Lung cancer Classification & Management
Small-cell carcinoma (SCLC) (20%, smoking) Referral
Central location, near bronchi Cancer pathway appointment w/i 2 weeks if
Histology small, poorly differentiated cells CXR findings of lung cancer
80% presents w/ advanced disease >40 yrs w/ unexplained haemoptysis
Very chemosensitive but poor prognosis
Ectopic hormone secretion OFFER: Urgent CXR w/i 2 weeks if
ACTH Cushing’s (causes bilateral adrenal hyperplasia hypokalaemic alkalosis) >40 yrs + ≥ 2 symptoms/smoker + ≥ 1 symptom
ADH Hyponatraemia Cough, fatigue, SOB, chest pain, weight loss, appetite
Associated w/ Lambert-Eaton syndrome (Abs to VGCC causing Myasthenic-like loss
syndrome)
CONSIDER: Urgent CXR w/i 2 weeks if
> 40 yrs AND:
Persistent/recurrent chest infection
Non-small cell carcinoma (NSCLC) Finger clubbing
Squamous cell carcinoma (SCC) (35%, M>F, smoking, radon gas) Supraclavicular/cervical lymphadenopathy
Histology centrally located, evidence of squamous differentiation + keratinisation Chest signs consistent w/ lung cancer
(keratin pearls) Thrombolysis
Usually invasive- metastasise late (via LN)
PTHrP hypercalcaemia Ix
Finger clubbing, hypertrophic pulmonary osteoarthropathy (HPOA), raised TSH CXR
Large cell carcinoma CT
Peripherally/central Bronchoscopy biopsy + endobronchial USS
Histology Large, poorly differentiated cells PET scanning
Poor prognosis, lack light-microscopic feature of other tumour types o Non-small cell lung cancer
May secrete β- HCG o Uses 18-fluorodeoxygenase taken up by
Adenocarcinoma (25%, non-smokers, Far East) neoplastic tissue
Peripherally located Mx
Histology glandular differentiation, glandular formation + mucus production SCLC
Extra-thoracic metastases common + early – 80% presents w/ metastases Combination of chemo + radiotherapy
Gynaecomastia, HPOA Extensive disease palliative chemotherapy
NSCLC
20% surgery
Curative/palliative radiotherapy
CI Metastases present, FEV1 <1.5, tumour near hilum, vocal
cord paralysis, SVC obstruction
Mesothelioma Pancoast’s tumour
Affects the pleura Affects apices of lung
Associated w/ asbestosis Produces Horner’s syndrome
Histology Psammoma bodies are Miosis, Ptosis, Anhidrosis
seen
Small-cell carcinoma (SCLC) (20%, smoking) Referral
Central location, near bronchi Cancer pathway appointment w/i 2 weeks if
Histology small, poorly differentiated cells CXR findings of lung cancer
80% presents w/ advanced disease >40 yrs w/ unexplained haemoptysis
Very chemosensitive but poor prognosis
Ectopic hormone secretion OFFER: Urgent CXR w/i 2 weeks if
ACTH Cushing’s (causes bilateral adrenal hyperplasia hypokalaemic alkalosis) >40 yrs + ≥ 2 symptoms/smoker + ≥ 1 symptom
ADH Hyponatraemia Cough, fatigue, SOB, chest pain, weight loss, appetite
Associated w/ Lambert-Eaton syndrome (Abs to VGCC causing Myasthenic-like loss
syndrome)
CONSIDER: Urgent CXR w/i 2 weeks if
> 40 yrs AND:
Persistent/recurrent chest infection
Non-small cell carcinoma (NSCLC) Finger clubbing
Squamous cell carcinoma (SCC) (35%, M>F, smoking, radon gas) Supraclavicular/cervical lymphadenopathy
Histology centrally located, evidence of squamous differentiation + keratinisation Chest signs consistent w/ lung cancer
(keratin pearls) Thrombolysis
Usually invasive- metastasise late (via LN)
PTHrP hypercalcaemia Ix
Finger clubbing, hypertrophic pulmonary osteoarthropathy (HPOA), raised TSH CXR
Large cell carcinoma CT
Peripherally/central Bronchoscopy biopsy + endobronchial USS
Histology Large, poorly differentiated cells PET scanning
Poor prognosis, lack light-microscopic feature of other tumour types o Non-small cell lung cancer
May secrete β- HCG o Uses 18-fluorodeoxygenase taken up by
Adenocarcinoma (25%, non-smokers, Far East) neoplastic tissue
Peripherally located Mx
Histology glandular differentiation, glandular formation + mucus production SCLC
Extra-thoracic metastases common + early – 80% presents w/ metastases Combination of chemo + radiotherapy
Gynaecomastia, HPOA Extensive disease palliative chemotherapy
NSCLC
20% surgery
Curative/palliative radiotherapy
CI Metastases present, FEV1 <1.5, tumour near hilum, vocal
cord paralysis, SVC obstruction
Mesothelioma Pancoast’s tumour
Affects the pleura Affects apices of lung
Associated w/ asbestosis Produces Horner’s syndrome
Histology Psammoma bodies are Miosis, Ptosis, Anhidrosis
seen
