Clinical Features of Lung Cancer Flashcards

1
Q

What are risk factors for lung cancer?

A

Smoking (85%)
Passive smoking
Exposure to asbestos, radon, air pollution

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2
Q

List symptoms

A
Cough > 3 weeks  
Haemoptysis (endobronchial tumour)
Wheeze 
Chest pain 
Chest infections 
Difficulty swallowing
Hoarse voice 
SOB 
Weight loss
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3
Q

What are some symptoms of advanced metastatis lung cancer?

A
Bone pain 
Paraesthesia 
Ataxia 
Dizziness 
Anaemia
Hypercalcaemia 
Thrombosis
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4
Q

What are clinical signs of lung cancer?

A
Nail clubbing
Lymphadenopathy 
Horner's syndrome (pupil constriction)
Pancoast tumour
SVC obstruction 
Hepatomegaly 
Skin nodules (metastases)
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5
Q

What is a pan coast tumour and how can it present?

A

Tumour of apex of the lungs, it might put pressure on or damage a group of nerves that runs from the upper chest into your neck and arms

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6
Q

Initial investigations carried out

A
CXR
FBC - anaemia 
U+Es
LFT
Biochem - Ca increase, Na decrease 
Clotting screen (normal = not PE)
Spirometry
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7
Q

Can a CXR diagnose lung cancer?

A

No, it is a screening test

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8
Q

What test is used for staging cancer?

A

CT and CT-PET

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9
Q

What investigations are used for tissue diagnosis?

A
Bronchoscopy
Endobronchial ultrasound (EBUS)
Image guided lung/liver biopsy
Fine needle aspiration of neck nodes or skin
Excision of cerebral metastases
Bone biopsy
Mediastinoscopy/otomy
Surgical excision biopsy
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10
Q

What is classification is used to stage tumours?

A

TNM classification
T - size of primary tumour and its invasion
N - lymph node involvement
M - distant metastasis

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11
Q

Define stages of T classification

A

Tx - malignant cells in bronchial secretion
Tis - carcinoma in situ
T1 - < 3cm in distal airway
T2 - > 3cm and 2cm form carina
T3 - > 7cm and invasion to chest was, diaphragm, mediastinal pleura
T4 - invasion to mediastinum, heart, great vessels, trachea, vertebrae, oesophagus

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12
Q

Define stages of N classification

A

N0 - No node involvement
N1 - involves ipsilateral hilar
N2 - involves ipsilateral mediastinal nodes
N3 - involves contralateral mediastinal or hilar nodes

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13
Q

Define stages on M classification

A

M0 - no distant metastases

M1 - distant m present

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14
Q

How can tumour be staged from CT scan?

A
Size 
Mediastinal nodes 
Metastatic disease
Pleural/pericardial effusion 
Diaphragmatic involvement
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15
Q

How can MRI help stage tumour?

A

Determines degree of vascular and neurological involvement in pancoast tumour

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16
Q

How can bone scan help stage tumour?

A

Chest wall invasion and bony metastasis

17
Q

How can echo help stage tumour?

A

Show presence of pericardial effusion

18
Q

What is treatment dependent on?

A

Performance status
Patient wishes
Histological types and stage
Aims of treatment i.e. radical or palliative

19
Q

What surgery types are available?

A

Wedge resection
Lobectomy
Pneumonectomy

20
Q

What types of radiotherapy are available?

A

Radical
Palliative
Stereotactic

21
Q

What is chemo used for in treatment?

A
Radical or palliative treatment 
Alone, with radiotherapy, adjuvant (after surgery)
Small cell 
Adenocarcinoma 
Squamous
22
Q

What can be used for palliative treatment?

A

Chemo
Radiotherapy
Opiate, bisphosphonates, benzodiazepines
Treatment of hypercalcaemia, dehydration, hyponatraemia