Respiratory: - Lecture 1. Clinical aspects of Bronchial Carcinoma. Flashcards
What are the general features of Cancer?
Maligant Growth Uncontrolled replication Local invasion Metastasis Non-Metastatic Systemic effect.
How can Metastasis spread?
Lymphatic spread
Blood stream
Serous Cavities
What causes systemic effects from a cancer?
Tumour cells are biologically active molecules
Tumours can mimic the effects of naturally occurring hormones.
-These are called Paraneoplastic features.
What percentage of lung cancer is incurable?
90% incurable at time of diagnosis
Describe what a lung cancer presentation may consist of?
A formation of a primary tumour
Local invasion of other tissues
Metastases/ Non-Metastatic
Paraneoplastic effects.
What is the split between the bronchi called?
The Carina
What type of cell lines the bronchial mucosa?
Cilliated epithelium
What is Haemoptysis?
Coughing up of blood
How does Haemoptysis form/occur?
The tumour forms a haemorrhage of the mucosa/tissue of the bronchial tract. This then ulcerates through the surface - causing bleeding.
Haemoptysis is a direct consequence of the primary tumour.
What is Stridor?
Stridor is a distressing symptom of difficulty breathing in. Rather like having a rope gradually tightened round your neck. It is usually accompanied by a coarse audible wheeze during inspiration. Almost all other forms of airways disease (asthma & COPD) produce an Expiratory wheeze and symptoms of difficulty breathing out.
If a tumour is on the carina of the bronchi, what could be affected by local invasion of the tumour?
Pericardium Recurrent laryngeal nerve Oesophagus Pleural Cavity Brachial plexus Superior vena cava
If a tumour has invaded the Recurrent Laryngeal Nerve what symptom will there be??
Hoarse Voice
What symptoms are there, if there is local invasion of the pericardium by a tumour?
Breathlessness
Artial Fibrillation
Percardial effusion
What symptoms are there, if there is local invasion the Oesophagus by a tumour?
Dysphagia (Not being able to swallow, or keep food down)
What is a Pancoast? And what are its symptoms?
This is tumour in the pulmonary apex.
Can cause weakness in hands/limbs, by eroding the T1 root and into the brachial plexus.
Chest pain not always a symptom
What is a Pleural effusion?
Generation of a large amount of pleural fluid. This causes a lung collapse.
What is a presenting symptom of pleural effusion?
Breathlessness.
What could a distended external jugular vein be a symptom of?
Local invasion of the superior vena cava (SVC) obstructs drainage of blood from the arms and head.
What are the other symptoms if there is a distended external jugular vein?
Puffy eyelids
Headache
Superfical veins standing upright
Anastamoses to inferior vena cava - (distended veins are visible on the abdomen and thorax)
How could a distended external jugular and its other symptoms be palliated?
Insertion of a stint.
What are common sites of metastases for a primary lung cancer?
Liver Brain Bone Adrenal Skin Lung
What does insidious onset mean?
Effeacts that gradually come on.
What are the symptoms of a cerebral metastases?
Weakness
Visual disturbance
Headaches - Worse in morning, not Photophobic
Fits.
In a cerebral metastases there is a lot of oedematous brain tissue. How is treated?
High dose corticosteroid therapy removes the odema. This however is shortlived and therapeutic effect does not last long.
In Liver Metastases from a primary lung tumour what can become obstructed and cause presentation of obstructive jaundice?
Obstruction of the biliary drainage.
What tests are abnormal if there is a liver metastasis?
Alkaline Phosphatase test
Liver function tests
What are the common presentations of a bone metastases?
Localising pain - worse at night
Pathological fracture
What scan can be done to detect a bone metastases?
Isotope bone scan
What are symptoms that result from the effects of biochemically active products from the primary tumour?
Finger clubbing Hypertrophic pulmonary osteoarthropathy - HPOA Weight loss Thrombophlebitis Hypercalcaemia Hyponatraemia - SIADH Weakness - Eaton Lambert syndrome
What causes Hypercalcaemia?
Hypercalcaemia can result from the tumour producing a substance which mimics the effects of parathyroid hormone.
What is Hypercalcaemia and its symptoms?
Elevated Calcium level in the blood.
Headaches, confusion, thirst and constipation are features of hypercalcaemia.
What is Hyponatraemia?
Low levels of sodium in the body.
What causes Hyonatraemia?
Hyponatraemia may result from production of a substance which mimics Anti Diuretic Hormone.
What is Hypertrophic Pulmonary Osteoarthropathy?
Elevation of the periostium away from the bone surface.
- cause by metastasis
What is Thrombophlebitis?
Red lines along were veins are.
Caused by increased coagulability of blood in cancer.
What to ask in a history for lung cancer?
Cough Haemoptysis Cigarette smoker Breathless Weight loss Chest wall pain Tiredness Recurrent infection
What are the symptoms of lung cancer?
Finger clubbing Breathless Cough Weight loss Bloated face Hoarse voice Lymphadenopathy Tracheal deviation Dull percussion Stridor Enlarged liver
How do you make a tissue diagnosis for lung cancer?
Bronchoscopy
CT guided biopsy
Lymph node aspirate
Aspiration of pleural fluid
What is an endobronchail ultrasound?
Bronchoscope with ultrasound tip
Enables visualisation of hilar and mediastinal structures
Target and sample lymph nodes
Day case procedure that can replace Mediastinoscopy
What is PET scan?
Positron Emission Tomography (PET)
Scan to asses function rather than structure
Analysis of tissue uptake of radiolabelled glucose
Tissues with high metabolic activity “light up”
