1. Dr A.J.France. Ninewells Hospital, Dundee Lung Cancer 2010

2.  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

3. 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

4. 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

5. 100 new cases per day Two of these every day © A.J.France 2010

6. Prognosis - 6 months © A.J.France 2010

7. Presentation of lung cancer Primary tumour Local invasion Metastases Non-metastatic (paraneoplastic) © A.J.France 2010

8. Haemoptysis Normal carina Tumour

9. Recurrent pneumonia © A.J.France 2010

10. Stridor

11. Local invasion Recurrent laryngeal nerve Pericardium Oesophagus Brachial plexus Pleural cavity Superior vena cava © A.J.France 2010

12. Pancoast tumour Brachial plexus invasion © A.J.France 2010

13. Pancoast tumou r Brachial plexus invasion © A.J.France 2010

14. Pleural effusion © A.J.France 2010

15. Recurrent laryngeal nerve palsy Hoarse voice © A.J.France 2010

16. Superior Vena Cava Obstruction Distended external jugular vein © A.J.France 2010

17. Anastamoses to Inferior Vena Cava © A.J.France 2010

18. Chest wall invasion by lung cancer

19. Common sites for metastases Liver Brain Bone Adrenal Skin Lung © A.J.France 2010

20. Cerebral metastases Insidious onset Weakness Visual disturbance Headaches Worse in the morning Not photophobic Fits © A.J.France 2010

21. CT scan cerebral metastases © A.J.France 2010

22. Liver metastases © A.J.France 2010

23. Bone metastases © A.J.France 2010

24. Bone metastases © A.J.France 2010

25. Non-metastatic: paraneoplastic Finger clubbing Hypertrophic pulmonary osteoarthropathy - HPOA Weight loss Thrombophlebitis Hypercalcaemia Hyponatraemia - SIADH Weakness - Eaton Lambert syndrome © A.J.France 2010

26. Finger clubbing © A.J.France 2010

27. Hypertrophic pulmonary osteoarthropathy - bone scan © A.J.France 2010

28. Thrombophlebitis © A.J.France 2010

29. Thrombophlebitis © A.J.France 2010

30. Weight loss © A.J.France 2010

31. 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

32. 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

33. 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

34. Making a tissue diagnosis – lung cancer Bronchoscopy CT guided biopsy Lymph node aspirate Aspiration of pleural fluid © A.J.France 2010

35. Fibreoptic bronchoscopy © A.J.France 2010

36. CT guided biopsy © A.J.France 2010

37. Differential diagnosis Have you thought of an alternative cause ? © A.J.France 2010

38. 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

39. 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

40. Lung cancer summary A very common disease Presents in many ways Poor survival © A.J.France 2010