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Respiratory Malignancy

Charlotte Miller. Respiratory Malignancy. Contents. Definition Classifications Clinical Presentation Management Prognosis Clinical Scenario Emergency. Definition. Neoplasia Abnormal growth of cells which persists after initial stimulus has been removed Benign

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Respiratory Malignancy

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  1. Charlotte Miller Respiratory Malignancy

  2. Contents • Definition • Classifications • Clinical Presentation • Management • Prognosis • Clinical Scenario • Emergency

  3. Definition • Neoplasia • Abnormal growth of cells which persists after initial stimulus has been removed • Benign • Compact mass that remains at the site of origin • Malignant • Uncontrolled growth, not organised, necrotic centre, illmargined

  4. Classification • Primary • Small Cell • Non Small Cell • Squamous • Large cell • Adenocarcinoma • Secondary • Breast • Bone • Kidney • Prostate • thyroid • Bronchial Carcinoma • 95% of primary tumours • 3:1 M:F

  5. Pathophysiology • 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

  6. History

  7. Presentation • 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

  8. Important Information • PMHx of Malignancy • Hodgkins • Testicular • Endometrial • Family History • 1st degree increase by 51% • Social History • Smoking • Occupation • Asbestos, Radon Gas, • Foreign Travel

  9. Signs • Peripheral • Clubbing • Cyanosis • Hypertrophic Pulmonary Osteoarthropathy • AcanthosisNigricans • Central • Lymphadenopathy • Tracheal Deviation • Chest defects

  10. Investigations • Peak Flow • Pulse Oximetry • Sputum • ABG • Bedside • Bloods • Imaging • Special Tests • Full Blood Count • Bone – Calcium • Urea + Electrolytes • Liver Function • Thyroid Function • Chest X-ray • CT Scan • PET scan • Bronchiolar Lavage • Trans-thoracic Needle Biopsy • Pleural Aspiration • Respiratory Function

  11. Management • Biological • Conservative • Medical • Surgical • Psychological • Social In order to effectively manage this patient I would like to involve a multidisciplinary team to use the biological – psychological - social approach

  12. Biological • Conservative • Symptom relief • Smoking Cessation • Medical • Radiotherapy • Chemotherapy • Surgical • Assessment for surgery • De-bulking

  13. Psychological • Counselling • Mood altering medications • End of Life discussions

  14. Social • Support Networks • Services for Families / Carers • Physiotherapy / Occupational Therapist • Adaptation to home • Maintaining Mobility

  15. Prognosis • Staging • Tumour • Metastatic • Nodes

  16. Clinical Scenario • 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

  17. What are your main differential diagnoses for this lady? • ?Risk Factors • How would you investigate her?

  18. Clinical Scenario… • O/E • Cachectic • Stoney dullness at her right lung base • No air entry right lower lobe • CXR • Right sided pleural effusion • Other Investigations?

  19. Transudate Vs Exudate • 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

  20. Emergencies • SVC Obstruction • Steroids - Dexamethasone • Stent • Oncology R/v – Radiotherapy, Chemotherapy • Erosion of Blood Vessels • Supportive • Palliation

  21. Questions???

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