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Lung Cancer History

 
 
 
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Overview

  • Ask About

  • 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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