
For doctors, this originally meant trying to avoid clerical duties but now includes training non-medics to do work to keep costs down and provide a resilient workforce.
What is NSCLC?
NSCLC accounts for more than 80% of all lung cancers.
Lung cancer is divided into NSCLC and small cell lung cancer.
What is lung cancer?
This comprises a group of indignant epithelial tumours arising from the cells lining the respiratory tract.
How many types of NSCLC are there?
3.
Adenocarcinoma
Squamous cell carcinoma
Large cell carcinoma
Causes of NSCLC
Cigarette smoking is the most important cause.
Lung cancer also linked to radon gas.
Exposure to asbestos.
Pathophysiology of NSCLC
45% of NSCLC are adenocarcinomas which tend to be located more peripherally in the lung.
Squamous cell carcinoma tend to be in the central airways.
Large cell carcinomas (10%) tend to arise centrally and are undifferentiated tumours.
Typical patient with NSCLC
>65 year old man. Dry persistent cough 4-5kg unintentional weight loss COPD and HTN 20 pack history
Risk factors of NSCLC
Cigarette smoking Environmental tobacco exposure Positive FHx COPD Radon gas exposure Older age
Investigations of NSCLC
CXR (can detect pulmonary nodules ), mass, lung collapse, pleural effusion.
Contrast-enhanced CT scan- shows size, location and extent of primary tumour
Sputum cytology- malignant cells in sputum
Bronchoscopy- endobronchial lesions
Biopsy- specimen for pathological diagnosis
Differentials of NSCLC
Small cell lung cancer Metastatic cancer Pulmonary TB Rheumatoid arthritis Pneumonia/bronchitis Organising pneumonia Sarcoidosis Carcinoid tumour Actinomycosis Nocardiosis Amyloidosis Non-Hodgkin’s lymphoma
The most common cause of lung cancer
Smoking causes 90% of all lung cancers
Signs & symptoms of NSCLC
Cough Dyspnoea Haemoptysis Chest and/or shoulder pain Weight loss Fatigue Wheeze Crackles Decreased breath sounds Dullness to percussion Facial swelling (From weeks to months)
Signs of bronchial carcinoma
weight loss finger clubbing lymphadenopathy chest assymmetry focal chest signs consolidation hepatomegaly neuropathy
Approach to the management of NSCLC
History Examination Chest radiograph / CT Scan Bloods (FBC, LFTs, Calcium) Fibreoptic bronchoscopy ~ 60% Percutaneous needle biopsy Node biopsy Mediastinoscopy / mediastinotomy Thoracotomy- this has been replaced with EBUS
Which tumours are not operable?
Tumours invading the atrium
Tumours invading the chest wall
Metastasis in the femur
Inoperable if: Distant metastasis Mediastinal spread eg Recurrent laryngeal nerve palsy Phrenic nerve palsy Poor pulmonary function Frequent angina / heart failure Psychological failure
Link between egfr and lung cancer
Epidermal growth factor receptor (EGFR) is a protein found in abnormally high levels on the surface of many types of cancer cells, particularly non-small cell lung cancer (NSCLC) cells.
A patient‘s EGFR mutation status
(positive or negative) can be confirmed using a sample of tumour tissue.
EGFR mutation-positive cells predict response to specific chemotherapy
- gefitinib.
Gefitinib only used if mutation present
Complications of NSCLC
-Post-obstructive pneumonia/hypoxia
-Superior vena cava syndrome: The most common cause is lung cancer Bulky mediastinal adenopathy or medial extension of a right upper lobe tumour can compress the SVC. Physical examination show: Facial plethora Distended neck and chest wall.
-Paraneoplastic syndromes:
Neo-metastatic manifestations.
what are the red flag symptoms of lung cancer?
Cough (dry/productive) Haemoptysis Dyspnoea Hoarse voice- recurrent laryngeal nerve involvement Chest pain Fatigue Appetite loss Weight loss
