Specific types of cancer Flashcards
Lung cancer: Red flag symptoms (7)
- persistent cough
- haemoptysis
- dyspnoea
- chest pain
- weight loss and anorexia
- hoarseness
seen with Pancoast tumours pressing on the recurrent - laryngeal nerve - superior vena cava syndrome
Lung cancer: Investigations
- Blood tests (FBC, renal function, bone profile, liver function)
- Pulmonary function tests
- CT scan
- Bronchoscopy and biopsy
- PET-CT scans
Lung cancer: Social and family hx
- Smoking hx - cessation improves prognosis
- Alcohol intake - poorer ability to tolerate chemo
- Occupation - asbestos exposure
- Who’s at home - what support do they have
- Family hx of cancer - explore pre-conceived ideas
Lung cancer: Examination findings
- a fixed, monophonic wheeze may be noted
- supraclavicular lymphadenopathy or persistent cervical lymphadenopathy
- clubbing
Lung cancer: Paraneoplastic features - Small cell
- ADH
- ACTH - not typical, hypertension, hyperglycaemia, hypokalaemia, alkalosis and muscle weakness are more common than buffalo hump etc
- Lambert-Eaton syndrome
Lung cancer: Paraneoplastic features - Squamous cell
- Parathyroid hormone-related protein (PTH-rp) secretion causing hypercalcaemia
- Clubbing
- Hypertrophic pulmonary osteoarthropathy (HPOA)
- Hyperthyroidism due to ectopic TSH
Lung cancer: Paraneoplastic features - Adenocarcinoma
- Gynaecomastia
- Hypertrophic pulmonary osteoarthropathy (HPOA)
Lung cancer: Types
Lung cancer is initially classified histologically as being either small cell lung cancer (SCLC) or non-small cell lung cancer (NSCLC) due to the different features, management and prognosis see in the two groups.
SCLC accounts for around 15% of cases and generally carries a worse prognosis.
NSCLC can be broken down into (percentages refer to total lung cancer cases, not just NSCLC):
- squamous: c. 35%
- adenocarcinoma: c. 30%
- large cell: c. 10%
- alveolar cell carcinoma: not related to smoking, ++sputum
- bronchial adenoma: mostly carcinoid
Differentiating between NSCLC is now more important than before due to the different drugs available treat the subtypes.
Lung cancer: Small cell - Features
- usually central
- arise from APUD* cells
- associated with ectopic ADH, ACTH secretion
- ADH → hyponatraemia
- ACTH → Cushing’s syndrome
- ACTH secretion can cause bilateral adrenal hyperplasia, the high levels of cortisol can lead to hypokalaemic alkalosis
- Lambert-Eaton syndrome: antibodies to voltage gated calcium channels causing myasthenic like syndrome
- an acronym for
- Amine - high amine content
- Precursor Uptake - high uptake of amine precursors
- Decarboxylase - high content of the enzyme decarboxylase
Lung cancer: Small cell - Management
- Usually metastatic disease by time of diagnosis
- Patients with very early stage disease (T1-2a, N0, M0) are now considered for surgery. NICE support this approach in their 2011 guidelines
- However, most patients with limited disease receive a combination of chemotherapy and radiotherapy
patients with more extensive disease are offered palliative chemotherapy
Lung cancer: Non-small cell - Main subtypes (3)
There are three main subtypes of non-small cell lung cancer:
- Squamous cell cancer:
- Adenocarcinoma:
- Large cell lung carcinoma:
Lung cancer: non-small cell management
Management only 20% suitable for surgery mediastinoscopy performed prior to surgery as CT does not always show mediastinal lymph node involvement curative or palliative radiotherapy poor response to chemotherapy
Surgery contraindications assess general health stage IIIb or IV (i.e. metastases present) FEV1 < 1.5 litres is considered a general cut-off point* malignant pleural effusion tumour near hilum vocal cord paralysis SVC obstruction
- However if FEV1 < 1.5 for lobectomy or < 2.0 for pneumonectomy then some authorities advocate further lung function tests as operations may still go ahead based on the results
Non-small cell lung cancer: Squamous cell
- typically central
- associated with parathyroid hormone-related protein
- (PTHrP) secretion → hypercalcaemia
- strongly associated with finger clubbing
- hypertrophic pulmonary osteoarthropathy (HPOA)
Non-small cell lung cancer: Adenocarcinoma
- typically peripheral
- most common type of lung cancer in non-smokers, although the majority of patients who develop lung adenocarcinoma are smokers
Non-small cell lung cancer: Large cell lung carcinoma
- typically peripheral
- anaplastic, poorly differentiated tumours with a poor
prognosis - may secrete β-hCG
