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Dr A.J.France. Ninewells Hospital, Dundee
Lung Cancer 2010
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
• 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
© 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
HaemoptysisNormal 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 plexusinvasion
© A.J.France 2010
Pancoast tumourBrachial plexus invasion
© A.J.France 2010
Pleural effusion
© A.J.France 2010
Recurrent laryngeal nerve palsyHoarse voice
© A.J.France 2010
Superior Vena CavaObstruction
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 scancerebralmetastases
© 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 guidedbiopsy
© 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