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

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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

© A.J.France 2010

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 ?”

© 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

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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 ?

© A.J.France 2010

Lung cancer summary

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

© A.J.France 2010