RESP: Malignancy Flashcards
2 Main types of lung cancer?
Small cell- 15% of cases and worse prognosis
Non-small cell- more common
Types of non-small cell lung cancer?
Adenocarcinoma
Squamous cell carcinoma
Large cell carcinoma
Most common type of lung cancer?
Adenocarcinoma
Symptoms of lung cancer?
Persistent cough Haemoptysis Dyspnoea Chest pain Weight loss and anorexia SVC obstruction
What type of tumour causes a hoarse voice?
Pancoast tumour pressing on the recurrent laryngeal nerve
Sign of lung cancer?
Cachexia
Finger Clubbing
Hypertrophic pulmonary osteoarthropathy
Anaemia
Horner’s syndrome (if the tumour is apical)
Enlargement of supraclavicular and axillary lymph nodes
Paraneoplastic syndromes: Cushing’s syndrome, SIADH, and Lambert-Eaton syndrome (suggest small-cell), hyperparathyroidism (suggests squamous cell)
On auscultation of the lungs, how might lung cancer sound?
Features of consolidation (pneumonia); collapse (absent breath sounds, ipsilateral tracheal deviation); pleural effusion (Stony dull percussion, decreased vocal resonance and breath sounds)
Features of squamous cell carcinoma?
Typically central tumour
Associated with PTHrP- hypercalcaemia, finger clubbing and hypertrophic pulmonary osteoarthropathy
May also get hyperthyroidism due to ectopic TSH
Features of large cell carcinoma?
Peripheral
Usually anaplastic and poorly differentiated with poor prognosis
May secrete B-hCG
Features of small cell carcinoma?
Associated with ectopic ADH–> hyponatraemia
ectopic ACTH–> hyperglycaemia, hypertension, hypokalaemia, alkalosis, muscle weakness–> may get bilateral hyperplasia of the adrenal glands
Lambert- Eaton syndrome
What is Lambert- Eaton syndrome?
Antibodies to voltage gated calcium channel–> myasthenic like symptoms
What is SVC obstruction?
Oncological emergency
Compression of the SVC most commonly due to lung cancer
Features of SVC obstruction?
Dyspnoea Swelling of face and neck, conjunctival and periorbital oedema Headache- often worse in the morning Visual disturbance Pulseless jugular venous distension
Management options for SVC obstruction?
Dependent on pt, options range from:
endovascular stenting for symptoms relief
Radical chemo or chemo-radio therapy
Glucocorticoids are usually given but evidence is weak
Investigations in suspected lung cancer?
Cxr- may see nodules, lung collapse, pleural effusion, consolidation, and bony metastases
CT- confirm diagnosis and to stage it, ensure adrenals and liver are also scanned to have a look
Bronchoscopy- allow biopsy to be taken
PET scanning- usually in non-small cell lung cancer–> eligibility for curative treatment. Uses 18-fluorodeoxygenase which is preferentially taken up by neoplastic tissue
Management of small cell lung cancer?
Most pts will be on palliative chemo
May try chemo-radiotherapy for some patients, however prognosis is poor
Management of Non-small cell lung cancer?
Only 20% suitable for surgery, before surgery mediastinoscopy performed as CT doesn’t always show mediastinal involvement
Curative or palliative radiotherapy
Chemo may be offered palliatively
Ddx for lung cancer?
pneumonia, bronchitis, exacerbation of COPD, mets from another site, sarcoidosis, TB
What blood abnormality would you most likely see in lung cancer?
Raised platelets
Context:Pt has lung cancer.
What scale is used to interpret a patient’s level of fitness?
WHO scale to find out performance status
WHO scale for fitness level in pts with lung cancer is from 0 to 5. Describe each level.
0 - normal fitness - fully active without restriction
1 - restricted in physically strenuous activity. Ok with light work e.g. office work, light house work
2 - capable of all self care, ambulatory but can not carry out work activities. Active (up and about ) over 50% of waking hours
3 - capable of only limited self care. Confined to bed or chair for more than 50% of waking hours
4 - completely disabled. Can no self care. Totally confined to bed or chair.
5 - dead.
Gold standard investigation for bronchiectasis?
High resolution (1/2) CT (1/)
