Lung Cancer Flashcards
How would you classify lung cancer?
Small cell and non-small cell (75%)
Squamous is the most common type, associated with smoking
Small cell more common in non-smokers
Small cell usually disseminated at presentation and therefore not amenable to radical surgical treatment
What is the most common type of non small cell lung cancer?
Adenocarcinoma (40-50%)
Squamous cell (25-30%)
Bronchoalveolar
Large cell (least common - 10%)
What are the risk factors for lung cancer?
- Smoking
- Asbestos
- Radon
- Arsenic
- Ionising radiation
- Chronic inflammatory lung disease
How does a patient with lung cancer present?
- Primary tumour
- Cough, dyspnoea, haemoptysis, pneumonia - Mediastinal spread
- SVCO, Horner’s syndrome, pleural effusion, pericardial effusion
- Phrenic nerve palsy, hoarseness of voice, T1 wasting - Metastasis
- Liver, bone, brain, skin, adrenal glands - Paraneoplastic symptoms
- Systemic effects
- LOA, LOW, fatigue
What are the clinical features of patients with lung cancer?
- Cachexia
- Hand clubbing
- Tar staining
- Wasting of small muscles of hands (Pancoast tumour)
- HPOA (digital clubbing + periostosis of tubular bones)
- Horner’s syndrome (Pancoast tumour)
- Collapse +/- consolidation
- Pleural effusion
What are the broad categories of manifestations in paraneoplastic syndromes?
(Refer other questions for details on the manifestations)
- Endocrine
- Neurological
- Cutaneous
- Musculoskeletal
- Systemic - cardiovascular, renal, haematological
What are the endocrine paraneoplastic manifestations of lung cancer? (6)
- SIADH (small cell)
- Cushing’s syndrome (ACTH producing)
- hypokalaemic met alkalosis - Hypercalcaemia (PTHrP from SqCC)
- Hyperthyroidism
- Hypoglycaemia
- Gynaecomastia
What are the neurological paraneoplastic manifestations of lung cancer? (4)
- Lambert-Eaton myasthenic syndrome
- Sensory peripheral neuropathy
- Limbic encephalopathy
- Subacute cerebellar degeneration
What are the cutaneous (6) and musculoskeletal (2) paraneoplastic manifestations of lung cancer?
Skin
1. Polymyositis
2. Dermatomyositis
3. Migratory venous thrombophlebitis (Trosseau’s sign)
4. Acanthosis nigricans
5. Gynaecomastia
6. Herpes zoster
Musculoskeletal
7. Clubbing
8. Hypertrophic pulmonary osteoarthropathy
What are the systemic manifestation of paraneoplastic syndromes? (5)
- DIC
- Anaemia
- Non-thrombotic endocarditis
- Nephrotic syndrome
- Membranous glomerulonephritis
What are the complications of lung cancer?
- Pancoast tumour
- Superior vena cava obstruction (SVCO)
- Metastases to LN, hepatosplenomegaly, spine, brain
What is pancoast tumour?
Lung cancer over superior sulcus of lung causing destruction to thoracic inlet, brachial plexus and cervical sympathetic ganglia.
Clinical features due to compression of unilateral nerves and vessels:
1. T1 nerve root - Horner syndrome, wasting of hand muscles
2. Cervical sympathetic ganglia - Horner syndrome
3. Recurrent laryngeal nerve - hoarse voice, bovine cough
4. Subclavian vein - upper limb oedema
What are the treatment options for non-small cell lung cancer?
- Surgery (lobectomy or pneumonectomy)
- Radiotherapy
- Chemotherapy
Stage 1 & 2 - surgery + adjuvant chemotherapy
Stage 3A - surgery in selected patient, chemotherapy
Stage 3B & 4 - chemotherapy
- surgery requires FEV evaluation
In advanced stages, for palliative radiotherapy +/- chemotherapy
- Pain, bone metastasis
- Dyspnoea from bronchial obstruction, dysphagia
- SVCO, pancoast tumour
What are the non-surgical options for NSCLC?
- Chemotherapy
- 3rd gen agents: gemcitabine, paclitaxel, vinorelbine, docetaxel
- Platinum: cisplatin or carboplatin - Biologics
- EGFR inhibitor - gefitinib, erlotinib - Radiation
- Combined chemoradiotherapy
What is the minimum FEV1 required for surgical treatment of NSCLC?
Lobectomy - 1L
Pneumonectomy - 2.5L
