Flashcards in Lung Cancer Deck (28):
Red flag symptoms for lung cancer:
Weight loss, appetite loss
What does hoarse voice indicate?
Could be symptom of recurrent laryngeal nerve involvement, which could indicate mediastinal involvement of the cancer.
What are para-neoplastic syndromes? Examples.
Rare disorders caused by immune response to cancer.
e.g. Hypercalcaemia in squamous cell lung cancer.
Appropriate investigations for suspected lung cancer.
What do radiology need to know before performing a contrast CT?
Allergies to contrast dye
Renal function: if GFR is <40ml/min, contrast may risk causing AKI
Metformin for diabetes
Why check renal function prior to chemotherapy?
Most lung-cancer chemotherapy is excreted through the kidneys, so good kidney function is necessary.
What specialist investigations are necessary for suspected lung cancer?
Bronchoscopy & Biopsy
Also pulmonary function tests
What is the structure for breaking bad news?
Perception (what does pt. already know/think?)
Invitation (what does the pt. want to know?)
Knowledge (Foreshadow bad news. Tell. Check understanding)
Emotions (explore and address pt's emotions).
What is likely in never-smoker patients with lung cancer?
EGFR (epidermal growth factor) mutation.
Types of lung cancer
Small cell lung cancer (12%)
- Usually caused by smoking
Non-small cell lung cancer (88%)
- Adenocarcinoma (most common)
- Squamous cell cancer (usually caused by smoking)
- Large cell cancer
Main features of small cell lung cancer
- Smoking related
- Rapid growth
- Very chemo/radiosensitive, but rarely cured
- Mean survival without treatment: 2-4 months
- Mean survival with treatment: 6-12 months for metastatic disease
- Mean survival with treatment: 16-24 months for localised disease
Main features of squamous cell carcinoma
- Smoking related
- Highly operable
- Best survival
- Doubling time: 90 days
Main features of adenocarcinoma
- Slower growth: doubling period of 160 days
- Can metastasise early
- Can occur in non-smokers
- Can respond to newer agents: tyrosine kinase inhibitors
How do you treat cerebral oedema due to brain tumours?
Most common presenting symptoms in non-small cell lung cancer
Cough and haemoptysis
When is non-small cell lung cancer diagnosed?
Non-small cell lung cancer is typically asymptomatic in early stages, so most are diagnosed when locally advanced or metastatic.
Shoulder pain in patient with respiratory symptoms:
Pancoast tumour (tumour at apex of lung)
What is Horner's syndrome and how might it be related to lung cancer?
Ptosis, miosis, ipsilateral anhydrosis
Most common sites of metastasis
Brain (headaches, confusion, personality changes, seizures, focal neurological deficits)
Bone (bony pain, fractures)
Liver (nausea, vomiting)
Blood tests for suspected lung cancer
FBC (anaemia could be sign of advanced disease)
Renal function (fitness for chemo)
LFTs (fitness for chemo, signs of liver mets)
Bone profile (raised calcium could be sign of bone mets or paraneoplastic hypercalcaemia)
What can cause hypercalcaemia in a lung cancer patient?
Parathyroid hormone secretion in squamous cell lung cancer.
Non blood test investigations in suspected lung cancer
Chest X-ray first!
Then, contrast-enhanced CT scan of thorax and abdomen (staging)
Pulmonary function tests
Bronchoscopy and biopsy (histological dx and staging)
Other tests if symptoms indicate:
- e.g. brain MRI if headaches / confusion / seizures etc.
Differentials for lung cancer
- Small cell lung cancer
- Non-small cell lung cancer
- Metastases from other cancer (skin, thyroid, oesophagus, ovarian, colon, breast, kidney, testicle)
- Pulmonary tuberculosis
Treatment for lung cancer
Surgery (lobectomy or pneumonectomy)
Chemotherapy (pre-operative and post-operative)
Radiotherapy (pre-operative and post-operative)
Three common complications of lung cancer
Superior vena cava syndrome
Paraneoplastic syndromes (e.g. hypercalcaemia)
What is superior vena cava syndrome?
A potential complication of lung cancer.
Right upper lobe tumour presses on SVC, impeding venous return.
Causes oedema (face and arms), shortness of breath, cough, and orthopnoea (SoB when lying flat).
Small cell lung cancer vs non-small cell lung cancer.
Which one is worse?
Prognosis for small cell lung cancer is very poor (25% 5-year survival rate at best)
Prognosis for non-small cell lung cancer is better.