- 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
Smokers more likely to develop this.
May produce PTHrP (hypercalcaemia)
5yr survival: 35%
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%)
Important to image upper abdomen as liver/adrenal mets are common.
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%
Large cell lung cancer
Large hilar mass with mediastinal adenopathy.
5yr survival: 27%
Dx of exclusion (from other types of lung Ca)
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)
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)
- additional Ix if suspicion (clinical/biochemical/radiological) of metastatic disease
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
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.