What are the two main types lung cancer and which is the most common? What are its subtypes and which is the most common?
1. Non-small cell (80%) Subtypes: i. Squamous (35%) ii. Adenocarcinoma iii. Large cell iv. Alveolar cell v. bronchial adenoma 2. Small cell (20%)
What type of cancer commonly spreads locally?
squamous non small cell
What type of cancer is most associated with asbestos?
adenocarcinoma (non small cell)
What types of cancer metastasise early?
Small cell and large cell
What type of cancer is unrelated to smoking?
alveolar
what cancer secretes polypeptide hormones?
small cell
What are the main causes of lung cancer?
smoking
asbestos
What are the clinical features associated with local cancer w/in the bronchi?
cough
chest pain
haemoptysis
SOB
What clinical features are associated w cancer spread w/in the chest?(include specific areas)
- pain, bone fractures
- pain in shoulder and arm if affecting brachial plexus
- Horners syndrome
- L recurrent laryngeal nerve - hoarseness and bovine cough
- Pressure on oesophagus, heart, SVC
Where does lung cancer commonly metastasise to?
Brain
Bone
Liver
Adrenals
What are non-specific signs and sx of lung cancer?
finger clubbing
malaise, lethargy
weight loss
What are Chest signs of lung cancer?
lymphadenopathy
pleural effusion
lobar collapse
unresolved pneumonia
What tests would you do to confirm a diagnosis of lung cancer?
- CXR
- CT
- Cytology - sputum + pleural fluid
- Fine needle aspiration or biopsy (peripheral lesions/LNs)
- Bronchoscopy aided by endobronchial US - histology + assess operability
What are the main sx which would make you suspicious of lung cancer?
Cough Haemoptysis Dyspnoea Chest pain Recurrent/slowly resolving pneumonia Lethargy Anorexia/WL
What may you see on CXR in a patient w lung cancer?
peripheral nodule hilar enlargement consolidation lung collapse pleural effusion bony secondaries
What tests may help with staging lung cancer?how doe it work?
PET scan - 18 flurodeoxygenase preferentially taken up by neoplastic tissue
What test can be done to help assess suitability for lobectomy?
Lung function tests
What is the treatment of non small cell carcinoma?
Surgery - lobectomy
Radical radiotherapy for stages I, II, III
Chemotherapy +/- radiotherapy for more advanced disease
What is the treatment of small cell carcinoma?
If v early stage - surgery
Most have combination of chemo +/- radio if fit enough
If extensive - palliative care
What does palliation of small cell carcinoma involve, what are the indications for each aspect of treatment?
Radiotherapy - bronchial obstruction, SVCO, haemoptysis, bone pain and cerebral metastases
Endobrachial therapy - tracheal stenting, cryotherapy, last, brachytherapy
Pleural drainage - for symptomatic pleural effusions
What drugs are used in palliative therapy of SCC
Analgesia steroids anti-emetics cough linctus bronchodilators anti-depressants
What is SCC usually associated w?
Ectopic ADH, ACTH secretion
ADH -> hyponatraemia
ACTH -> Cushings