dr a.j.france. ninewells hospital, dundee lung cancer 2010
TRANSCRIPT
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Dr A.J.France. Ninewells Hospital, Dundee
Lung Cancer 2010
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Lung Cancer 2010 Objectives• How common is it ?• What are the usual clinical features
?• How do you make the diagnosis ?
• What to tell the patient ?• Which treatments can we use ?
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General features of “cancer”• Malignant growth• Uncontrolled replication• Local invasion• Metastasis - secondary cancer• Lymphatic spread• Blood stream• Serous cavities
• Non-metastatic systemic effects
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Lung cancer in UK - figures
• 35 - 40,000 new cases per year• 100 new cases every day
• 90 % incurable at time of diagnosis
• 6 months from diagnosis to death• Most frequent cancer in men and
women
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100 new cases per day
Two of these every day© A.J.France 2010
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Prognosis - 6 months
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Presentation of lung cancer
• Primary tumour• Local invasion• Metastases• Non-metastatic• (paraneoplastic)
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HaemoptysisNormal carina Tumour
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Recurrent pneumonia
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Stridor
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Local invasion
• Recurrent laryngeal nerve• Pericardium• Oesophagus• Brachial plexus• Pleural cavity• Superior vena cava
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Pancoast tumour
Brachial plexusinvasion
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Pancoast tumourBrachial plexus invasion
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Pleural effusion
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Recurrent laryngeal nerve palsyHoarse voice
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Superior Vena CavaObstruction
Distended external jugular vein
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Anastamoses to Inferior Vena Cava
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Chest wall invasion by lung cancer
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Common sites for metastases
• Liver• Brain• Bone
• Adrenal• Skin• Lung
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Cerebral metastases• Insidious onset• Weakness• Visual disturbance• Headaches• Worse in the morning• Not photophobic
• Fits
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CT scancerebralmetastases
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Liver metastases
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Bone metastases
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Bone metastases
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Non-metastatic: paraneoplastic
• Finger clubbing• Hypertrophic pulmonary
osteoarthropathy - HPOA• Weight loss• Thrombophlebitis• Hypercalcaemia• Hyponatraemia - SIADH• Weakness - Eaton Lambert
syndrome© A.J.France 2010
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Finger clubbing
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Hypertrophic pulmonary osteoarthropathy - bone
scan
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Thrombophlebitis
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Thrombophlebitis
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Weight loss
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Taking a history – Lung Cancer• Cough• Haemoptysis• Cigarette smoker• Breathless• Weight loss
• Chest wall pain• Tiredness• Recurrent infection• Other smoking
related disease• “Is there anything
you are worried about ?”
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Examination – Lung cancer• Finger clubbing• Breathless• Cough• Weight loss• Bloated face• Hoarse voice
• Lymphadenopathy• Tracheal deviation• Dull percussion• Stridor• Enlarged liver
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Investigations – Lung Cancer• Full blood count• Coagulation screen• Na, K, Ca, Alk Phos• Spirometry, FEV1
• Chest X-ray• CT scan of thorax• Bronchoscopy• NOT sputum
cytology
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Making a tissue diagnosis – lung cancer• Bronchoscopy• CT guided biopsy• Lymph node aspirate• Aspiration of pleural fluid
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Fibreoptic bronchoscopy
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CT guidedbiopsy
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Differential diagnosis
• Have you thought of an alternative cause ?
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Differential diagnosis
• Clinical picture• Smoker• Haemoptysis• Abnormal chest X-
ray
• Possible causes• Lung cancer
• Tuberculosis
• Vasculitis
• Pulmonary embolism
• Secondary cancer
• Lymphoma
• Bronchiectasis© A.J.France 2010
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Things to say – Lung cancer• Have you thought about what might
be wrong with you ?• It would help if you could bring your
spouse or other relative with you next time ?
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Lung cancer summary
• A very common disease• Presents in many ways• Poor survival
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