1. The Diagnosis of Lung Cancer
Sarah Goodall

2. Different Types of Lung Cancer
Bronchocarcinomas
• Non Small Cell Carcinoma
– Squamous Cell Carcinoma, 40%
– Adenocarcinoma, 10%
– Large Cell Carcinoma, 25%
– Bronchoalveolar Cell Carcinoma, 1-2%

3. • Small Cell Carcinoma, 20-30%
– oat cell carcinoma
– Endocrine origin
– Highly Malignant
– Prognosis Poor
Mesothelioma
– Tumour of mesothelial cells which
usually occurs in the pleura

4. Presenting Symptoms
• Cough 41%
• Chest Pain 22%
• Cough and Pain 15%
• Haemoptysis 7%
• Chest Infection <5%
• Malaise <5%
• Weight Loss <5%
• SOB <5%
• Hoarseness <5%
• Distant Spread <5%
• No Symptoms <5%

5. Risk Factors
• Smoking
• Asbestos Exposure
• Chromium Exposure
• Arsenic
• Iron Oxides
• Radiation (Radon
Gas)
• Family History
Asbestos

6. Signs
• Cachexia
• Anaemia
• Clubbing
• Hypertrophic pulmonary
oteoarthropathy (causing
wrist pain)
• Supraclavicular/Axillary
Lymphadenopathy

7. Chest Signs
• Maybe None
• Consolidation
• Collapse
• Pleural Effusion

8. Metastasis Signs
-Bone Tenderness
-Hepatomegally
-Confusion
-Fits
-Focal CNS deficit
-Cerebellar Syndrome
-Proximal Myopathy
-Peripheral Neuropathy

9. Complications
LOCAL
– Recurrent Laryngeal Nerve Palsy
– Phrenic Nerve Palsy
– SVC Obstruction
– Horner’s Syndrome (Pancoasts Tumour)
– Rib Erosion
– Pericarditis
– AF

10. METASTATIC
– Brain
– Bone (bone pain, anaemia, increased Ca2+
)
– Liver (Hepatomegally, Raised LFTs)
– Adrenals (Addison’s)

11. ENDOCRINE
– Ectopic Hormone Secretion e.g. SIADH,
ACTH by oat cell carcinoma
PTH by squamous cell carcinomas

12. Investigations
Cytology
– Sputum and Pleural Fluid
FNA
– Peripheral Lesions, Superficial Lymph Nodes
Bronchoscopy
– For Histological Diagnosis and assessment of
operability
CT
– Stage the Tumour
Radionuclide Bone Scan
– For suspected metastases
Lung Function Tests

13. Looking at the Chest X-Ray
• Cell type can’t be diagnosed from
X-Ray
• Lesions rarely seen until >1cm
• Lesions >4cm be suspicious of
malignancy
• 20% cavitate – usually scc
• Lobular or irregular edges
• Metastasises to Liver, Adrenals,
Bones, Brain
• NB: presence of calcification, air
bronchogram – unlikely to be
malignancy

14. Stages of the Tumour
• Primary Tumour
– TX malignant cells in bronchial secretions
– Tis Carcinoma in situ
– T0 Non Evident
– T1 < or = 3cm in lobar or more distal airway
– T2 > 3cm and >2cm distal to carina or pleural
involvement
– T3 Involves chest wall, diaphragm, medistinal pleura,
pericardium or <2cm from carina
– T4 Involves mediastinum, heart, great vessels,
trachea, oesophagus, vertebral body, carina or
malignant effusion present

15. Treatment
Non Small Cell Tumours
– Excision if no metastatic spread
– Curative radiotherapy

16. Small Cell tumours
– Almost always disseminated at presentation
– May respond to chemotherapy
– Palliation
– Radiotherapy for bronchial obstruction, SVC
obstruction, Haemoptysis, Bone Pain,
cerebral metastases
Mesothelioma
– Diagnosis often only made PM

17. Prognosis
Non Small Cell – 50% 2 year survival
without spread, 10% with spread
Small Cell – 3 months if untreated, 1- 1.5
years if treated
Mesothelioma – Less than 2 years

18. Prevention
• Discourage Smoking
• Avoid occupational
exposure to
carcinogens