FN: Lung Cancer: Investigations and Management Flashcards Preview

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Flashcards in FN: Lung Cancer: Investigations and Management Deck (18):
1

Investigations:
- Bloods
- Cytology

FBC, U+E, calcium, LFTs
Sputum, pleural fluid

2

Imaging

CXR
Contrast-enhanced Volumetric CT
PET-CT
Radionucleotide bone scan

3

CXR shows

Coin lesion
Hilar enlargement
Consolidation, collapse
Effusion
Bony secondaries

4

Contrast-enhanced Volumetric CT

- Staging: lower-neck, chest, upper abdomen
- Consider CT brain

5

Pet- CT show

Exclude distant mets

6

Biopsy

1. Percutaneous FNA: peripheral lesions and LNs
2. Bronchoscopy: biopsy and assess operability
3. Endoscopic bronchial US biopsy: mediastinal LNS
4. Mediastinoscopy

7

Lung function tests

Assess treatent fitness

8

CXR Coin Lesion Differential

Foreign body
Abscess: staph, TB, Klebsiella, Mycetoma
Neoplasia (primary and secondary)
Granuloma: RA, Wegener's, TB, sarcoid
Structural: AVM

9

Non small cell carcinoma staging

TNM

10

Management

1. MDT
2. Assess risk of operative mortality e.g. thoracoscore
- Cardiorespiratory function
- Co-morbidities

3. Advise smoking cessation

11

NSCLC

1. Surgical Resection
2. Curative radiotherapy
3. Chemo ± radio for more advanced disease

12

NSCLC surgical resection

- Rx of choice for peripheral lesions with no metastatic spread = stage I/I (25%)
- Need good cardiorespiratory function
- Wedge resection, lobectomy or pneumoectomy ± adjuvant chemo

13

Curative radiotherapy

If cardiorespiratory reserve is poor

14

Chemo ± radio for more advanced disease

- Platinum- based regimens
- MAbs targeting EGFR (e.g. cetuximab) or TKI (e.g. erlotinib)

15

SCLC Rx

Typically disseminated @ presentation
- May respond to chemo but invariably relapse

16

SCLC Palliation

1. Radio: bronchial obstruction, haemoptysis, bone or CNS mets
2. SVC obstruction: stenting + radio + dexamethasone
3. Endobronchial therapy: stenting, bracytherapy
4. Pleural drainage/Pleurodesis
5. Analgesia

17

Prognosis NSCLC

50% 5 yrs w/o spread, 10 with spread

18

Prognosis SCLC

1-1.5 yrs median survived treated; 3 mo untreated

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