LUNG CANCER

Main Presenting SymptomsChronic CoughPersistant Cough, may present as change in chronic cough. Also presistant pneumonia due to obstruction

Haemoptysis

Chest Pain

SOB

Loss of weight, anorexia, lethargyGeneral Malignancy symtoms

Metastasis (local) presentationPleural effusionExudative lesion

Monophonic wheezeTumour into the airway lumen

HoarsenessRecurrent laryngeal paralysis

Paralysed diaphragmPhrenic paralysis

Brachial plexus palsy (c8, T1)Horners syndromePancoast tumour

SVC syndromeThoracic outlet crowding

Spinal compression pain and neurological defecitsVertebral compression fracture (osteolytic mets/PTHrP)

Metastasis to bone, brain, liver, adrenals

Paraneoplastic SymptomsLung CancerAcanthosis nigricans, dermatomyositis

NSCLCHPOA, Clubbing

SCLCCushings (ectopic ACTH)SIADH (ectopic (ADH)Neurological

SCCHypercalcaemia (PTHrP/osteolysis)Hypophosphataemia

Risk Factors Smoking : main risk factor for both SCC and SCLC, which are both more commonly central (1st/2nd degree) Asbestos, Radiation and shit (more adenocarcinoma) Genetics EGFR mutation associated with adenocarcinoma, typically non-smoking relatively young Asian women KRAS mutation also adenocarcinoma ALK mutation tyrosine kinase dependent NSCLC

Different type factors

Diagnosis Diagnosis must be made with a tissue biopsy (bronchoscopy, needle guided biopsy, sputum cytology) and assessed by pathology Imaging (CT chest/abdo, PET scan) is used to assist in the staging of the cancer essential Brain imaging common metastatic site Reel off the regular investigations: UECs (electrolytes (Calcium) and renal function (Chemo) FBE (anaemia and shit)

Staging and TreatmentSCLC Limited: one side of chest + ipsilat nodes (one radiation field) Radiation and Chemo + prophylactic brain radiation Extensive: anything beyond Chemo aloneNSCLC Stage IA: surgical resection Stage IB, II: surgical resection and adjunctive chemotherapy Radiotherapy where surgery contraindicated Stage III: Neo-adjuvant chemo then surgery Stage IV: Palliative therapy mostly systemic therapy, but also symptom based radiotherapy/met resection

If you have stage IIIB or Stage IV NSCLC your odds are very slimIf you have SCLC your odds are very slim

Mets to lung Bladder Breast Colon Kidney

Mets from Lung: Adenocarcinoma and SCLC metastasise early relative to TN(M) Brain - SCLC Bone Liver Adrenals - NSCLC