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Old lady, respiratory & constitutional symptoms
O/E pleural effusion
Old lady, respiratory & constitutional symptoms
O/E pleural effusion
Lung Cancer Pathology
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Clinical Presentation
- Where does each type of lung cancer arise from?
- What symptoms do they produce?
Location
- Squamous & small: central
- Adeno & large: peripheral
Squamous (30% of all)
- 2/3 central
- 1/3 peripheral
Cell of origin
- Squamous: large airway epithelial
- Small: neuroendocrine @ small airways bifurcations
- Adeno: small airway epithelial & type 2 alveolar
- Large cell: undifferentiated, epithelial
Symptoms
SCLC
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Neuro
- Lambert-Eaton mysthenic syndrome, limbic encephalitis
- Paraneoplastic cerebellar degeneration, OMAS (opsoclonus myoclonus ataxic syndrome)
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NSCLC
Peripheral tumours
airway irritation, pleural infiltration
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Pleura
Pleural infiltraion
- pleuritic chest pain
- pleural effusion
Adjacent structures
Pancoast tumour
- Horner's
- Brachial plexus compression
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Smoking association
Do you know any differences between different types of lung cancer & their association with smoking?
Smoking-associated
- Squamous
- Small cell (1st 2 strongest)
- Adeno
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Non-smoking associated
- Adeno (never-smokers, females, young <45yo)
Natural History & Prognosis
What are the differences btwn NSCLC & SCLC in natural history and prognosis?
Natural history
- SCLC: distally spread @ diagnosis, rapid mets
- NSCLC: slower mets
Response to treatment
- SCLC: responsive to chemotherapy
- NSCLC: less responsive to chemo → surgical resection, EGFR mutations → targeted EGFR drugs
Paraneoplastic Syndromes
Neuro (SCLC)
- LEMS (Lambert-Eaton myasthenic syndrome)
- Limbic encephalitis
- Paraneoplastic cerebellar degeneration
- OMAS (opsoclonus myoclonus ataxia syndrome)
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