FN: Lung Cancer: presentation Flashcards Preview

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Flashcards in FN: Lung Cancer: presentation Deck (26):
1

Classification

clinically, the most important distinction is between small-cell and non-small-cell

2

Non-small cell types

Adeno
SCC
Large-cell

3

SCC
Epidemiology

35%, M>F, smoking, Radon gas

4

SCC Pathology

Centrally located
Histo: evidence of sqaumous differentiation - keratinisation

5

SCC behaviour

Locally invasive
Metastasise late (via LN)
PTHrP - raised calcium

6

Adeno Epi

25%
Females
Non-smokers
Far east

7

Adeno Pathology

Peripherally located
Histo: Glandular differentiation
- gland formation
- Mucin production

8

Adeno behaviour

Extrathoracic mets common and early - 80% present with mets

9

large-cell epi

10%

10

Large cell pathology

Peripheral or central
Histo: large, poorly differentiated cells

11

Large-cell behaviour

Poor prognosis

12

Small-cell epi

20%
Smoking

13

Small-cell pathology

Central location, near bronchi
Histo: small, poorly differentiated cells

14

Small-cell behaviour

80% present with advanced disease
V. chemosensitive but v. poor prognosis
Ectopic hormone secretion

15

Other lung tumours: all rare

- Adenoma: 90% are carcinoid tumours
- Hamartoma
- Mesothelioma

16

Epi

19% of all cancers
27% of cancer deaths (commonest)

17

Symptoms

Cough and haemoptysis
Dyspnoea
Chest pain
Recurrent or slow resolving pneumonia
Anorexia and reduced weight
Hoarseness

18

Signs in the chest

Consolidation
Collapse
Pleural effusion

19

General signs

Cachexia
Anaemia
Clubbing an dHPOA (painful wrist swelling)
Supraclavicular and/or axillary LNs

20

Metastasis signs

- Bone tenderness
Hepatomegaly
Confusion, fits, focal neuro
Addisons

21

Complications local

recurrent laryngeal N. palsy
Phrenic N. palsy
SVC obstruction
Horners (Pancoast tumour)
AF

22

Paraneoplastic endo

1. ADH - SIADH (euvolaemic reduced Sodium)
2. ACTH - Cushings syndrome
3. Serotonin - carcinoid (flushings, diarrhoea)
4. PTHrP - primary HPT (raised Calcium, bone pain) - SCC

23

Paraneoplastic Rheum

Dermatomyositits/polymyositis

24

Paraneoplastic neuro

Purkinje Cells (CDR2) - cerebellar degeneration
- Peripheral neuropathy

25

Paraneoplastic Derm

- Acanthosis nigricans (hyperpigmented body folds)
- Trousseau syndrome: thrombophlebitits migrans

26

Metastic signs

- Pathological fractures
- Hepatic failure
- Confusion, fits, focal neuro
- Addisons

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