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She got it. She said hi guys. Thank you for those of you that have joined. Um We'll probably wait till five past just to start if that's OK. OK, guys, I think I might start, get started. Ok. Can everyone see, can someone just say if they can see my screen? Ok, I'm gonna assume that you guys can see this. So thank you very much for joining. Um So today, um me and NIA are gonna be going through lung cancer and restriction of lung disease. So if you're new to teaching things, um we do weekly tutorials and um and it's a biomedical students for medical students. Oh, I just found out that you can't see this. Ok? Hopefully you should be able to see this now. Ok. So I'm gonna start off by talking about lung cancer. So the types of lung cancer are nonsmall cell and small cell. And within nonsmall cell cancer, you have adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. Um And some common sites of metastases of lung cancer are the brain, which is the most common um and liver adrenal glands and bones. So, the general lung cancer pathway comes up quite a lot in question, um particularly the referral criteria which is on the left. So, if a patient has had a chest X ray and incidentally find anything suggesting of lung cancer, they would get referred by this two week wait pathway and uh or otherwise, if they're age 40 or over with unexplained he hemoptysis, and we also offer an urgent chest x-ray toes for lung cancer in people 40 or over if they have two of these symptoms. Um So cough fatigue, shortness of breath, chest pain, weight loss, um and appetite loss. Um, and, or one or more of these symptoms if they've ever smoked. So I got a question on here. I can't see the chart but if, maybe you could, um, tell me, uh, if someone puts something, but what investigations do you think come next after doing a chest X ray? Has there anything on the chat today? Yeah. Someone says CT contrast and staging CT. Ok. I'm gonna assume not. So, um, after a chest X ray to investigate it further, you can do act, uh, you can do pet scanning and then to confirm the diagnosis of lung cancer, you can do bronchoscopy um with a biopsy being taken. Ok. So we've got an SBA now, um I'm just gonna ask, uh may need to put the pole up. Ok. So what was the most popular answer? N um Yeah, so people, people haven't answered yet. Um But actually one person's put in a, just waiting for a few more answers. Ok. II can't hear you. Give me one second. Hello? Ok. So, uh, I've been told everyone, everyone's put A or B so the answer is b, and we'll go through a little bit, um, about squamous cell carcinoma. Um, so it is a noncell small cell carcinoma and it's m, it's almost exclusively in smokers. So 98% of incidents are in smokers, they tend to be centrally loaded. Um So closer to the mediastinum. Um And the way I like to remember what is centrally located is all the ones that start with s so squamous cell, small cell and they tend to be near the center. Um And then some of the other ones tend to be more uh more in the periphery. Um And then the x-ray description of it um would be a cavitating lesion. So in the middle picture here, um you can see there's an f fluid level. So you've got this solid, solid area and then this black area in between which is a cavity. And so squamous cell carcinoma is normally cavitating. So that might be that may, it might come up as an image in your exams or as a description. So it's good to learn both um and the histology description. Um uh you feel really like putting in a few histology questions and it would be a Keratin pearl. So if you can see in the center of the image on the left. Um that swirl area is called a keratin pearl. OK. So we need to know about some of the paraneoplastic syndromes that come with squamous cell carcinoma. Um So, one of them is parathyroid hormone related protein secretion. So, th RP is a protein that mimics the action of thy thyroid hormone and it causes hypercalcemia but um it doesn't work the same as P th. Um so it doesn't increase Vitamin D activation and phosphate levels will stay normal or low. It will have all these clinical signs of hypercalcemia, um which is uh also remembered as stones, um, bones growths and psychiatric overturns which is confusion and some of them are like confusion, constipation, thirst, polyuria and abdominal pain and biochemically, there'll be raised calcium but.
