Bronchial Carcinoma Flashcards
(24 cards)
What is % of all cancers is bronchial carcinoma?
Bronchial carcinoma accounts for 19% of all cancer and 27% of cancer deaths.
What are the risk factors of bronchial carcinoma?
- smoking
- asbestos
- chromium
- arsenic
- iron oxides
- radon gas (radiation)
What percentage of bronchial carcinomas are squamous cell?
35% of bronchial carcinomas are Squamous cell
What % of bronchial carcinomas are adenocarcinomas?
27% of bronchial ca are adenorcarcinoma
small oat cell ca makes up what % of bronchial carcinomas?
20%
Who does bronchial ca affect?
3X more men than women.
What are the symptoms of bronchial carcinoma/
- Cough
- haemoptysis
- SOB
- chest pain
- slow resolving pneumonia
- lethargy
- weight loss
- loss of appetite
- hoarse voice
What are the signs of bronchial carcinoma?
- Cachexia
- anaemia
- clubbing
- supraclavicular / axillary nodes
chest signs:
- can be none OR
- consolidation
- pleural effusion
- collapse
Signs of metastases:
- bone tenderness
- hepatomegaly
- confusion
- peripheral neuropathy
What are the chest signs of bronchial carcinoma?
There can be no chest signs OR
collpase,
Pleural effusion
consolidation
What are the signs of metastases?
bone pain hepatomegaly confusion peripheral neuropathy proximal myopathy
What are the LOCAL complications of bronchial carcinoma?
Local:
- recurrent laryngeal nerve palsy (hoarse voice)
- Horner’s syndrome (pancoast tumour —> involvement of sympathetic ganglion)
- Pancoast tumour —> brachial plexus —> pain in shoulder and inner surface of arm.
- phrenic nerve palsy (paralysis of diaphragm)
- SVC obstruction (SOB, chest pain, oedema)
- rib erosion
- pericarditis
- atrial fibrillation
- dysphagia
What is horner’s syndrome?
Horner’s syndrome involves 3 symptoms:
1) Ptosis (eyelid drooping)
2) Miosis (pupillary constriction)
3) hemifacial anhidrosis (absence of sweating on one side of face)
what is a pancoast tumour?
Tumour in apex of lung.
If it invloves the sympathetic ganglion can lead to horner’s syndrome.
If involved the brachial plexus can cause shoulder pain and pain in inner arm.
What are the metastatic complications of bronchial carcinoma?
BONE : bone pain, anaemia, hyperCa2+
Adrenals : Addisons
Endocrine: ectopic hormone secretion e.g. ACTH in cushing’s
Brain: confusion, fits, proximal myopathy
Other: clubbing, dermomyositis (rash and muscle weakness), ancanthosis nigricans
What are the investigations done for bronchial carcinoma?
Bloods:
FBC (anaemia)
LFT (liver mets?)
U&E ( hyperCa2+ , hypoNa)
Cytology:
- sputum
- pleural fluid
CXR shows:
- peripheral nodule
- hilar enlargement
- consolidation
- lung collapse
Fine needle aspiration/ biopsy
CT / PET CT (to stage tumour)
Bronchoscopy
Lung function test (to assess suitability for lobectomy)
What is the treatment of Non small cell bronchial tumours?
1) Surgical Excision (for peripheral tumour with no mets)
2) Curative Radiotherapy (if resp reserve poor)
3) Chemo + Radiotherapy for more advanced disease
How are non small cell bronchial carcinomas staged?
TNM staging.
T = primary tumour, N = regional nodes, M=mets
T0) (no primary carcinoma evident)
T1) <3cm in lobar or more distal airway
T2) more than 3cm tumour distal to carina / pleural involvement
T3) involved chest wall, diaphragm, pleura, pericardium and nodules in same lobe.
T4) involved heart, trachea, oesoph, vertebral body, nodules in another lobe.
N0 (no nodes involved) —-> N3 nodes in hilum, supraclavicular involved.
M0 (no mets), M1 (mets present)
What is the treatment of small cell tumours?
Small cell tumours are nearly always disseminated at presentation so chemotherapy +/- radiotherapy is best.
What symptoms may radiotherapy be used to treat in a palliative patient with bronchial carcinoma/
- bone pain
- haemoptysis
- SVC obstruction
What is involved in palliative care of bronchial tumours?
palliative care:
- radiotherapy for symptoms of bone pain, haemoptysis, svc obstruction.
- SVC stent
- endobronchial therapy ( tracheal stent, laser)
- pleural drainage
Medications:
- steroids to improve appetite
- morphine (pain) + antiemetic
- codeine (cough suppressant)
- laxitives
- bronchodilator
What are the differentials for bronchial carcinoma?
Pneumonia
TB
What is the prognosis of non small cell bronchial carcinoma?
50% two year survival without spread, 10% with spread.
What is the prognosis of small cell bronchial carcinoma?
3 months if untreated.
1- 1.5 years if treated
What are the differentials for a nodule on a CXR?
- malignancy
- carcinoid tumour
- skin tumour
- pulmonary harmatoma (area of fibrosis)
Infective:
- abscess
- granuloma
- cyst
- encysted effusion
- arterio venous malformation
- foreign body
