1. Charlotte Miller

2.  Definition  Classifications  Clinical Presentation  Management  Prognosis  Clinical Scenario  Emergency

3.  Neoplasia  Abnormal growth of cells which persists after initial stimulus has been removed  Benign  Compact mass that remains at the site of origin  Malignant  Uncontrolled growth, not organised, necrotic centre, illmargined

4.  Primary  Small Cell  Non Small Cell ▪ Squamous ▪ Large cell ▪ Adenocarcinoma  Secondary  Breast  Bone  Kidney  Prostate  thyroid Bronchial Carcinoma 95% of primary tumours 3:1 M:F

5.  Genetic  Environmental  The British Doctors Study MAGNIFICENT SEVEN Self Sufficiency in Growth Signals Insensitivity to negative signals Defects in DNA repair Evasion of Apoptosis Limitless replication potential Angiogenesis Invasion & Metastasis

7.  Local effects ▪ Breathlessness ▪ Cough ▪ Chest Pain ▪ Haemoptysis  Spread within the chest ▪ Pancoast tumour ▪ Horners Syndrome ▪ SVC obstruction ▪ Pleural infiltration  Metastatic ▪ Bone ▪ Brain ▪ Lymph Nodes  Non Metastatic ▪ Endocrine ▪ Neurological ▪ Vascular ▪ Skeletal ▪ Cutaneous

8.  PMHx of Malignancy  Hodgkins  Testicular  Endometrial  Family History  1 st degree increase by 51%  Social History  Smoking  Occupation ▪ Asbestos, Radon Gas,  Foreign Travel

10.  Peripheral  Clubbing  Cyanosis  Hypertrophic Pulmonary Osteoarthropathy  Acanthosis Nigricans  Central  Lymphadenopathy  Tracheal Deviation  Chest defects

11.  Bedside  Bloods  Imaging  Special Tests  Peak Flow  Pulse Oximetry  Sputum  ABG  Full Blood Count  Bone – Calcium  Urea + Electrolytes  Liver Function  Thyroid Function  Chest X-ray  CT Scan  PET scan  Bronchiolar Lavage  Trans-thoracic Needle Biopsy  Pleural Aspiration  Respiratory Function

12.  Biological  Conservative  Medical  Surgical  Psychological  Social In order to effectively manage this patient I would like to involve a multidisciplinary team to use the biological – psychological - social approach

13.  Conservative  Symptom relief  Smoking Cessation  Medical  Radiotherapy  Chemotherapy  Surgical  Assessment for surgery  De-bulking

14.  Counselling  Mood altering medications  End of Life discussions

15.  Support Networks  Services for Families / Carers  Physiotherapy / Occupational Therapist  Adaptation to home  Maintaining Mobility

16.  Staging  Tumour  Metastatic  Nodes Clinical stage Five-year survival (%) Non-small cell lung carcinoma Small cell lung carcinoma IA5038 IB4721 IIA3638 IIB2618 IIIA1913 IIIB79 IV21

17.  72 year old woman presents with worsening shortness of breath for the last 3 months. HxPC: 2 weeks she has been coughing up bright red blood with her sputum 2 stone weight loss over 2/12 PMHx : COPD Hypertension Meds: Seretide 250 2 puffs BD, Salbutamol PRN, Ramipril 5mg OD Allergies: NKDA SHx: Retired, previously worked in a post office Stopped smoking 5 years ago after a 40 year pack history No alcohol

18.  What are your main differential diagnoses for this lady?  ?Risk Factors  How would you investigate her?

19.  O/E  Cachectic  Stoney dullness at her right lung base  No air entry right lower lobe  CXR  Right sided pleural effusion  Other Investigations?

21.  Exudates have a protein level of >30 g/L  Transudates have a protein level of <30 g/L  Light's criteria state that the pleural fluid is an exudate if one or more of the following criteria are met  Pleural fluid protein divided by serum protein >0.5  Pleural fluid LDH divided by serum LDH >0.6  Pleural fluid LDH more than two-thirds the upper limits of normal serum LDH

22.  SVC Obstruction  Steroids - Dexamethasone  Stent  Oncology R/v – Radiotherapy, Chemotherapy  Erosion of Blood Vessels  Supportive  Palliation