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Malignant Neoplasms
 
 

Lung Cancer

 
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Overview

    • Types of Lung Cancer

    • Non-Small Cell Lung Cancer - adenocarcinoma, squamous cell carcinoma, large cell carcinoma
    • Small Cell Lung Cancer

Pathogenesis

    • Risk Factors for Lung Cancer

    • Genetic factors
    • Smoking (active or passive)
    • Air pollution
    • Occupational exposure - asbestosis, silicosis,
    • Chronic scarring - interstitial lung disease, tuberculosis, COPD
    • Alcohol

Manifestations

    • Potential Presentations

    • Disease-Related

    • Respiratory symptoms - cough, haemoptysis, dyspnoea, pleuritic chest pain
    • Constitutional symptoms - anorexia, weight loss, fatigue
    • Complication-Related

    • SVC obstruction - facial swelling, plethora, upper limb oedema, positive Pemberton’s sign
    • Pancoast tumour - Horner’s syndrome (partial ptosis, miosis, anhydrosis), wasting of the hand
    • Laryngeal nerve involvement - hoarse voice
    • Paraneoplastic - hypercalcaemia, neurologic symptoms, hypertrophic pulmonary osteoarthropathy, Cushing’s syndrome
    • Complications of Lung Cancer

    • Pleural effusion
    • Metastases - brain, liver, adrenal, bone
    • Local compression - SVC obstruction, sympathetic chain compression (Pancoast tumour) , laryngeal nerve palsy, phrenic nerve palsy, brachial plexopathy
    • Paraneoplastic syndromes - hypercalcaemia, SIADH, Cushing’s, hypertrophic pulmonary osteoarthropathy, neurologic syndromes

Diagnosis

    • Clinical Signs

    • General Signs

    • Oxygen
    • Respiratory distress - tachypnoea, pursed lip breathing, accessory muscle use, intercostal / subcostal recession
    • Cough
    • Sputum - purulent, bloody
    • Lymphadenopathy - cervical, supraclavicular, axillary
    • Signs of Complications

    • Pleural effusion - dull percussion note, reduced breath sounds, reduced vocal resonance
    • Laryngeal nerve involvement - hoarse voice, dysphonic cough
    • SVC obstruction - facial swelling, plethora, upper limb oedema, positive Pemberton’s sign
    • Pancoast tumour - Horner’s syndrome (partial ptosis, miosis, anhydrosis), wasting of the small muscles of the hand
    • Hypertrophic pulmonary osteodystrophy
    • Signs of Management

    • Scars - from lobectomy or pneumonectomy
    • Radiation tattoos

Management

    • Non-Small Cell Lung Cancer

      Depends on the stage and the patient's functional status.
    • Non-Metastatic

    • Surgical resection (lobectomy) with or without adjuvant chemotherapy
    • Chemoradiotherapy
    • Metastatic

    • Immunotherapy - pembrolizumab, nivolumab
    • Targetted therapy - EGFR inhibitors, ALK inhibitors
    • Surgical resection
    • Chemotherapy
    • Radiotherapy
    • Small Cell Lung Cancer

      Depends on whether the disease is limited or extensive.
    • Chemoradiotherapy with or without cranial irradiation to prevent brain metastasis
    • Chemotherapy
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