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Lung Cancer (Key facts (Ix (Staging (CT: neck, thorax, upper abdo ± brain,…

- - - - Adenocarcinoma: 25%
        
        RF: female non-smokers
        Peripherally located
        80% present w/ extrathoracic mets
      - Large-cell: 10%
      - SCC: 35%
        
        Highly related to smoking
        Centrally located
        PTHrP → ↑ Ca2+
    - - Highly related to smoking
      - Central location
      - 80% present w/ advanced disease
      - Ectopic hormone secretion
  - - - Rheum
        
        Dermatomyositis / polymyositis
      - Neuro
        
        Cerebellar degeneration
        
        Peripheral neuropathy
      - Endo
        
        ADH → SIADH (euvolaemic ↓Na+)
        
        ACTH → Cushing’s syndrome
        
        Serotonin → carcinoid (flushing, diarrhoea)
        
        PTHrP → primary HPT (↑Ca2+, bone pain) – SCC
      - Derm
        
        Acanthosis nigricans
        
        Trousseau syndrome: thrombophlebitis migrans
    - - Pathological #
      - Hepatic failure
      - Confusion, fits, focal neuro
      - Addison’s
    - - Recurrent laryngeal N. palsy
      - Phrenic N. palsy
      - SVCO
      - Horner’s (Pancoast’s tumour)
      - AF
  - - - Cytology
        
        Induced sputum
        
        US-guided pleurocentesis
      - Histology
        
        Percutaneous FNA: adenocarcinoma
        
        Endoscopic transbronchial biopsy: SCC
    - - CT: neck, thorax, upper abdo ± brain
      - PET
      - Radionucleotide bone scan
      - Thoracoscopy, mediastinoscopy + LN sampling
    - - CXR
        
        Coin lesions
        
        Effusion
        
        Consolidation or collapse
        
        Hilar LNs
        
        Bony mets
      - Contrast-enhanced volumetric CT thorax
    - - FBC: anaemia, ↑WCC if consolidation
        U+E: ↓ Na (SIADH or Addison’s)
        LFTs: deranged LFTs 2O to liver mets
        Bone profile: ↑ Ca2+ (bone mets, ↑PTHrP)
    - - Assess fitness for surgery
      - Pneumonectomy CI if FEV1 <1.2L
  - - - Surgery
        
        Rx of choice if no metastatic spread
        Stage 1/2:~25%
        
        Wedge resection, lobectomy, pneumonectomy
      - Curative Radio: if poor cardiorespiratory function
      - Chemo: platinum-based + biologics
    - - Usually disseminated @ presentation
        Some benefit w/ chemo
    - - Analgesia: opiates for pain and cough
      - Radiotherapy: haemoptysis, bone or CNS mets
      - SVCO: dex + radio or intravascular stent
      - Persistent effusions: chemical pleurodesis
    - - NSCLC: 50% 5ys w/o spread; 10% w/ spread
      - SCLC: 1-1.5yrs median survival treated; 3mo untreated
- - - - Cachexia
        Hoarse voice or stridor
    - - Clubbing ± HPOA
        Tar staining
        Claw hand w/ wasting of interossei
    - - Anaemia
        Horner’s
        Plethora
    - - LNs: check axilla too
        Dilated veins
- - - - Tracheal + apex shift
        
        To abnormal side
      - Throughout abnormal side
        
        ↓ expansion
        
        Dull percussion
        
        NO breath sounds
    - - Tracheal shift
        
        Mainly upper lobectomy
        
        To abnormal side
      - Focal signs
        
        ↓ expansion
        
        Dull percussion
        
        Reduced breath sounds
  - - - Lobectomy / pneumonectomy
      - Scar but normal lung
        
        Thoracotomy: abscess, empyema, biopsy, wedge
        
        Transplant: ? other lung normal
    - - 90% for non-disseminated bronchial carcinoma
      - Other
        
        Bronchiectasis
        
        COPD: lung-reduction surgery
        
        TB: historic, upper lobe
    - - ↑ risk w/
        
        ↑ ASA grade
        
        Age >70
        
        Poor resp function
        
        FEV1:FVC <55%