Transcript Respiratory Malignancy

Charlotte Miller
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Definition
Classifications
Clinical Presentation
Management
Prognosis
Clinical Scenario
Emergency
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Neoplasia
 Abnormal growth of cells which persists after
initial stimulus has been removed
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Benign
 Compact mass that remains at the site of origin
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Malignant
 Uncontrolled growth, not organised, necrotic
centre, illmargined
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Primary
 Small Cell
 Non Small Cell
▪ Squamous
▪ Large cell
▪ Adenocarcinoma
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Secondary
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Breast
Bone
Kidney
Prostate
thyroid
Bronchial Carcinoma
• 95% of primary tumours
• 3:1 M:F
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Genetic
Environmental
 The British Doctors Study
MAGNIFICENT SEVEN
• Self Sufficiency in Growth Signals
• Insensitivity to negative signals
• Defects in DNA repair
• Evasion of Apoptosis
• Limitless replication potential
• Angiogenesis
• Invasion & Metastasis
 Local effects
▪ Breathlessness
▪ Cough
▪ Chest Pain
▪ Haemoptysis
 Spread within the chest
▪ Pancoast tumour
▪ Horners Syndrome
▪ SVC obstruction
▪ Pleural infiltration
 Metastatic
▪ Bone
▪ Brain
▪ Lymph Nodes
 Non Metastatic
▪ Endocrine
▪ Neurological
▪ Vascular
▪ Skeletal
▪ Cutaneous
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PMHx of Malignancy
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Social History
 Hodgkins
 Smoking
 Testicular
 Occupation
▪ Asbestos, Radon Gas,
 Endometrial
 Foreign Travel
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Family History
 1st degree increase by
51%
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Peripheral
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Central
 Clubbing
 Lymphadenopathy
 Cyanosis
 Tracheal Deviation
 Hypertrophic
 Chest defects
Pulmonary
Osteoarthropathy
 Acanthosis Nigricans
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Bedside
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Bloods
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Imaging
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Special Tests
 Peak Flow
 Pulse Oximetry
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 Sputum
Full Blood Count
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 ABG
Bone – Calcium
 Urea + Electrolytes
 Liver
ChestFunction
X-ray
 Thyroid
CT Scan Function
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scan Lavage
 PET
Bronchiolar
 Trans-thoracic Needle Biopsy
 Pleural Aspiration
 Respiratory Function
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Biological
 Conservative
 Medical
 Surgical
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Psychological
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Social
In order to effectively
manage this patient I
would like to involve a
multidisciplinary team to
use the biological –
psychological - social
approach
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Conservative
 Symptom relief
 Smoking Cessation
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Medical
 Radiotherapy
 Chemotherapy
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Surgical
 Assessment for surgery
 De-bulking
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Counselling
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Mood altering medications
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End of Life discussions
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Support Networks
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Services for Families / Carers
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Physiotherapy / Occupational Therapist
 Adaptation to home
 Maintaining Mobility
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Staging
 Tumour
 Metastatic
 Nodes
Five-year survival (%)
Non-small
cell lung
carcinoma
Clinical stage
Small cell
lung
carcinoma
IA
50
38
IB
47
21
IIA
36
38
IIB
26
18
IIIA
19
13
IIIB
7
9
IV
2
1
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72 year old woman presents with worsening
shortness of breath for the last 3 months.
HxPC: 2 weeks she has been coughing up bright red blood with her sputum
2 stone weight loss over 2/12
PMHx : COPD Hypertension
Meds: Seretide 250 2 puffs BD, Salbutamol PRN, Ramipril 5mg OD
Allergies: NKDA
SHx: Retired, previously worked in a post office
Stopped smoking 5 years ago after a 40 year pack history
No alcohol
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What are your main differential diagnoses for
this lady?
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?Risk Factors
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How would you investigate her?
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O/E
 Cachectic
 Stoney dullness at her right lung base
 No air entry right lower lobe
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CXR
 Right sided pleural effusion
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Other Investigations?
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Exudates have a protein level of >30 g/L
Transudates have a protein level of <30 g/L
Light's criteria state that the pleural fluid is an
exudate if one or more of the following criteria are
met
 Pleural fluid protein divided by serum protein >0.5
 Pleural fluid LDH divided by serum LDH >0.6
 Pleural fluid LDH more than two-thirds the upper limits
of normal serum LDH
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SVC Obstruction
 Steroids - Dexamethasone
 Stent
 Oncology R/v – Radiotherapy, Chemotherapy
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Erosion of Blood Vessels
 Supportive
 Palliation