Рак лёгкого

Investigations

• initial diagnosis

  • imaging: CXR, CT chest + upper abdomen, PET scan, bone scan

  • cytology: sputum

  • biopsy: bronchoscopy, percutaneous mediastinoscopy

• staging work-up

  • TMN staging system: T - primary tumour (size); N - regional lymph nodes; M - distant metastasis

  • blood work: electrolytes, LFTs, calcium, ALP

  • imaging: CXR, CT thorax and upper abdomen, bone scan, neuroimaging

  • invasive: bronchoscopy (EBUS), mediastinoscopy, mediastinotomy, thoracotomy

SCLC vs. NSCLC

Risk Factors

• cigarette smoking: the relative risk of developing lung cancer is 10-30 times higher for smokers than for nonsmokers

• other risk factors include cigar smoking, pipe smoking, second-hand smoke, asbestos without smoking (relative risk is 5), asbestos with smoking (relative risk is 92), metals (e.g. chromium, arsenic, nickel), radon gas, ionizing radiation, genetics

Signs and Symptoms

• may be due to primary lesion, metastasis, or paraneoplastic syndrome

• primary lesion:

  • cough (75%): beware of chronic cough that changes in character

  • dyspnea (60%)

  • chest pain (45%)

  • hemoptysis (35%)

  • other pain (25%)

  • clubbing (21%)

  • constitutional symptoms: anorexia, weight loss, fever, anemia

• Metastasis

  • lung, hilum, mediastinum, pleura: pleural effusion, atelectasis, wheezing

  • pericardium: pericarditis, pericardial tamponade

  • esophageal compression: dysphagia

  • phrenic nerve: paralyzed diaphragm

  • recurrent laryngeal nerve: hoarseness

  • superior vena cava syndrome:

    • obstruction of SVC causing neck and facial swelling, as well as dyspnea and cough

    • other symptoms: hoarseness, tongue swelling, epistaxis, and hemoptysis

    • Px findings: dilated neck veins, increased number of collateral veins covering the anterior chest wall, cyanosis, edema of the face, arms, and chest, Pemberton’s sign (facial flushing, cyanosis, and distension of neck veins upon raising both arms above head)

    • milder symptoms if obstruction is above the azygos vein

  • lung apex (Pancoast tumours): Horner's syndrome, brachial plexus palsy (most commonly C8 and T1 nerve roots)

  • rib and vertebrae: erosion

  • distant metastasis to brain, bone, liver, adrenals

  • paraneoplastic syndromes

    • a group of disorders associated with malignant disease, not related to the physical effects of the tumour itself

Paraneoplastic Syndromes