1. Lung Cancer for Finals SypRFSignsCompInxHistologyRxSurg Simple Success Tim Robbins Academic FY1 UHCW

2. SypRFSignsCompInxHistologyRxSurg Ron Ailman: Symptoms Patient photo/data from: http://www.macmillan.org.uk Cough Haempotysis Dyspnoea Chest Pain Recurrent pneumonia Anorexia/weight loss Hoarseness of voice

3. Risk Factors Cigarette Smoking Industrial contaminants: Asbestos/arsenic Radon gas Genetic pre-disposition SypRFSignsCompInxHistologyRxSurg

4. General: – Cachexia/anaemia/clubbing/supraclavicular or axillary nodes. Chest signs: – None/consolidation/collapse/effusion Metasteses: – Bone tenderness/hepatomegaly/focal CNS Signs SypRFSignsCompInxHistologyRxSurg

5. Pleural Effusion:Atelectasis: Consolidation: Chest Signs SypRFSignsCompInxHistologyRxSurg -Decreased chest wall movement -Stony dullness -Decreased breath sounds -Decreased vocal fremitus -Pleural Rub (above) -Mediastinal shift away -Decreased chest wall movement - Dullness to percussion - Decreased breath sounds - Decreased vocal resonance - Mediastinal shift towards - Crackles - Decreased chest wall movement - Dullness to percussion - Bronchial breathing / increased breath sounds - Increased vocal resonance

6. Complications Recurrent Laryngeal nerve palsy Horner's Syndrome (Pancoast’s tumour) Rib erosion Local Brain, bone, liver, adrenals Metastases SIADH Excess ACTH secretion Addisons Syndrome Gynaecomastia Endocrine Lambert Eaton Syndrome Proximal Myopathy Neurological Pericarditis SVC obstruction Venous Thomboembolism Cardiovascular SypRFSignsCompInxHistologyRxSurg

7. Investigations DiagnosisStageGrade Chest X-ray CT Radio-nucleotide uptake scan Sputum Pleural fluid LN aspiration Bronchoscopy SypRFSignsCompInxHistologyRxSurg

8. Histology Small Cell Non-Small Cell Adenocarcinoma Squamous cell Large-cell 50% 2 year survival if caught before spread Neurosecretory cells 3 month median survival if untreated 1/1.5 yrs with Rx Staging: TNM SypRFSignsCompInxHistologyRxSurg

9. Treatment Small Cell Non-Small Cell Excision if no metastatic spread Curative radiotherapy if respiratory reserve poor Chemotherapy +/- radiotherapy in advanced disease (likely palliative) Almost inevitably disseminated Chemotherapy, but relapse Radiotherapy for symptomatic relief: Bronchial Obstruction SVC obstruction Haemoptysis SVC stenting / endobronchial therapy SypRFSignsCompInxHistologyRxSurg

10. Surgery – the curve ball OSCE Lobectomy / pneumonectomy with LN excision The similarities: Both have thoracotomy scars. Both have reduced chest expansion and reduced AE. The differences: 1. The signs of lobectomy are confined to lobe which is removed. 2. The signs of pneumonectomy are extensive i.e. involve the whole lung. The side involved would be flatten. It is similar to whole lung collapse. 3. Normally, the tracheal is central in lobectomy (except for upper lobe). The tracheal is almost always shifted in pneumonectomy. SypRFSignsCompInxHistologyRxSurg