Troublesome Cough Flashcards
(24 cards)
Red flag symptoms for lung cancer (8)
Cough (dry/productive) - productive = send sputum sample Haemoptysis Dyspnoea Hoarse voice - recurrent laryngeal nerve - mediastinal involvement Chest pain - character important Fatigue Loss of appetite Weight loss - quantify, intentional?
What are para-neoplastic syndromes?
Rare disorders caused by immune response to cancer
Non-metastatic systemic effects
EG
- hypercalcaemia in squamous cell lung cancer due to PTrH
- HPOA
What is HPOA?
Hypertrophic Osteoarthropathy Characterised by abnormal proliferation of skin and periosteal tissues involving the extremities Three clinical features -digital clubbing -periotosis of tubular bones -synovial effusions
Management for patient (lifelong smoker) returning to GP with no improvement, following antibiotics given for cough 2 weeks prior
Urgent referral (2ww) for CXR Smoking Cessation
CT required if CXR is abnormal
Information needed before CT contrast
Any previous reaction
Rental function - if GFR <40 there is a risk of contrast induced AKI
DM - metformin may need to be stopped pre contrast if renal impairment
Importance of PMH in cancer patient
Consider fitness for treatment options:
Surgery - lung/cardiac function
Chemotherapy - renal/liver function
Radiotherapy - lying flat
Bloods in suspected Lung Ca
FBC - anaemia
Rental function - check fitness for chemo
Bone profile - Increased calcium could be a sign of bony mets or a para-neoplastic syndrome
Liver function
Further tests
Pulmonary function test - essential to measure lung reserve before potential surgery or radical radiotherapy
Bronchoscopy and biopsy - histological diagnosis and staging
PETCT
Factors important in deciding treatment (6)
Patient preference Patients social support networks Stage of disease Patient fitness/performance Histology and other characteristics Co-morbidities
When is surgery not possible in lung cancer?
If there is invasion of the mediastinum
ECOG Performance Scale
0 - fully active, able to carry out all pre disease performance without restriction
1 - restricted in physically strenuous activity but ambulatory and able to carry out light work
2 - ambulatory and capable of self care but unable to carry out work activities. Up and about >50% waking hours
3 - capable of limited self care. Confined to bed/chair >50% waking hours
4 - completely disabled and confined to bed/chair. No self care
5 - deceased
Important aspects of oncology history
Smoking history
Alcohol history
Occupation -asbestos, compensation, inability to work, loss of income
Who’s at home
Family history (preconceived pos/neg ideas)
2 chemo drugs
Cisplatin
Etoposide
Side effects of Radiotherapy
Fatigue
Pain flare
Diarrhoea
Oesophagitis -occurs within 2 weeks, settles within 2-4 weeks
Skin reaction
Nausea
Hair loss
Dyspnoea - due to lung damage (pneumonitis)
- can occur 2-3 weeks into therapy, can progress several months after treatment finishes
- can be life threatening
Precautions for radiotherapy
Volume of lung receiving 20Gy should be kept to <35% to limit lung damage Lung toxicity (pneumonitis) is treated with high dose steroids but may be irreversible
Small Cell Lung Cancer (15%)
Usually disseminated - smoking related
Rapid growth - doubling approx 29 days
Very chemo/radiosensitive but rarely cured
No curative treatment - median survival 2-4 months
Median survival is 6-12 months for extensive (metastatic) disease
Median survival is 16-24 months for localised disease
Squamous Cell Carcinoma(30%)
Typically central so symptoms develop early
Smoking related
Best survival due to potential operability
Doubling time 90 days
Adenocarcinoma (30-40%)
Typically peripherally located Slower growth - doubling time 160 days Metastasise early Can occur in non smokers Can respond to newer systemic agents - i.e tyrosine kinase inhibitors
Tumour staging
T
T1 - <3cm
T2 - 3-5cm
T3 - 5-7cm or invades chest wall or separate nodule same lobe
T4 - >7cm or invading local structures - inoperable
Tumour Staging
N
N0 - no nodes
N1 - local ipsilateral nose
N3 - ipsilateral mediastinal node(s)
N4 - contralateral mediastinal nodes
Tumour Staging
M
M1a separate tumour nodule(s) in a contralateral lobe
M1b single extra thoracic metastasis in single organ
M1c multiple extra-thoracic metastases
Complications of Lung cancer
1/3 of lung cancer patients develop brain mets
- Common in advanced disease and adenoma
CVA less likely but possible
Treatment of headaches in cancer
Dexamethasone, 8mg BD PO
- Check baseline blood sugars as steroids can exacerbate diabetes
PPI may be helpful too
1 year survival rate for patients diagnosed with lung cancer in UK
30%
