lung cancer Flashcards
(25 cards)
risk factor
gender,smoking history,older age, airflow obstruction,genetic,occupational:arsenic,asbestos,chromium,nickel
4 major types
broadly:small cell and non-small cell
Epidermiod [squamous] -35%
Adeno carcinoma -30%
Large cell carcinoma -15%
Small cell lung cancer -20%
Epidermiod carcinoma(Squamous)
- most frequently in men and old people
- Usually starts on one airway.
- Tend to be localized in the chest
- Does not tend to metastasize early.
- It is strongly associated with smoking
Adenocarcinoma
Most common cancer among women and non-smoker
* Usually started near the outer edges of the
lung.
* Invasion of pleura and mediastinal lymph node
is common.
Large cell carcinoma
- Less well – differentiated.
- May occur at any part of the lung.
- Tumors are large by the time they are
diagnosed. - Has greater possibility of spreading to brain
and mediastinum.
Small cell lung cancer:
- AKA oatcell because
SCLC cells have oat grain appearance. - It arises from endocrine cells [kulchitisky cells]
where many hormones are secreted - spread to lymph nodes and other organs -lungs
bones/brain/liver more quickly than NSCLC
Usually started in one larger airway.
-Tend to grow rapidly .
Commonly has spread by the time and is considered a systemic
disease.
-It is the only one of the bronchial carcinomas that respond to
chemotherapy
Cough
- most common early symptoms.
- Sputum is purulent if there is sec. infection.
-A change in the character of the (regular cough) associated with other
new respiratory symptoms increase the possibilityof B.C.
Haemoptysis
Repeated episodes of scanty cough hemoptysis or blood –streaking
of sputum in smokers are highly suggestive
Dyspnea
occlusion of a large bronchus resulting
in collapse of a lobe of the lung or
development of pleural effusion.
Pleural pain
malignant invasion of the pleura or reflect infection distal
to a tumour
Involvement of pleura and ribs .
Pancoast’s tumour:
involvement of lower part of the brachial plexus ( C8 , T1,T2) causing severe pain of the shoulder and down inner surface of the arm.
Horner’s syndrome-Due to involvement of sympathetic ganglion
partial ptosis
* upside-down ptosis (slight elevation of
the lower lid)
* anhidrosis
* miosis
* pseudoenophthalmos (the impression
that the eye is sunken, caused by a
narrow palpebral aperture)
* loss of ciliospinal reflex
unilateral vocal cord paresis with hoarsness
of voice and a bovine cough.
Recurrent laryngeal nerve palsy
paralysis of the diaphragm
Invasion of phrenic nerve
OTHERS
Involvement of esophagus , causing dysphagia.
Cardiovascular:
atrial fibrillation, tamponade ,pericarditis ,pericardial
effusion .
Superior vena cava obstruction
morning headache, facial congestion and edema
involving the upper limb, distention of jugular vein and veins of
the chest.
Blood borne metastasis:
Bony metastasis giving severe bony pain and pathalogical
fractures.
Liver metastasis (Jaundice)
Brain metastasis (change in personality, epilepsy,focal
neurological symptoms).
Paraneoplastic syndromes
Endocrine manifestation:
12% of tumors ,in particular small cell tumors present with
SIADH,
ACTH secretion(SCLC),
Hypercalcemia(sq.cell carcinoma) ,
Bone metastasis
Gynaecomastia(LCLC)
Neurological manifestation:
sensory polyneuropathy ,
myelopathy,
cerebellar degeneration
Others:
Digital clubbing ,
Hypertrophic pulmonary osteo-arthropathy (sq.cell cancer) ,
Nephrotic syndrome,
DIC, hypercoagulopathy (adenocarcinoma),
Thrombophelibitis migricans.
Physical signs:
1- Physical signs of collapse (in large obstructing tumor) which
may give rise to pneumonia.
2- Monophonic or unilateral wheeze (fixed bronchial
obstruction).
3- Stridor (obstruction at or above the level of main carina).
4- Hoarsness of voice associated with bovine cough (recurrent
laryngeal nerve palsy).
5- Dullness percussion and absent breath sounds at the lung
base (unilateral diaphragmatic palsy due to involvement of
phrenic nerve)
6- Physical signs of pleursy or pleural effusion (involvement of
pleura).
7- Bilateral engorgement of the jugular vein and later edema
affecting face, neck, arms.( SVC obstruction)
8- Tenderness and pain of long bone and joints (HPOA).
INVESTIGATION
-Chest X-ray
-CT: the most valuable radiologic study for evaluation,
staging, and therapeutic planning of lung cancer
-MRI: mediastninum or paravetebral region
PE: H & N lymph nodes
Sputum cytology: 20% to 30%
sensitivity
Bronchoscopic examination: 90%
positive
CT-guided Bx: 95% positive
Brain CT scan: small cell carcinoma.
Pulmonary function tests: ability to
undergo surgical resection or withstand
irradiation
Bone scans: stage III before curative
therapy
common radiological presentation
-unilateral hilar-enlagement
-peripheral pulmonary opacity ( TUMOUR MASS)
- lung, lobe or segmental collapse
- pleural effusion
-broad mediastisum with enlarged cardiac shadow
-hemidiaphragm elevation (phrenic nerve palsy
-canon ball opacity(metastasis)
-apical mass with rib destruction ( pancoast tumour)
staging must know
refer notes
Small cell lung cancer staging
Limited stage: The cancer is found in one lung, sometimes including
nearby lymph nodes.
Extensive stage: Cancer has spread to the other lung, the fluid
around the lung (the pleura) or to other organs in the body.
