Diagnosing Lung Cancer Flashcards
(20 cards)
If a patient comes in with a chest infection, what questions would you ask?
o Haemoptysis
o Weight loss
o Persistent cough
o Breathlessness
o Pain
o Changes in fingers suggesting clubbing
o Pain in the limbs suggesting hypertrophic osteoarthropathy
What causes lung cancer?
- Tobacco smoke
- Ionising radiation
- Asbestos
- Fibrosing alveolitis
- Industrial chemicals
Who would you send on the 2WW referral for lung cancer?
- Have a CXR that suggests lung cancer
* >40yrs with unexplained haemoptysis
When do you offer an urgent CXR to assess for lung cancer?
People >40yrs with 2+ unexplained symptoms or if they have ever smoked and have 1 unexplained symptom: • Cough • Fatigue • SOB • Chest pain • Weight loss • Appetite loss
When would you consider an urgent CXR to assess for lung cancer in people >40yrs?
- Persistent or recurrent chest infection
- Finger clubbing
- Supraclavicular lymphadenopathy or persistent cervical lymphadenopathy
- Chest signs consistent with lung cancer
- Thrombocytosis
What are the types of primary lung cancers?
- Small cell cancers
- Non-small cell cancers
Squamous cell
Adenocarcinoma
Large cell carcinoma
What is characteristic of small cell cancers?
- Homogenous
- Rapidly dividing
- Neuroendocrine tumours -> associated with paraneoplastic syndromes
What is characteristic of squamous cell cancers?
- Flat cells that cover airways
- Tends to grow near centre of lung
- Strong association with smoking
- Cavitary lesions are common -> lucent area contained within a consolidation, mass or nodule
- Direct spread to hilar lymph nodes
What is characteristic of adenocarcinomas?
- Mucous cells of bronchial epithelium
- Commonly invades mediastinal lymph nodes, brain and bones
- Most common in non-smokers and women
What is characteristic of large cell cancers?
- Anaplastic, poorly differentiated tumours with poor prognosis
- May secreted B-hCG
What symptoms may suggest lung cancer?
- Cough
- Haemoptysis
- Chest pain
- Breathlessness
- Stridor
- Hoarse voice
- Weight loss
- Facial swelling
What may you find on clinical examination that suggests lung cancer?
- Weight loss
- Finger clubbing
- Lymphadenopathy
- Chest asymmetry
- Focal chest signs
- Hepatomegaly
- Neuropathy
- Pancoast syndrome
- Horner’s syndrome
- SVC obstruction
What is Pancoast sydnrome?
o Destruction of T1-C8 nerve roots of lower part of brachial plexus by apical lung tumour
- Pain in inner aspect of arm
- Small muscle wasting in hands
What is Horner’s syndrome?
Tumour presses on sympathetic ganglion
o Ipsilateral ptosis = drooping eyelid
o Enophthalmos = eye bulging
o Miosis = constriction of pupils
o Anhidrosis = reduced sweating
What is Pemberton’s sign?
Raising hands over head causes facial congestion and cyanosis
What could mediastinal spread to the oesophagus present as?
Dysphagia
What could mediastinal spread to the pericardium present as?
- Arrhythmia
- Pericardial effusion
What could mediastinal spread to the left recurrent laryngeal nerve present as?
- Vocal cord paralysis
- Voice alteration
- Bovine cough
What investigations would you do for lung cancer?
- CXR
- CT
- FBC
- LFTs
- Calcium
- Biopsy
What could lung cancer show on a CXR?
- Hemithorax whiteout
- Hilar enlargement
- Peripheral pulmonary opacity
- Lung, lobe or segmental collapse
- Pleural effusion
- Paratracheal lymphadenopathy
- Pericardial effusion
- Raised hemidiaphragm
- Osteolytic rib destruction
