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

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

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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

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100 new cases per day

Two of these every day© A.J.France 2010

Prognosis - 6 months

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Presentation of lung cancer

• Primary tumour• Local invasion• Metastases• Non-metastatic• (paraneoplastic)

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HaemoptysisNormal carina Tumour

Recurrent pneumonia

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Stridor

Local invasion

• Recurrent laryngeal nerve• Pericardium• Oesophagus• Brachial plexus• Pleural cavity• Superior vena cava

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Pancoast tumour

Brachial plexusinvasion

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Pancoast tumourBrachial plexus invasion

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Pleural effusion

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Recurrent laryngeal nerve palsyHoarse voice

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Superior Vena CavaObstruction

Distended external jugular vein

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Anastamoses to Inferior Vena Cava

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Chest wall invasion by lung cancer

Common sites for metastases

• Liver• Brain• Bone

• Adrenal• Skin• Lung

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Cerebral metastases• Insidious onset• Weakness• Visual disturbance• Headaches• Worse in the morning• Not photophobic

• Fits

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CT scancerebralmetastases

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Liver metastases

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Bone metastases

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Bone metastases

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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

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Hypertrophic pulmonary osteoarthropathy - bone

scan

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Thrombophlebitis

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Thrombophlebitis

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Weight loss

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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 ?”

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Examination – Lung cancer• Finger clubbing• Breathless• Cough• Weight loss• Bloated face• Hoarse voice

• Lymphadenopathy• Tracheal deviation• Dull percussion• Stridor• Enlarged liver

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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

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Making a tissue diagnosis – lung cancer• Bronchoscopy• CT guided biopsy• Lymph node aspirate• Aspiration of pleural fluid

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Fibreoptic bronchoscopy

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CT guidedbiopsy

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Differential diagnosis

• Have you thought of an alternative cause ?

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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 ?

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Lung cancer summary

• A very common disease• Presents in many ways• Poor survival

© A.J.France 2010