Page 1275 - TNFlipTest

Toronto Notes 2019 Neoplasms
■ superior vena cava syndrome
◆ obstruction of SVC causing neck and facial swelling, as well as dyspnea and cough
◆ other symptoms: hoarseness, tongue swelling, epistaxis, and hemoptysis
◆ physical findings: dilated neck veins, increased number of collateral veins covering the anterior
chest wall, cyanosis, edema of the face, arms, and chest, Pemberton’s sign (facial flushing,
cyanosis, and distension of neck veins upon raising both arms above head) ◆ milder symptoms if obstruction is above the azygos vein
■ lung apex (Pancoast tumour): Horner’s syndrome, brachial plexus palsy (most commonly C8 and T1 nerve roots)
■ rib and vertebrae: erosion
■ distant metastasis to brain, bone, liver, adrenals • paraneoplasticsyndromes
■ a group of disorders associated with malignant disease, not related to the physical effects of the tumour itself
Respirology R29
■ most often associated with SCLC
Table 29. Paraneoplastic Syndromes
System
Skeletal Dermatologic Endocrine
Neuromyopathic
Vascular/Hematologic Renal
Investigations
Clinical Presentation
Clubbing, hypertrophic pulmonary osteoarthropathy (HPOA)
Acanthosis nigricans Dermatomyositis
Hypercalcemia (osteolysis or PTHrP) Hypophosphatemia
Hypoglycemia
Cushing’s syndrome (ACTH) Somatostatinoma syndrome
SIADH
Lambert-Eaton syndrome Polymyositis
Subacute cerebellar degeneration Spinocerebellar degeneration Peripheral neuropathy
Nonbacterial endocarditis
Trousseau’s syndrome (migratory thrombophlebitis) DIC
Nephrotic syndrome
Associated Malignancy
Non-small cell lung cancer (NSCLC)
Bronchogenic cancer Bronchogenic cancer
Squamous cell cancer Squamous cell cancer Sarcoma
Small cell lung cancer (SCLC) Bronchial carcinoid
SCLC SCLC
Bronchogenic cancer NSCLC
Horner has a MAP of the Coast
A Pancoast tumour compresses the cervical sympathetic plexus causing a Horner’s syndrome:
Miosis
Anhydrosis
Ptosis
• initialdiagnosis
■ imaging: CXR, CT chest + upper abdomen, PET scan
■ cytology: sputum
■ biopsy: bronchoscopy, EBUS, CT-guided percutaneous needle biopsy, mediastinoscopy
• stagingworkup
■ TNM staging system: T – primary tumour (size); N – regional lymph nodes; M – distant metastasis ■ blood work: electrolytes, LFTs, calcium, ALP
■ imaging: CXR, CT thorax and upper abdomen, bone scan, neuroimaging, PET scan
■ invasive: bronchoscopy (EBUS), mediastinoscopy, mediastinotomy, thoracotomy
■ screen adenocarcinoma for EGFR and ALK mutations
Endobronchial Ultrasound (EBUS)
• Allows visualization of peri-bronchial structures and distal peripheral lung lesions • Provides detailed assessment of the airway
wall layers
• Allows for guided biopsies of lymph nodes
and tumours
• Used for diagnosis and staging