Oncology - Lung Cancer General Flashcards
How common is lung Ca?
MOST COMMON cancer
LEADING CAUSE of cancer death
Describe clinical features of Adenocarcinoma
- 85% of NSCLC
- Typically peripheral
- assoc with SMOKING
BUT
most common type of lung Ca in NONSMOKERS
Histo features of adenocarcinoma
Histo: signet ring, or clear cell
Describe clinical features of Squamous Cell Carcinoma
Usually central
MORE COMMON in smokers
Describe clinical features of small cell cancer and the poor prognostic features
- MORE AGGRESSIVE than NSCLC
- MORE SENSITIVE to chemo
Poor Px:
- Extensive stage
- Poor performance status
- Hyponatraemia
- Elevated ALP
- Elevated LDH
Poor Prognosis Factors in NSCLC
- reduced performance status
- higher stage
- weight loss >10% in large 6 months
- presence of systemic symptoms
- histology:
large cell (LEAST FAVOURABLE), Adenocarcinoma (MOST FAVOURABLE)
Aside from hx of smoking (including passive) or exposure to indoor cooking fumes, what other risk factors for lung cancer?
Asbestos Marijuana Heavy metals Radon Radiation (esp breast and Hodgkins)
Describe bronchial carcinoid Tumour: who gets them, how do they present
- Most common in CHILDREN and ADOLESCENTS
- Present with Sx of endobronchial narrowing or obstruction
- Carcinoid syndrome in 1-5%
Features of Carcinoid syndrome
Release vasoactive substances ie serotonin
–> flushing, bronchospasm, diarrhoea
Assoc with:
- larger size
- presence of liver mets
Describe mesothelioma
- Aggressive
- Most significant RF is asbestos exposure
- usually develop Sx from slowly enlarging pleural effusion
How do you diagnose mesothelioma?
Either thoracentesis or closed pleural biopsy
Where do pulmonary metastasis usually come from?
Carcinomas (colon, kidney, breast, testicle and thyroid)
Sarcoma
Melanoma
Where do ENDOBRONCHIAL metastasis come from?
Usually renal cell carcinoma
What tumours spread with lymphangitic spread?
Adenocarcinomas (esp lung, breast and GIT)
If you see peripheral interstitial abnormality on HRCT which metastatic Cancers could you think of?
Melanoma
Lymphoma
Leukaemia
DDx ANTERIOR mediastinal mass
1) Anterior mediastinal thymoma
2) lymphoma (usually younger, most commonly Hodgkins, then lymphoblastic then primary mediastinal diffuse large B Cell lymphoma)
3) teratoma
Which paraneoplastic syndromes do you see in anterior mediastinal thymoma?
Usually in middle aged adults
- myasthenia gravis
- pure red blood cell aplasia
- nonthymic cancers
- acquired hypogammaglobulinaemia
DDx middle mediastinal mass
Lymphadenopathy is most common
Cystic structures
Where do NSCLC metastasise to?
Brain
Bone
Liver
Adrenal gland
Which lung cancer do you NOT see finger clubbing in?
Small cell lung cancer
Features of PANCOAST Tumour
- superior sulcus tumours
- usually NSCLC
- pain in shoulder and neuropathic arm pain
- Horner’s syndrome
- wasted hand muscles (T1)
Difference between PET and MRI in diagnosis
PET
- does T well
- good NPV for N but poor PPV
- Very good for extrathoracic mets
MRI is superior for brain mets
Small Cell Lung Ca STAGING
LIMITED: confined to ipsilateral hemithorax
EXTENSIVE: mets outside
Small Cell Lung Ca TREATMENT
LIMITED:
- curable in 20-30% with chemoradiotherapy
- cisplatin and etoposide
- prophylactic cranial irradiation
EXTENSIVE:
incurable
Palliative chemoradiotherapy
Staging of NSCLC
STAGE 1:
T<5cm and N0
STAGE 2:
T 5-9cm OR N1 (peribronchial or hilar LNs)
STAGE 3:
T <9cm OR invasion OR N2-3 (mediastinal or supraclavicular)
STAGE 4:
M1 including malignant effusion
Treatment of resectable STAGE 1, 2 & 3 lung NSCLC
STAGE 1:
T<5cm and N0
STAGE 2:
T 5-9cm OR N1 (peribronchial or hilar LNs)
STAGE 3:
T <9cm OR invasion OR N2-3 (mediastinal or supraclavicular)
Surgery!
- lobectomy preferred
STAGE 2 ADD IN ADJUVANT CHEMO
- cisplatin based (plus vinorelbine)
Why is LOBECTOMY preferred in Stage 1 and 2 NSCLC
WEDGE: higher rate local recurrence
PNEUMECTOMY: higher risk complications and mortality, ESP RIGHT SIDED
Treatment of non-resectable Stage 2 or 3 Lung Ca
STAGE 2:
T 5-9cm OR N1 (peribronchial or hilar LNs)
STAGE 3:
T <9cm OR invasion OR N2-3 (mediastinal or supraclavicular)
Treat with CHEMORADIOTHERAPY
If N2 disease and pancoast can give chemo as neoadjuvant and then try surgery
Treatment of Advanced NSCLC (stage 4)
Early referral to palliative care
(Survival benefit)
Look for targets for targeted therapy
If no targetable mutations:
First give double platinum chemo
Then use pemetrexed if squamous cell
Contraindications to Lung Ca Surgery
- SVC obstruction
- FEV <1.5
- MALIGNANT pleural effusion
- Vocal cord paralysis
- Tumour near hilum
- Metastasis
