Lung cancer - clinical features and staging Flashcards
Explain the risk factors for lung cancer
Smoking
Passive smoking
Exposure to asbestos, radon, air pollution and diesel exhaust
What are symptoms of lung cancer?
Chronic coughing, haemoptysis, wheeze, chest and bone pain, chest infections, clubbing, weight loss, SOB, hoarse and difficulty swallowing
What are advanced disease symptoms that can show sign of metastases?
Bone pain
Spinal cord compression - limb weakness, paraesthesia and bladder/bowel dysfunction
Cerebral - headache, vomiting, dizziness, ataxia and focal weakness
Thrombosis
What are advanced disease symptoms that show sign of paraneoplastic spread?
Hyperaemia
Anaemia
Hypercalcaemia
Dermatomyositis
Eaton-Lambert syndrome - upper limb weakness
Cerebellar ataxia
Sensorimotor neuropathy
Explain some clinical signs of lung cancer
Clubbing, chest signs, lymphadenopathy, Horner’s syndrome, Pancoast tumour (at apex of lung), SVC obstruction, hepatomegaly (enlarged liver) and skin nodules
What are the investigations in GP are used to diagnose Lung cancer?
CXR, FBC, Renal, liver functions and calcium
Clotting screen and spirometry
What is hyponatraemia?
Sodium levels in the blood are low
Can cause inappropriate hormone secretion
What are some investigations used to tissue diagnose lung cancer?
Bronchoscopy, EBUS, image guided lung and liver biopsy, FNA of node metastases, excision of cerebral metastasis, mediastinoscopy/otomy and surgical excision biopsy
Explain a bronchoscopy
A bronchoscopy is a procedure that allows a doctor to see the inside of your airways and remove a small sample of cells
Thin tube with a camera at the end, called a bronchoscope, is passed through your mouth or nose, down your throat and into your airways
Explain an EBUS
Endobronchial ultrasound scan (EBUS), which combines a bronchoscopy with an ultrasound scan
EBUS allows a doctor to see the inside of your airways. and the ultrasound probe on the end of the camera also allows the doctor to locate the lymph nodes in the centre of the chest so they can take a biopsy from them
Explain image guided biopsy
When an area of concern is detected by an imaging study, biopsies are the only definitive way to confirm whether suspicious tissue is normal or abnormal. In a biopsy, a tiny amount of tissue is taken from the suspicious area and sent to a pathologist
What are the types of lung cancer?
Small cell lung cancer
NSCLC - adenocarcinoma, squamous cell carcinoma and large cell carcinoma
Others
What is used to determine staging in lung cancer?
CT and PET-CT
Describe what is included in treatment decisions
Performance status, patient wishes, histological type and stage, MDT and aim of treatment (radical or palliative)
Describe the 0-4 in performance status?
0 - fully active
1 - symptoms but ambulatory
2 - up and about more than 50% but unable to work
3 - up and about less than 50% and limited self care
4 - bed or chair bound
