lung cancer Flashcards
what are the clinical features/presentations of lung cancer?
- asymptomatic, incidental finding
- any respiratory symptom
- superior vena caval obstruction
- horners syndrome
- metastatic disease - liver, adrenals (Addison’s), bone, pleural, CNS
what are the risk factors for lung cancer?
- large number of smoking pack years
- airflow obstruction
- increasing age
- family history of lung cancer
- exposure to other carcinogens e.g asbestos
what is the WHO performance status assesment?
gives an indication to a patients level of fitness
Normal - Fully active without restriction
1) Restricted in physically strenuous activity but
ambulatory and able to carry out light work e.g.,
light house work, office work
2) Ambulatory and capable of all self-care but
unable to carry out any work activities. Up and
about more than 50% of waking hours
3) Capable of only limited self-care, confined to
bed or chair more than 50% of waking hours
4) Completely disabled. Cannot self-care. Totally
confined to bed or chair
5) Dead
what are the diagnostic tests for lung cancer?
MDT approach
- bloods e.g FBC, U&E, Ca, LFTs, INR
- CXR
- Staging CT = spiral CT thorax and upper abdo - helps to stratify TNM stage
histology
- US guided neck node FNA for cytology if lymphadenopathy
- bronchoscopy = endobronchial, trans bronchial, endobronchial US (if mediastinal lymphadenopathy)
- CT biopsy
- thoracoscopy if pleural effusion present
PET scan
- MDT decision if patient is surgical candidate and initial CT suggests low stage
- helps detect small metastases not seen on staging CT
what is the histological classification for cancers?
1) small cell lung cancers
2) non small cell lung cancer
3) mesenthelioma
what are the features of small cell lung cancers?
20% of all cancers.
patients usually smokers. Less common but the worst.
Never operate on as by the time they’ve recovered they’d have recurrence usually. Rapid growth rate.
If small, mainstay treatment is palliative chemo and radio.
life expectancy = 6-15 months.
what are the features of non small cell lung cancer?
get squamous cell carcinomas and adenocarcinomas (not as common).
can treat with surgery.
If low stage on CT, do PET to check its isolated to lung then send to surgery.
what are the features of a mesenthelioma?
(asbestos related)
usually due to work.
can present 40-50yrs post exposure along the pleura of the lungs (so painful). Patients often have pleural effusion on presentation.
incurable.
does metastases make an illness incurable?
usually incurable
what are the treatments for lung cancer?
- curative for stage 1 and 2 if fit for surgery
- surgery and adjuvant chemotherapy for stage 3a
- chemotherapy is stage3/4
- radiotherapy - curative for people not fit for surgery or palliative
- palliative
- do nothing/ wait and watch
what are the signs of lung cancer?
- Cachexia
- anaemia
- clubbing
Chest signs:
- none, or consolidation
- collapse
- pleural effusion
Metastases:
- bone tenderness
- hepatomegaly confusion
- fits
- focal cns signs
- peripheral neuropathy.
