Lung Cancer ☺️ Flashcards
Epidemiology, prognosis
No 1 cancer worldwide and death cause
5 year cancer survival is still v low
Risk factors
- environmental
- genetics
Cigarette/passive smoking Occupational exposures -asbestos, radon, vinyl chloride Diet Lung disease Air pollution HPV
Genes - EGFR, ALK, ROS, KRAS
Presentation
-2ww criteria
2ww - CXR with potential lung cancer findings/40+ with unexplained haemptysis
Persistent cough, haemoptysis SOB, chest pain Anorexia, weight loss Hoarseness SVC obstruction Clubbing Cervical, supraclavicular LN Horners Recurrent chest infections
Small cell
- prevalence and prognosis
- location
- features
15% of all cases - v aggressive, poor prognosis, treatment often palliative
-central
SMOKING
ADH => low Na
ACTH => Cushings
LES => proximal limb weakness that improves with mv
Diagnosis and investigations needed
CXR, CT
DEFINITIVE - tissue, cell biopsy
- EBUS => tissue sample
- FNA => cell sample
Staging - FDG PETCT
Management
- when is surgery suitable
- what are the options for surgery
Surgery - pneunectomy, lobectomy, segmentectomy
- based on patient’s surgical fitness score
- if S3+, unlikely to be used
Radiotherapy
Chemotherapy
Immunotherapy
EGFR overexpression
Checkpoint inhibition - ipilimumab, nivolumab
-SE from T cell overactivation - fatigue, nausea, rash, AI -itis
Squamous
- population
- location
- features
Central - SMOKERS
PTHrp => high Ca
TSHrp => hyperthyroid
HPOA
Clubbing
Adenocarcinoma
- population
- location
- features
Peripheral - Most common in non smokers but majority do smoke
Gynecomastia
HPOA
Large
- location, prognosis
- features
Peripheral - anaplastic, poorly differentiated => poor prognosis
bhCG
How may lung cancer contribute to delirium and dementia
Hypoxia
-from tumour, infective consolidation, pleural effusions and pain from intercostal nerve
Paraneoplastic syndromes => electrolyte imbalances
- SiADH in SCLC => low Na
- PTHrP in NSCLC => high Ca
Brain metastases
