Overview
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- Diagnosis - presenting symptoms, type of lung cancer
- Functional status
- Risk factors - environmental exposures, chronic scarring
- Family history of lung cancer
- Management - surgery, chemotherapy, radiotherapy, targetted therapy
- Complications - pleural effusion, metastases, local compression, paraneoplastic
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
Diagnosis
Types of Lung Cancer
- Non-Small Cell Lung Cancer - adenocarcinoma, squamous cell carcinoma, large cell carcinoma
- Small Cell Lung Cancer
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
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
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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