Lung tumours Flashcards
(43 cards)
What is lung cancer?
Carcinoma (malignant tumour) of the bronchus or pleura. [PTS]
What are the main types of lung cancer in order of prevalence?
Non-small cell (80%) -squamous 35%, adenocarcinoma 30%, large-cell 15%
Small-cell (20%) [KC]
Give 3 risk factors for lung cancer.
Smoking Asbestos Chromium Arsenic [pts]
Give 3 features of lung squamous cell carcinoma.
May cavitate with central necrosis
Cause obstructing lesions of bronchus with post-obstructive infection
Local spread common, metastases relatively late. [kc]
Give 3 features of lung adenocarcinoma.
Originate from mucus-secreting glandular cells, causes excess mucus secretion
Most common type in non-smokers.
May cause peripheral lesions on X ray/CT
Metastases common to bones, brain, pleura, lymph nodes and adrenal glands.
Give 3 features of small-cell lung carcinoma.
Tumour arising from neuroendocrine (APUD) cells.
Often secrete polypeptide hormones
Arise centrally and metastasise early.
Which lung cancer is more likely in a non-smoker?
Adenocarcinoma
Give 3 local effects of lung cancer.
Cough (40%) - 3-week cough -> CXR!
Chest pain (20%) - sharp pleuritic pain as chest wall and pleura well innervated.
Haemoptysis (7%) - tumour bleeds into airway
Breathlessness - occlusion, SOBOE, may also have COPD
Wheeze - monophonic, partial obstruction
Hoarse voice - left recurrent laryngeal nerve compression. [kc]
What would be the effect of metastases to the adrenal gland?
Asymptomatic - no adrenal insufficiency [kc]
Give a clinical feature of metastatic spread to the liver.
Liver - anorexia, weight loss, nausea, RUQ pain [kc]
Give a clinical feature of metastatic spread to bone.
Bony pain, fractures, risk of spinal cord compression
Give a clinical feature of metastatic spread to the lymph nodes.
Lymphadenopathy?
Give a clinical feature of metastatic spread to the brain.
Space occupying lesion -> raised ICP -> headache.
Give 3 paraneoplastic syndromes seen in non-small cell lung cancer.
Clubbing
Anorexia
Hypertrophic pulmonary osteoarthropathy (clubbing, periostitis)
Give 3 differential diagnoses of cough other than lung cancer.
COPD Asthma (diurnal variation) Sarcoidosis Heart failure Upper airway cough syndrome/ post-nasal drip
Give 3 investigations you would do to diagnose lung cancer.
Staging, tissue diagnosis, assess fitness for treatment. [ck] CXR Chest CT Biopsy - surgical Bronchoscopy [pts]
Give the T stages for lung cancer.
TNM staging.
T1a,b,c: <1,<2,<3cm. contained within the lung;
T2a,b: <4,<5cm/ spread to bronchus or pleura but not chest wall.
T3: 5-7cm/ >1 tumour in same lobe/ spread to chest wall, phrenic nerve or pericardium.
T4: >7cm/ >1 lobe affected/ spread outside chest wall. [cancer research uk]
Give the N stages for lung cancer.
N1= in lung or hilar LNS N2 = in mediastinal or subcarinal LNs N3 = contralateral hilar, mediastinal or supraclavicular LNs.
Describe the M stages for lung cancer.
M1a - both lungs/ pleura/ pericardium (effusion)
M1b - single met outside the chest
M1c - multiple mets outside the chest.
What determines management for lung cancer?
Tumour resectability and patient fitness for operation as well as patient preference.
How is operability assessed?
WHO performance status: how restricted they are and how much time they spend in chair/bed.
ECG, lung function, exercise capacity
[lecture 8/12/17]
Describe the management of stage 1 or 2 NSCLC.
Surgical excision
Radical deep X ray therapy
[lecture, pts]
Describe the management of stage 3 or 4 NSCLC.
Palliative chemotherapy
Chemo + radio therapy
Supportive and palliative care
[lecture, pts]
Give 3 local complications of lung cancer.
Recurrent laryngeal nerve palsy Horner's syndrome SVC obstruction Pericarditis AF [ohcm]
