Dr A.J.France. Ninewells Hospital, Dundee 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 ? © A.J.France 2010
General features of “cancer” Malignant growth Uncontrolled replication Local invasion Metastasis - secondary cancer Lymphatic spread Blood stream Serous cavities Non-metastatic systemic effects © A.J.France 2010
Lung cancer in UK - figures ,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 © A.J.France 2010
100 new cases per day Two of these every day © A.J.France 2010
Prognosis - 6 months © A.J.France 2010
Presentation of lung cancer Primary tumour Local invasion Metastases Non-metastatic (paraneoplastic) © A.J.France 2010
Haemoptysis Normal carina Tumour
Recurrent pneumonia © A.J.France 2010
Stridor
Local invasion Recurrent laryngeal nerve Pericardium Oesophagus Brachial plexus Pleural cavity Superior vena cava © A.J.France 2010
Pancoast tumour Brachial plexus invasion © A.J.France 2010
Pancoast tumou r Brachial plexus invasion © A.J.France 2010
Pleural effusion © A.J.France 2010
Recurrent laryngeal nerve palsy Hoarse voice © A.J.France 2010
Superior Vena Cava Obstruction Distended external jugular vein © A.J.France 2010
Anastamoses to Inferior Vena Cava © A.J.France 2010
Chest wall invasion by lung cancer
Common sites for metastases Liver Brain Bone Adrenal Skin Lung © A.J.France 2010
Cerebral metastases Insidious onset Weakness Visual disturbance Headaches Worse in the morning Not photophobic Fits © A.J.France 2010
CT scan cerebral metastases © A.J.France 2010
Liver metastases © A.J.France 2010
Bone metastases © A.J.France 2010
Bone metastases © A.J.France 2010
Non-metastatic: paraneoplastic Finger clubbing Hypertrophic pulmonary osteoarthropathy - HPOA Weight loss Thrombophlebitis Hypercalcaemia Hyponatraemia - SIADH Weakness - Eaton Lambert syndrome © A.J.France 2010
Finger clubbing © A.J.France 2010
Hypertrophic pulmonary osteoarthropathy - bone scan © A.J.France 2010
Thrombophlebitis © A.J.France 2010
Thrombophlebitis © A.J.France 2010
Weight loss © A.J.France 2010
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 ?” © A.J.France 2010
Examination – Lung cancer Finger clubbing Breathless Cough Weight loss Bloated face Hoarse voice Lymphadenopathy Tracheal deviation Dull percussion Stridor Enlarged liver © A.J.France 2010
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 © A.J.France 2010
Making a tissue diagnosis – lung cancer Bronchoscopy CT guided biopsy Lymph node aspirate Aspiration of pleural fluid © A.J.France 2010
Fibreoptic bronchoscopy © A.J.France 2010
CT guided biopsy © A.J.France 2010
Differential diagnosis Have you thought of an alternative cause ? © A.J.France 2010
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
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 ? © A.J.France 2010
Lung cancer summary A very common disease Presents in many ways Poor survival © A.J.France 2010