Lung Cancer Flashcards
(53 cards)
What different ways can lung cancers present?
Primary tumour
Local invasion symptoms
Metastases
Paraneoplastic syndrome (e.g. hormones)
What symptoms should prompt you to think of making a lung cancer referral?
- Cough >3 weeks
- Breathless for no reason
- Chest infection that doesn’t clear up
- Coughing up blood
- Unexplained weight loss
- Chest/shoulder pain
- Unexplained tiredness
- Hoarse voice
When you look at any chest X-ray, the smaller of the two lungs is usually the diseased one. TRUE/FALSE?
TRUE
- enlarging tumour obstructs proximal divisions of the bronchial tree
- air beyond obstruction is absorbed
- lung tissue shrinks
Describe the appearance of the lung mucosa when a tumour lies underneath it
red (prone to haemoptysis) and ulcerated
Why do lung cancers often cause stridor (inspiratory noise) rather than an expiratory wheeze?
- tumour causes bronchi narrowing and pools of secretions
=> difficulty breathing in - asthma and COPD have expiratory wheeze as the air can enter the lungs but has difficulty getting out
What structures can be locally invaded by a lung cancer?
Recurrent laryngeal nerve Pericardium Oesophagus Brachial plexus Pleural cavity Superior vena cava
What symptom does the patient experience if a lung cancer invades the recurrent laryngeal nerve?
Hoarse voice
What symptoms can the patient experience if a lung cancer invades the pericardium?
AF
pericardial effusion
What symptom would indicate that a lung tumour has spread to the oesophagus?
Dysphagia to solids
A pancoast tumour can invade what structure and cause what symptoms?
Invades brachial plexus
=> causes neuropathy in hand/arm
Why do lung cancers cause pleural effusions?
- tumour invades the pleural space
- generates large volume of pleural fluid (can be litres!!)
- presenting symptom = breathlessness
What symptoms are caused by local invasion and obstruction of the SVC?
- obstructs drainage of blood from the arms and head
- superficial veins on abdomen distend to avoid SVC
Bone pain due to lung cancer invasion is often worse at what time of the day?
Night
Where do lung cancers commonly metastasise to?
Adrenal Skin Liver Brain Bone Other Lung
What sign in the hands may point towards a lung cancer diagnosis?
Finger clubbing
What hormones can be secreted from lung tumours and what effects do these cause?
PTH Mimic => causes Hypercalcaemia (Bones, groans, moans, stones etc)
ADH released => SIADH => hyponatraemia and confusion
What acute neuropathy is caused by a primary lung tumour and resolves upon tumour resection?
Lambert Eaton syndrome
causes weakness similar to mysathenia gravis
What is Hypertrophic pulmonary osteoarthropathy?
- association of lung cancers
- causes bone pain/tenderness near joints
- periosteum of bone lifts away from bone surface
- it is NOT a sign of metastasis to the bone
How is hypercalcaemia due to a lung tumour treated?
- Bisphosphonates may need to be used to prevent bone disease
- initial Tx = rehydration
What type of lung cancer is more likely to release a mimic of PTH and cause hypercalcaemia?
Squamous Cell
What type of lung cancer usually secretes ADH?
Small cell
How is SIADH due to lung cancer treated?
Fluid restriction – 1.5L/day
What other differential diagnoses exist for patients who smoke, have experienced haemoptysis and have an abnormal CXR?
Tuberculosis Vasculitis Pulmonary embolism Secondary cancer Lymphoma Bronchiectasis
What chemicals are found in tobacco smoke that are responsible for lung cancer?
polycyclic hydrocarbons aromatic amines phenols nickel cyanates
