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Lung cancer

Definition
  • A malignant tumour that originates in the bronchial epithelium.
Epidemiology
  • Leading cause of cancer deaths worldwide.
  • Strong association with tobacco smoking.
Types
  • Non-small cell lung cancer (NSCLC): 85% of cases
    • Adenocarcinoma: Most common subtype, often peripherally located.
    • Squamous cell carcinoma: Central, linked to smoking, may produce parathyroid hormone-related peptide.
    • Large cell carcinoma: Poor prognosis, can appear anywhere in the lung.
  • Small cell lung cancer (SCLC): 15% of cases, aggressive, associated with paraneoplastic syndromes.
Risk Factors
  • Smoking: primary risk factor.
  • Asbestos exposure.
  • Radon gas.
  • Family history.
  • Chronic obstructive pulmonary disease (COPD).
Clinical Features
  • New or changing cough.
  • Haemoptysis.
  • Weight loss, anorexia.
  • Dyspnoea.
  • Chest pain.
  • Recurrent chest infections.
Investigations
  • Chest X-ray: May show mass or hilar lymphadenopathy.
  • CT scan: Assess tumour size, nodal involvement, metastasis.
  • Biopsy: Diagnostic; either bronchoscopic or CT-guided.
  • PET scan: Staging and looking for metastasis.
  • Blood tests: FBC, U&Es, liver function tests, calcium.
Management
  • Surgery: Curative intent, mainly for NSCLC.
  • Radiation: Can be curative or palliative.
  • Chemotherapy: Main treatment for SCLC, also used for advanced NSCLC.
  • Targeted therapies: Specific to mutations in tumour DNA.
  • Supportive care: Pain management, oxygen for dyspnoea.
Complications
  • Metastasis.
  • Paraneoplastic syndromes.
  • Superior vena cava obstruction.
  • Horner’s syndrome.
  • Pancoast tumour.
Prognosis
  • Generally poor, especially for SCLC.
  • 5-year survival varies: NSCLC (10-20%), SCLC (2-8%).
Prevention
  • Smoking cessation.
  • Avoidance of known carcinogens.
  • Regular health screenings for high-risk populations.

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