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Source: medscape.com |
Types of Lung Cancer Bronchocarcinomas
Small Cell Carcinoma, 20-30%- Endocrine origin
- oat cell carcinoma
- Prognosis Poor
- Highly Malignant
Non Small Cell Carcinoma
- Squamous Cell Carcinoma, 40%
- Large Cell Carcinoma, 25%
- Bronchoalveolar Cell Carcinoma, 1-2%
- Adenocarcinoma, 10%
Mesothelioma
- usually occurs in the pleura
- Tumour of mesothelial cells
Presenting Symptoms
- Cough 41%
- Cough and Pain 15%
- Chest Pain 22%
- Chest Infection <5%
- Haemoptysis 7%
- Hoarseness <5%
- Weight Loss <5%
- Malaise <5%
- No Symptoms <5%
- SOB <5%
- Distant Spread <5%
Risk Factors
- Smoking
- Arsenic
- Asbestos Exposure
- Radiation (Radon Gas)
- Family History
- Iron Oxides
- Chromium Exposure
Signs
- Hypertrophic pulmonary oteoarthropathy (causing wrist pain)
- Clubbing
- Supraclavicular/Axillary Lymphadenopathy
- Cachexia
- Anaemia
Chest Signs
- Collapse
- Maybe None
- Pleural Effusion
- Consolidation
Metastasis Signs
- Focal CNS deficit
- Fits
- Proximal Myopathy
- Hepatomegally
- Bone Tenderness
- Peripheral Neuropathy
- Confusion
- Cerebellar Syndrome
Complications
LOCAL- Horner's Syndrome (Pancoasts Tumour)
- Rib Erosion
- Recurrent Laryngeal Nerve Palsy
- AF
- SVC Obstruction
- Phrenic Nerve Palsy
- Pericarditis
METASTATIC
- Bone (increased Cat, anaemia,bone pain)
- Adrenals (Addison's)
- Liver (Raised LFTs, Hepatomegally)
- Brain
ENDOCRINE
- Ectopic Hormone Secretion e.g. PTH by squamous cell carcinomas, SIADH, ACTH by oat cell carcinoma
Investigations
- Bronchoscopy: For Histological Diagnosis and assessment of operability
- FNA: Peripheral Lesions, Superficial Lymph Nodes
- Bone Scan: For suspected metastases
- CT: Stage the Tumour Radionuclide
- Cytology: Sputum and Pleural Fluid
- Lung Function Tests
Looking at the Chest X-Ray
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Source: wikimedia.org |
- Cell type can't be diagnosed from X-Ray
- Lesions >4cm be suspicious of malignancy
- Lesions rarely seen until >1cm
- Lobular or irregular edges
- NB: presence of calcification, air bronchogram - unlikely to be malignancy
- Metastasises to Liver, Adrenals, Bones, Brain
- 20% cavitate - usually scc
Stages of the Tumour
Primary Tumour- TX malignant cells in bronchial secretions
- Tis Carcinoma in situ
- TO Non Evident
- T1 < or = 3cm in lobar or more distal airway
- T2 > 3cm and >2cm distal to carina or pleural involvement
- T3 Involves chest wall, pericardium, medistinal pleura, diaphragm or <2cm from carina
- T4 Involves mediastinum, oesophagus, carina, great vessels, vertebral body, heart, trachea or malignant effusion present
Treatment
Small Cell tumours- Radiotherapy for Bone Pain, bronchial obstruction, Haemoptysis, SVC obstruction, cerebral metastases
- Almost always disseminated at presentation
- Palliation
- May respond to chemotherapy
Non Small Cell Tumours
- Curative radiotherapy
- Excision if no metastatic spread
Mesothelioma
- Diagnosis often only made PM
Prognosis
Small Cell- if untreated: 3 months
- if treated: 1- 1.5 years
Non Small Cell
- 2 year survival without spread: 50%
- with spread: 10%
Mesothelioma
- Less than 2 years
Prevention
- Avoid occupational exposure to carcinogens
- Discourage Smoking
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