RESP: Malignancy Flashcards
2 Main types of lung cancer?
Small cell- 15% of cases and worse prognosis
Non-small cell- more common
Types of non-small cell lung cancer?
Adenocarcinoma
Squamous cell carcinoma
Large cell carcinoma
Most common type of lung cancer?
Adenocarcinoma
Symptoms of lung cancer?
Persistent cough Haemoptysis Dyspnoea Chest pain Weight loss and anorexia SVC obstruction
What type of tumour causes a hoarse voice?
Pancoast tumour pressing on the recurrent laryngeal nerve
Sign of lung cancer?
Cachexia
Finger Clubbing
Hypertrophic pulmonary osteoarthropathy
Anaemia
Horner’s syndrome (if the tumour is apical)
Enlargement of supraclavicular and axillary lymph nodes
Paraneoplastic syndromes: Cushing’s syndrome, SIADH, and Lambert-Eaton syndrome (suggest small-cell), hyperparathyroidism (suggests squamous cell)
On auscultation of the lungs, how might lung cancer sound?
Features of consolidation (pneumonia); collapse (absent breath sounds, ipsilateral tracheal deviation); pleural effusion (Stony dull percussion, decreased vocal resonance and breath sounds)
Features of squamous cell carcinoma?
Typically central tumour
Associated with PTHrP- hypercalcaemia, finger clubbing and hypertrophic pulmonary osteoarthropathy
May also get hyperthyroidism due to ectopic TSH
Features of large cell carcinoma?
Peripheral
Usually anaplastic and poorly differentiated with poor prognosis
May secrete B-hCG
Features of small cell carcinoma?
Associated with ectopic ADH–> hyponatraemia
ectopic ACTH–> hyperglycaemia, hypertension, hypokalaemia, alkalosis, muscle weakness–> may get bilateral hyperplasia of the adrenal glands
Lambert- Eaton syndrome
What is Lambert- Eaton syndrome?
Antibodies to voltage gated calcium channel–> myasthenic like symptoms
What is SVC obstruction?
Oncological emergency
Compression of the SVC most commonly due to lung cancer
Features of SVC obstruction?
Dyspnoea Swelling of face and neck, conjunctival and periorbital oedema Headache- often worse in the morning Visual disturbance Pulseless jugular venous distension
Management options for SVC obstruction?
Dependent on pt, options range from:
endovascular stenting for symptoms relief
Radical chemo or chemo-radio therapy
Glucocorticoids are usually given but evidence is weak
Investigations in suspected lung cancer?
Cxr- may see nodules, lung collapse, pleural effusion, consolidation, and bony metastases
CT- confirm diagnosis and to stage it, ensure adrenals and liver are also scanned to have a look
Bronchoscopy- allow biopsy to be taken
PET scanning- usually in non-small cell lung cancer–> eligibility for curative treatment. Uses 18-fluorodeoxygenase which is preferentially taken up by neoplastic tissue
