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Lung Cancer for Finals

Lung Cancer for Finals. Simple Success. Tim Robbins Academic FY1 UHCW. Ron Ailman : Symptoms. Cough Haempotysis Dyspnoea Chest Pain Recurrent pneumonia Anorexia/weight loss Hoarseness of voice. Patient photo/data from: http://www.macmillan.org.uk. Risk Factors. Cigarette Smoking

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Lung Cancer for Finals

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

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

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

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

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

  6. Complications

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

  8. Histology Non-Small Cell 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

  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

  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.

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