Lung Cancer - causes and treatment Flashcards
Pathological Diagnosis of Lung Cancer
Histopathology uses the clinical method
Distribution of tumour, gross appearances - number/shape/size
Growth pattern at margin of tumour
Histological type, prognostic and predictive features
All requires a multidisciplinary approach
Small Cell Carcinoma
Widespread bulky disease
Small, dark, delicate cells with little cytoplasm
‘Salt and pepper’ chromatin in the nuclei
Azzopardi effect
Squamous Cell Carninoma
Central origin often
Cigarette smoke provokes squamous metaplasia, then dysplasia of bronchial epithelium
Patterns of Spread of Lung Cancer
Local and direct spread - adjacent ling, intrapulmonary metastasis; pleura and pleural cavity
Lymphatic - lymphatics within lung; lymph nodes (hilar and mediastinal)
Systemic spread - liver, bone, brain, adrenal
When might palliative care have a role in lung cancer management
In terminal phase
After active oncological treatment or as only possible treatment
During treatment
Peri-diagnosis
Increasing palliative care need
Psychological distress Losing weight Cough worsening Worsening pain (analgesia, radiotherapy) Exploring wishes now fully acknowledging disease not curable
Epidemiology
478000 new cases in UK each year
Third most common cancer
35000 die each year
20% of all new cancers
More deaths than breast and colo-rectal, bladder and uterine combined
Leading cause of cancer death
Lung cancer is now the leading cause of cancer death in women
Four people die from lung cancer in the UK every hour
Despite label smokers disease 1:8 have never smoked
Causes of Lung Cancer
70% are caused by smoking
Deaths in men have reduced by more than a quarter
Lung cancer deaths in women are increasing
Symptoms of Lung Cancer
Usualy in a smoker of more than 20 years
- respiratory (cough, haemoptysis, dyspnoea, wheeze, chest pain, hoarseness)
- metastatic (from spread to distant sites); (weight loss, anorexia, nausea, malaise, fatigue)
- paraneoplastic/systemic (hyponatraemia - small cell carcinoma; hypercalcaemia - squamous cell carcinoma; gynaecomastia; pruritis; cerebellar degeneration; peripheral neuropathy)
Common signs on examination
Clubbing
Supraclavicular, cervical lymphadenopathy
Stridor due to large airway disease or vocal cord palsy
Focal chest signs of lung collapse, fixed wheeze
Pleural effusion
Clinical features of sub-types
Non small cell (NSCLC):
Squamous- central; invade locally; frequent cavitation; hypercalcaemia common (20%).
Adenocarcinoma- peripheral lung; more common in non-smokers Most common (40%).
Large cell (5%).
Undifferentiated (18%).
Small cell: central; early lymphatic spread; paraneoplastic syndromes (13%)
Investigations
CT
Bronchoscopy
Endobronchial Ultrasound Needle aspiration
Other biopsy procedure e.g. percutaneeous CT thorax, peripheral lymph node/liver
PET scanning
TNM Staging in Lung Cancer
Staging is one of the important factors in determining treatment and prognosis in lung cancer (general fitness and patient wishes being the others)
It takes into account tumour size, involvement of local structures, lymph and blood metastases
Role of surgery in NSCLC
Consider surgery for all patients with stage 1 and 2 disease
Usually involves lobectomy
In practice around 20% in UK undergo potentially curative resection for lung cancer
Other radical treatment for NSCLC
Radical radiotherapy (good symptom relief, but not expected to cure)
+/- chemotherapy (improve quality of life, modest improvement in survival, may be used in conjunction with radiotherapy)
Usually reserved for those with stage 1 or 2 disease who are unfit for surgery
