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Respiratory Malignancy

This article provides an overview of respiratory malignancy, including its definition, classifications, clinical presentation, management options, and prognosis. It also includes a clinical scenario and information on emergencies related to respiratory malignancy.

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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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