Lung cancer

  • Created by: MazzaW
  • Created on: 05-12-19 14:56

Squamous cell lung cancer

Central, may cavitate (ring enhancements, air-fluid level)

Other radiological findings: atelectasis, pneumonia, pleural effusion

Incidence: 20%

Smokers more likely to develop this.

May produce PTHrP (hypercalcaemia)

5yr survival: 35%

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Small cell lung cancer (SCLC)

Large bulky central mass, often around hilum/mediastinum. May cause right upper lobe obstruction (most likely type of Ca to cause SVC obstruction). Often have hilar/mediastinal lymphadenopathy

Paraneoplastic syndromes: Cushing's SIADH, encephalomyopathy, LEMS

Skin mets common

Surgery not recommended (use chemo/radiotherapy instead).

Worst prognosis of lung Ca types (5yr survival < 1%)

Incidence: 25%

Important to image upper abdomen as liver/adrenal mets are common. 

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5 different types: adenocarcinoma in situ, minimally invasive adenocarcinoma, lepidic adenocarcinoma, mucinous adenocarcinoma, mucinous adenocarcinoma in situ

Multiple bilateral nodules, large volumes of frothy pink sputum.

Most common type in non smokers (incidence = 40%)

May cause pleural effusion

5yr survival: 27%

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Large cell lung cancer

Large hilar mass with mediastinal adenopathy.

Many subtypes

Incidence: 10%

5yr survival: 27%

Dx of exclusion (from other types of lung Ca)

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Malignant mesothelioma

Arises primarily from surface serosal cells of pleura/pericardium/peritoneum

Starts in periphery

May cause effusion- leads to sudden presentation.

Thickened pleura: >5cm thickness may encase and constrict lungs with only superficial invasion (feel like they're suffocating)- may also constrict heart

No cure- death in 12-18 months

Mostly from asbestos exposure (pleural plaques)

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NSCLC staging

I: confined to lung

II: hilar involvement

IIIA/B: locally extensive intrathoracic involvement

IV: metastasis to other organs

Surgery indicated if stage IIIA or below. Patients being considered for radical treatment may require:

  • pulmonary function tests
  • contrast CT of thorax and upper abdomen
  • V/Q scan
  • MRI/PET-CT (looking for mets- if present, inoperable)
  • USS
  • mediastinoscopy/laryngoscopy
  • additional Ix if suspicion (clinical/biochemical/radiological) of metastatic disease
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Prognostic factors

Factors predicting poor survival:

  • HIGH VALUE: poor performance status, any site metastasis, raised LDH
  • MEDIUM VALUE: bone/liver mets, male gender, >5% weight loss
  • LOW VALUE: brain mets, age >65, non-squamous type, previous radiotherapy
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Brain mets

Leptomeningeal- CSF cytology. Can see with PET/SPECT imaging

Occur from lung (50%), breast (15-20%), CUP (10%), melanoma (10%), GI (5%)

Usually in cerebral hemispheres (80%) but can also occur in cerebellum/brainstem

Presentation: headache, cognitive dysfunction, neurological deficit, seizures

Rx: supportive (steroids, anticonvulsants), definitive (surgery if only 1 site, radiotherapy). Chemo useless as cannot cross blood-brain barrier very well. 

Anticonvulsants good if already had one seizure, may be useful prophylactically. Usually phenytoin, some places use valproate, can be IV or PO. Problems: enzyme inducing effect, erythema multiforme.

If surgical intervention, whole brain irradiation usually recommended post-surgery.

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