[Resp] Lung Cancer Flashcards
what are the 2 categories of lung cancer?
- Non-Small Cell (NSCLC)
2. Small Cell (SCLC)
what is NSCLC divided into?
- Squamous Cell Carcinoma (SCC)
2. Adenocarcinoma
what is the most common NSCLC and in whom?
adenocarcinoma, most common in non-smokers
what is SCC strongly linked to?
smoking
SCLC is fast growing. what does it often present with?
dissemination with many paraneoplastic syndromes associated (e.g. SIADH, Cushing’s, Lambert-Eaton syndrome)
what are the risk factors for lung cancer?
- smoking
- radon / asbestos / silica
- FHx
when do you refer pt for an urgent CXR?
2 or more OR smoking hx + 1 of:
- cough
- fatigue
- SOB
- chest pain
- wt loss
- appetite loss
when do you refer pt for suspected cancer (2 week wait)?
- CXR suggestive of lung cancer or
- age >40 with unexplained haemoptysis
what are the complications of lung cancer?
- widespread metastasis (brain, bone, liver, adrenal glands)
- SVCO (Pemberton’s sign)
- hypercalcaemia
- pathological fractures
- side effects of chemotherapy
what is done next after a CXR suspicious for lung Ca is referred to 2˚ care?
CT thorax
if the CT thorax shows suspicion of a neoplasm, what is done next?
biopsy
- image guided
- endobronchial US (EBUS)
if histology shows malignancy, what is done next?
- staging PET CT
- lung cancer MDT
what are the Rx options for NSCLC?
- surgical resection
- adjuvant chemotherapy
- radical radiotherapy
- systemic chemotherapy
what are the Rx options for SCLC?
- radical radiotherapy
2. systemic chemotherapy
what is the classification of hypercalcaemia?
mild <3
moderate 3-3.5
severe >3.5 mmol/L
what are the acute features of hypercalcaemia that can be seen on ECG?
- Osborn “J” wave
- short QT → VF
what are the chronic features of hypercalcaemia?
"stones" - renal stones "bones" - bone pain "moans" - lethargy "groans" - abdo pain "thrones" - polyuria, constipation psychic "overtones" - anxiety, psychosis
how do you manage severe hypercalcaemia (oncological emergency)?
IV saline 0.9% (4-6 litres in 24 hours)
in mx of severe hypercalcaemia, what do you give the pt once rehydrated?
IV Zolendronate 4mg (or Pamidronate)
in mx of severe hypercalcaemia, when do you re-check serum calcium?
day 2 and 4
SCLC, muscle strength improving on repetitive movement (i.e. Lambert-Eaton syndrome). antibody?
anti-voltage gated calcium channel
Breast Ca or SCLC, progressive muscle stiffness (i.e. Stiff Man Syndrome). antibody?
anti-amphiphysin
SCLC, cerebellar sx and sensory neuropathy. antibody?
anti-hu
why does hypercalcaemia develop in SCC?
due to parathyroid hormone related protein release
