Lung cancer

Lung cancer

Types
1. Small cell carcinoma (SCC) 15%
  1. arise from neuroendocrine cells (Kulchitsky cells)
  2. Rapidly growing and highly malignant; spread early and are almost always inoperable at presentation.
  3. Poor prognosis
2. Non- SCC (85%)
  1. Large cell (8%)
    1. less differentiated form, metastasize early
  2. Squamous (42%)
    1. Local spread is common but widespread metastases occur relatively late
  3. Adenocarcinoma
    1. arise from mucous cells in the bronchial epithelium.
    2. most common one assoc with asbestos
    3. most common one in NON-SMOKERS
    4. invades pleura, mediastinal lymph nodes, metastasize to brain and bone
  4. Carcinoid (7%)
  5. Brochoalveolar (4%)
Metastasis
1. kidney, prostate, breast, bone, gastrointestinal tract, cervix and ovary
Risk factor
1. Active and passive SMOKING
2. Age
3. previous history of cancer
4. Exposure to chemicals, dust, radiation, asbestos, heavy metals
5. COPD
Presentation
1. Lungs
  1. Dyspnoea, SOB, chest pain, hemoptysis, wheeze, cough
  2. collapse, pleural effusion
2. Systemic
  1. Wt loss, fever, fatigue, nausea and vomiting, clubbing
3. Local effects
  1. Dysphagia, hoarse voice (recurrent laryngeal nerve), Horner's syndrome (sympathetic chain), SVC obstruction
4. Metastasis
  1. Bone pain
  2. CNS: Headaches, weakness, confusion, fits, focal neurological deficit, cerebellar syndrome, proximal myopathy, peripheral neuropathy
  3. Hepatomegaly
  4. Lymphadenopathy
INVESTIGATIONS
1. CXR
  1. peripheral circular opacity, hilar enlargement, consolidation, pleural effusion or bony secondaries
2. CT and PET scan
3. Biopsy
  1. Bronchoscopy
  2. Percutaneous transthoracic needle
  3. Surgical biopsy

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