Respiratory - Lung Cancer Flashcards
What is the most common cause of lung cancer?
Smoking
What are the two broad types of lung cancer?
Small-cell lung cancer (20%)
Non-small-cell lung cancer (80%)
How are non-small-cell lung cancers divided?
Adenocarcinomas (40%)
Squamous cell carcinoma (20%)
Large-cell carcinoma (10%)
Other (10%)
What do small-cell lung cancers contain?
Neurosecretory granules that release neuroendocrine hormones
Can cause paraneoplastic syndromes
What is mesothelioma?
Malignancy affecting mesothelial cells of the pleura
Linked to asbestos
Up to 45 years latent period
How does lung cancer present?
Finger clubbing
Haemoptysis
Cough
SOB
Recurrent pneumonia
Weight loss
Supraclavicular lymphadenopathy
What are some extrapulmonary manifestations of lung cancer?
Recurrent laryngeal nerve palsy (tumour presses on nerve)
Phrenic nerve palsy
SVC obstruction
Horner’s syndrome (pancoast tumour pressing on sympathetic ganglion)
SIADH
Cushing’s syndrome
Hypercalcaemia
Limbic encephalitis
Lambert-Eaton myasthenic syndrome
What causes limbic encephalitis in lung cancer?
Small-cell lung causes immune system to make antibodies against brain tissue
Causes memory impairment, hallucinations, confusion and seizures
Anti-Hu antibodies
What causes Lambert-Eaton myasthenic syndrome in lung cancer?
Antibodies against small-cell lung cancer cells
Antibodies target voltage-gated calcium channels on presynaptic terminals in motor neurones
Causes weakness in proximal muscles
Intraocular muscles causing diplopia
Pharyngeal muscles
Autonomic dysfunction
How should patients with suspected lung cancer be managed?
CXR within 2 weeks to patients with:
- Clubbing
- Lymphadenopathy
- Recurrent chest infections
- Thrombocytosis
- Chest signs of lung cancer
Or
Two or more unexplained symptoms in patients that have never smoked
One or more unexplained symptoms in patients that haven’t smoked or had asbestos exposure
What investigations are used for lung cancer?
CXR first line
Staging CT
PET-CT
Bronchoscopy
Histology
How is lung cancer treated?
MDT meeting
Surgery is first-line in non-small-cell lung cancer
Radiotherapy can be curative if diagnosed early
Adjuvant chemotherapy
Small-cell is treated with chemotherapy and radiotherapy
Endo brachial treatment with stents or debulking to relieve obstruction
What signs of lung cancer would there be on a CXR?
- Hilar enlargement
- Peripheral opacity
- Pleural effusion
- Collapse
What are the different options for removing a lung tumour?
Segmentectomy or wedge resection (portion of one lobe)
Lobectomy (entire lobe removal)
Pneumonectomy (entire lung)
What are the different types of surgery for removing lung cancer?
- Thoracotomy ,open surgery and separation of rib to access thoracic cavity
- Video-assisted thoracoscopic surgery (VATS)
- Robotic surgery
