Lung Cancer

by Armando HF

Summary of Lung Cancer Lung Cancer is the leading cause of cancer related deaths. Fever, nights sweats and sudden weight loss +/- hemoptysis rings alarm bells especially in the presence of strong risk factors such as smoking, exposure to certain chemicals and family history. Chest X-ray is a helpful technique in ruling in/out diseases. Treatment includes chemotherapy and lung tissue resection

Video: Lung Cancer Overview

Overview

Overview Lung cancer is the leading cause of cancer deaths in men and women. Lung cancer can be divided into small cell and non-small cell carcinoma. Small cell lung carcinoma presents late stage and has poorer prognosis. A solitary pulmonary nodule measuring 8 mm or less can be followed radiographically. For larger lesions, a biopsy, whether bronchoscopic, percutaneous, or surgical, should be considered. Steps in management of a patient with suspected lung cancer include tissue diagnosis, staging, preoperative evaluation, and treatment with surgery, radiotherapy, or chemotherapy.

Defintion
Massive haemoptysis: More than 500 mL of blood loss that is coughed up within a 24-hour period
Horner Syndrome: Symptoms are ptosis, loss of pupillary dilation (miosis), and loss of sweating on the ipsilateral side (anhidrosis) caused by compression of the superior cervical ganglion and resultant loss of sympathetic innervation.
Superior Vena Cava syndrome: Obstruction of venous drainage, usually by external compression of the SVC, leading to edema of the face, neck, and upper part of the torso often with formation of collateral veins on the upper chest.

Risk Factors

There are many risk factors for lung cancer. Smoking, underlying lung disease and exposure to certain chemical are the most common

Signs and Symptoms

Small proportion of patients with lung cancer are asymptomatic when diagnosed. In these cases, a lung nodule usually is found incidentally on chest x-ray or CT. Common signs and symptoms include cough, dyspnea, chest pain, fatigue, weight loss and haemoptysis

Think Most patients with hemoptysis require evaluation with bronchoscopy. Massive hemoptysis may result in death by asphyxiation.

Differential Diagnosis

Bronchitis
Pneumonia
Sarcoidosis
Lymphoma
Bronchiectasis

Investigations

General

Chest X-Ray – opacity
Spirometry – if thinking of obstructive or restrictive lung disease
CT

Investigation Chest x-ray findings can vary in patients with lung cancer and can include pulmonary opacity, hilar enlargement, pleural effusion and collapsed lung.

Investigations for staging

CT
CT- Biopsy
PET scan
Pleural fluid aspiration
Lung biopsy with bronchoscopy
Endobronchial ultrasound
Sputum MCS

Lung Carcinoma classification

Lung cancer can be broadly divided into either small cell lung carcinoma or non-small cell carcinoma. Non small cell lung carcinoma making up the majority 80%

Small cell lung carcinoma (SCLC – 20%)

Non-small cell lung carcinoma ( NSCLC – 80%)

Adenocarcinoma
Squamous cell carcinoma
Large cell

Remember Staging of SCLC is limited or extensive. NSCLC uses the TNM classification for staging

Lung cancer characteristics
	SCLC	Adenocarcinoma	Squamous cell	Large cell
Location	Central	Peripheral	Central	Peripheral
Cavitation	Never		Most likely
Metastases	Early	Early	Late	Late
Neoplastic Syndrome and Extrapulmonary manifestation	ADH, ACTH	Thrombophlebitis	PTH	Superior vena cava syndromes + hoarseness

Management and staging

Once a patient presents with symptoms or radiographic findings suggestive of lung cancer, the next steps are as follows:

Tissue diagnosis to establish malignant diagnosis and histologic type
Staging to determine resectability or curative potential
Cancer treatment: surgery, radiotherapy, or chemotherapy

Summary Epidemiology, Staging and Management of Lung Cancer

Video: Lung Cancer Management and Staging

Prognosis and Prevention

Complication

NSCLC

Post-obstructive pneumonia/hypoxia
Superior vena vaca syndrome
Paraneoplastic syndromes

SCLC

Post-obstructive pneumonia/hypoxia
Superior vena vaca syndrome
Paraneoplastic syndromes
Chemothreapy induced hematological toxicity
Radiation induced esophageal/lung injury

Prognosis

SCLC mean survival is 3 months if untreated, 1-1.5 year if treated
NSCLC 50% 2 year survival without spread, 10% with spread.

Paraneoplastic syndrome

Paraneoplastic syndrome are a group of syndromes where cancer cells produce peptides that mimic certain hormones. This occurs through genetic mutations within cancer cells allow them to develop new abilities and become “neuroendocrine cells”. In lung cancer common hormone like substances produced include: PTH, ACTH and ADH

More info on Paraneoplastic Syndrome