Reference: OHCM 182, Lec Not Onc 156,
Causes by far the most deaths due to ca in Europe
Smoking (proportional to cigarettes)
Asbestos (esp mesothelioma)
Bronchiectasis, autoimmune (eg Wegeners/Goodpastures), pulmonary
Obstructive lesion. Occassionally cavitatates. Local spread common,
widespread mets late.
Less well differentiated that mets early
less common in smokers compared to the other types. Can be associated
with asbestos. Usually peripheral. Local and distant mets.
solitary nodule or diffuse nodular lesions.
cells, which often secrete polypeptides (paraneoplastic). ACTH
(Cushings). Early development of widespread mets. Responds to chemo.
(80%), haemoptysis (70%), dyspnoea (60%), chest pain (40%)
Pleura (pain), ribs (bone fractures), brachial
plexus (pain in shoulder and Horners), left recurrent laryngeal nerve
(hoarseness, bovine cough), SVC obstruction (upper limb oedema, facial
congestion, distended neck Vs)
Malaise, weight loss, lethargy, anorexia,
hypertrophic pulmonary osteoarthropathy (causing wrist pain),
lymphadenopathy, proximal myopathy, periph neuropathy
(anaemia), LFT/ALP (bone/liver mets), Liver USS, U+E (↓Na)
cytology, bronchoscopy + washings, FNA biopsy with CT guiding
(peripheral circular opacity, hilar enlargement, consolidation, lung
collapse, pleural effusion, bone secondaries), CT scan, radionucleotide
bone scan, PET (ideally), mediatinoscopy + LN biopsy.
Surgery can be lobectomy or pneumonectomy. Radiotherapy gives
short-term SEs of tiredness, oesophagitis, skin irritation,
pneumonitis, and long-term SEs of spinal cord myelopathy, radiation
pneumonitis, and strictures.
surgery (if limited T1/2 N0M0) + radiotherapy.
resectable. Radical radiotherapy if inadequate respiratory reserve
(FEV, transfer factor, USS heart).
for rest (those w Symptoms like
95% have mets at presentation.
(etoposide + cisplatin): 60% remission but
for bronchial obstruction, SVC obstruction,
haemoptysis, bone pain,
SVC stent + radiotherapy + dexamethasone.
Endobronchial therapy: tracheal stenting.
analgesia, steroids, antiemetics, codeine for cough,
hyponatraemia (↓ADH) :
Eaton-Lambert, peripheral neuropathy:
enzyme blocking (ketoconazole), adrenalectomy.
50% 2 year survival without spread, 10% 2 year survival with spread.
over 1 year with treatment.