Flashcards in Lung Cancer Deck (23)
What are the symptoms of a lung tumour that is compressing neighbouring structures?
SVC obstruction - causes distension of veins
Hoarse voice due to compression of the left recurrent laryngeal nerve
Dyspnoea due to compression of the phrenic nerve
Horner's syndrome (pancoast tumour)
What are the typical symptoms of a primary lung tumour?
Cough, dyspnoea, wheezing (main airway obstruction), haemoptysis (bleeding from the tumour itself or from erosion in to pulmonary vessels), chest/shoulder pain, weight loss, lethargy/malaise
What is meant by a paraneoplastic syndrome?
Give examples of paraneoplastic syndromes due to lung cancer!
The presence of a symptom or disease due to the presence of cancer in the body but not due to the local presence of cancer cells
Small cell - Cushing's syndrome, SIADH, Lambert Eaton
Squamous cell - Hypercalcaemia
Non-small cell - hypertrophic osteoarthropathy
How are lung tumours classified?
Divided into two groups depending on the presence or absence of cells
Non-small cell lung cancer (including squamous cell (more likely to be central), Adenocarcinoma (peripheral), large cell carcinoma)
Small cell lung cancer - they behave very aggressively
Non small cell is the most common
What different treatments are available for the treatment of lung cancer?
Curative surgery for stages 1&2 (presuming fit for surgery)
Surgery and adjuvant chemotherapy clinical trial for stage 2a
Radiotherapy (radical is curative and palliative is for symptom control)
Chemotherapy - consider in patients with stage 3/4 and PS 0-2
Radiotherapy - curative CHART for people not fit for surgery OR palliative
Consider prophylactic cranial radiotherapy
What imaging techniques can be used in the diagnosis and staging of lung cancer?
Staging is the most important thing in determining treatment and prognosis
Investigations include plain chest x-Ray upon first suspicion, ct scan, pet scan, isotope bone scan
What are the two staging systems for lung cancer?
TNM and number
Outline the number staging system for lung cancer
Stage 1 - small cancer, localised to one area of the lung
Stage 2/3 - larger cancer, may have grown into surrounding tissues
Stage 4 - cancer has metastasised
What does the prognosis of lung cancer depend on?
Stage of the disease
What is the clinical pathway to diagnosis and treatment?
2 week referral from presentation to primary care
Staging CT of chest, abdomen and pelvis
PET scan (uses radioactive glucose to look for areas of high metabolic activity as an indication of possible metastases)
MDT meeting to discuss patient and treatment options
62 day pathway from urgent referral
What are the stages of the WHO Performance Status system?
1: Restricted in strenuous physical activity
2: Up and about >50% of waking hours
3: >50% in bed, but not bed bound
Who is involved in the MDT meeting?
Radiologist, surgeon, specialist nurse, respiratory physician, oncologist, palliative care team, LOROS representative
What are the different options for obtaining a biopsy?
US guided neck node FNA for cytology if lymphadenopathy
Endobronchial biopsy - if central ariway obstruction
EBUS - for lymph nodes or tumour near the central airways
CT guided biopsy - LA, if the tumour is peripheral
Thoracoscopy - if a pleural effusion is present, fluid MCS, camera in to the pleural cavity to take a biopsy
Lambert-Eaton myasthenic syndrome is a paraneoplastic syndrome associated with lung cancer. What is it?
Autoimmune disorder that is characterised by muscle weakness of the limbs, antibodies against pre-synaptic vg Ca2+ channels
What are the common sites for a lung cancer metastasis?
Liver, adrenal glands, bone, brain
What are the associated causes of lung cancer?
Passive smoke exposure
Occupational exposure to asbestos
What are the neurological paraneoplastic syndromes associated with lung carcinoma?
Anti-Hu syndrome - paraneoplastic sensory neuropathy, +/- paraneoplastic encephalomyelitis
Subacute cerebellar degeneration - anti-Hu/anti-Yo, anti-Ri
What is meant by Pemberton's sign?
Associated with SVCO
Ask the attention to lift both arms as high as possible and hold, watch the patient's face for congestion/venous distension
N.b resp distress may occur
What is the management of small cell lung cancer?
If T1-2a, N0, M0 consider surgery
Most patients will receive a combination of radiotherapy and chemotherapy
What is the management of non small cell lung cancer?
Only 20% are suitable for surgery
Poor response to chemotherapy
Curative or palliative radiotherapy
What is meant by hypertrophic pulmonary osteoarthropathy?
Aka Pierre Marie Bamberger syndrome
Paraneoplastic syndrome associated with non small cell lung cancer
Typically squamous cell, then adenocarcinomas
Clubbing and periositits
Can present with pain in both wrists
What is the difference between limited and extensive staging of disease?
Limited - can be contained and treated within one targeted field of radiotherapy
Extensive - distant metastases