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The Diagnosis of Lung Cancer
Sarah Goodall
Different Types of Lung Cancer
Bronchocarcinomas
• Non Small Cell Carcinoma
– Squamous Cell Carcinoma, 40%
– Adenocarcinom...
• Small Cell Carcinoma, 20-30%
– oat cell carcinoma
– Endocrine origin
– Highly Malignant
– Prognosis Poor
Mesothelioma
– ...
Presenting Symptoms
• Cough 41%
• Chest Pain 22%
• Cough and Pain 15%
• Haemoptysis 7%
• Chest Infection <5%
• Malaise <5%...
Risk Factors
• Smoking
• Asbestos Exposure
• Chromium Exposure
• Arsenic
• Iron Oxides
• Radiation (Radon
Gas)
• Family Hi...
Signs
• Cachexia
• Anaemia
• Clubbing
• Hypertrophic pulmonary
oteoarthropathy (causing
wrist pain)
• Supraclavicular/Axil...
Chest Signs
• Maybe None
• Consolidation
• Collapse
• Pleural Effusion
Metastasis Signs
-Bone Tenderness
-Hepatomegally
-Confusion
-Fits
-Focal CNS deficit
-Cerebellar Syndrome
-Proximal Myopat...
Complications
LOCAL
– Recurrent Laryngeal Nerve Palsy
– Phrenic Nerve Palsy
– SVC Obstruction
– Horner’s Syndrome (Pancoas...
METASTATIC
– Brain
– Bone (bone pain, anaemia, increased Ca2+
)
– Liver (Hepatomegally, Raised LFTs)
– Adrenals (Addison’s)
ENDOCRINE
– Ectopic Hormone Secretion e.g. SIADH,
ACTH by oat cell carcinoma
PTH by squamous cell carcinomas
Investigations
Cytology
– Sputum and Pleural Fluid
FNA
– Peripheral Lesions, Superficial Lymph Nodes
Bronchoscopy
– For Hi...
Looking at the Chest X-Ray
• Cell type can’t be diagnosed from
X-Ray
• Lesions rarely seen until >1cm
• Lesions >4cm be su...
Stages of the Tumour
• Primary Tumour
– TX malignant cells in bronchial secretions
– Tis Carcinoma in situ
– T0 Non Eviden...
Treatment
Non Small Cell Tumours
– Excision if no metastatic spread
– Curative radiotherapy
Small Cell tumours
– Almost always disseminated at presentation
– May respond to chemotherapy
– Palliation
– Radiotherapy ...
Prognosis
Non Small Cell – 50% 2 year survival
without spread, 10% with spread
Small Cell – 3 months if untreated, 1- 1.5
...
Prevention
• Discourage Smoking
• Avoid occupational
exposure to
carcinogens
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Diagnosing Lung cancer

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Diagnosing Lung cancer

  1. 1. The Diagnosis of Lung Cancer Sarah Goodall
  2. 2. Different Types of Lung Cancer Bronchocarcinomas • Non Small Cell Carcinoma – Squamous Cell Carcinoma, 40% – Adenocarcinoma, 10% – Large Cell Carcinoma, 25% – Bronchoalveolar Cell Carcinoma, 1-2%
  3. 3. • Small Cell Carcinoma, 20-30% – oat cell carcinoma – Endocrine origin – Highly Malignant – Prognosis Poor Mesothelioma – Tumour of mesothelial cells which usually occurs in the pleura
  4. 4. Presenting Symptoms • Cough 41% • Chest Pain 22% • Cough and Pain 15% • Haemoptysis 7% • Chest Infection <5% • Malaise <5% • Weight Loss <5% • SOB <5% • Hoarseness <5% • Distant Spread <5% • No Symptoms <5%
  5. 5. Risk Factors • Smoking • Asbestos Exposure • Chromium Exposure • Arsenic • Iron Oxides • Radiation (Radon Gas) • Family History Asbestos
  6. 6. Signs • Cachexia • Anaemia • Clubbing • Hypertrophic pulmonary oteoarthropathy (causing wrist pain) • Supraclavicular/Axillary Lymphadenopathy
  7. 7. Chest Signs • Maybe None • Consolidation • Collapse • Pleural Effusion
  8. 8. Metastasis Signs -Bone Tenderness -Hepatomegally -Confusion -Fits -Focal CNS deficit -Cerebellar Syndrome -Proximal Myopathy -Peripheral Neuropathy
  9. 9. Complications LOCAL – Recurrent Laryngeal Nerve Palsy – Phrenic Nerve Palsy – SVC Obstruction – Horner’s Syndrome (Pancoasts Tumour) – Rib Erosion – Pericarditis – AF
  10. 10. METASTATIC – Brain – Bone (bone pain, anaemia, increased Ca2+ ) – Liver (Hepatomegally, Raised LFTs) – Adrenals (Addison’s)
  11. 11. ENDOCRINE – Ectopic Hormone Secretion e.g. SIADH, ACTH by oat cell carcinoma PTH by squamous cell carcinomas
  12. 12. Investigations Cytology – Sputum and Pleural Fluid FNA – Peripheral Lesions, Superficial Lymph Nodes Bronchoscopy – For Histological Diagnosis and assessment of operability CT – Stage the Tumour Radionuclide Bone Scan – For suspected metastases Lung Function Tests
  13. 13. Looking at the Chest X-Ray • Cell type can’t be diagnosed from X-Ray • Lesions rarely seen until >1cm • Lesions >4cm be suspicious of malignancy • 20% cavitate – usually scc • Lobular or irregular edges • Metastasises to Liver, Adrenals, Bones, Brain • NB: presence of calcification, air bronchogram – unlikely to be malignancy
  14. 14. Stages of the Tumour • Primary Tumour – TX malignant cells in bronchial secretions – Tis Carcinoma in situ – T0 Non Evident – T1 < or = 3cm in lobar or more distal airway – T2 > 3cm and >2cm distal to carina or pleural involvement – T3 Involves chest wall, diaphragm, medistinal pleura, pericardium or <2cm from carina – T4 Involves mediastinum, heart, great vessels, trachea, oesophagus, vertebral body, carina or malignant effusion present
  15. 15. Treatment Non Small Cell Tumours – Excision if no metastatic spread – Curative radiotherapy
  16. 16. Small Cell tumours – Almost always disseminated at presentation – May respond to chemotherapy – Palliation – Radiotherapy for bronchial obstruction, SVC obstruction, Haemoptysis, Bone Pain, cerebral metastases Mesothelioma – Diagnosis often only made PM
  17. 17. Prognosis Non Small Cell – 50% 2 year survival without spread, 10% with spread Small Cell – 3 months if untreated, 1- 1.5 years if treated Mesothelioma – Less than 2 years
  18. 18. Prevention • Discourage Smoking • Avoid occupational exposure to carcinogens

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