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CR - Lung Cancer (i) (intro (95% can be classified as small cell (20%) or…

- - - - adeno (often in parenchyma)
        
        incidence increasing, now most common Irish lung cancer
      - squamous (often in airways)
      - large cell
    - - endocrine origin
      - often associated with paraneoplastic syndromes
      - Dxed with EBUS-TBNA
- - - - once you quit risk of thrombotic events decreases quickly, but cancer risk takes longer to decrease
  - - - commonest cause of cancer in never smokers
      - odourless gas
      - esp in poor ventilation (windows closed)
- - - - related to stage + location
      - non-specific cough (irritative effect of tumour)
      - haemoptysis (angiogensis + friable tumour tissue)
      - dyspnoea (due to obstruction, pleural effusion or atelectasis distal to tumour)
      - hoarseness
        
        rarely due to direct invasion into cords (v advanced, patient would present before this)
        
        laryngeal N palsy due to invasion (wraps around aorta)
      - SVC obstruction (corrected with stent insertion under fluoroscopic guidance)
      - chest pain (indicates parietal pleural involvement - only part of lung with pain fibres)
      - mets
        
        seizures
        
        headaches
        
        cranial N defects
        
        confusion
        
        hepatomegaly
        
        bone pain
      - systemic symptoms (often due to mets)
        
        anorexia
        
        weightloss
        
        tumours are parasites - use nutrients
        
        tumours produce TNF-alpha (cachexin)
      - paraneoplastic syndromes
        
        PTH in squamous - hypercalcaemia
        
        in small cell
        
        SIADH - hyponatraemia
        
        ectopic ACTH - Cushing's
        
        cerebellar syndrome
        
        Lambert-Eaton Myasthenic Syndrome (LEMS) - autoimmune destruction @ NMJ
    - - 0: fully active, no restriction
      - 1: able for light not strenuous work
      - 2: able for selfcare not work
      - 3: limited selfcare, in bed/chair for >50% of awake time
      - 4: completely disabled
      - 5: dead