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Lung Cancer: Symptoms, Types, Risk Factors, Signs, Causes, Treatment, Complications, Diagnosis & Prevention

Dr. Walid October 30, 2019
lung_cancer_800x600
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

    Lung_CA_CXR
    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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