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AASM > 1 - Lung Cancer > Flashcards

1 - Lung Cancer Flashcards

1
Q

What may be the reason for a hoarse voice presentation?

A

Recurrent laryngeal nerve compression

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2
Q

What are 4 radiological tools for diagnosis?

A

X-ray CT
PET

MRI
Ultrasound

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3
Q

What are the 3 main types of lung cancer?

A

Adenocarcinoma
Squamous cell carcinoma
Small cell carcinoma

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4
Q

What cell types does adenocarcinoma arise from?

A

Glandular cells

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5
Q

What cell type does squamous cell carcinoma arise from?

A

Epithelial dysplasia

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6
Q

What cell types does small cell cancer arise from?

A

Neuroendocrine cells

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7
Q

Which lung cancer is most associated with smoking as a risk factor?

A

Squamous cell carcinoma

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8
Q

What appearance does an adenocarcinoma have on X-ray?

Why?

A

Ground glass

Slow growing

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9
Q

Where are adenocarcinomas most likely to appear within the lung?

A

Peripherally

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10
Q

What do squamous cell carcinomas tend to arise most commonly?

A

Centrally

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11
Q

What 3 features are commonly seen in small cell carcinomas?

A

Aggressive (early metastasis)

Small primary nodule

Extensive lymph node involvement

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12
Q

What % of cancers are small-cell?

A

12%

according to cancer research UK

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13
Q

What % of cancers are non-small cell?

A

87%

according to cancer research UK

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14
Q

What is most common form of NSCLC? Rank them.

A

Adenocarcinoma
Squamous cell
Large cell

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15
Q

PET scanning uses a combination of which two techniques?

A

X-ray

Radioactive isotopes

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16
Q

Give 1 example of a radioactive substance that is used in PET scanning.

A

Fluorodeoxyglucose

18 FDG

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17
Q

What procedure will surgeons request prior to tumour excision? For what reason?

A

Percutaneous lung biopsy (CT guided)

To stage the cancer to determine how much surrounding tissue will need to be excised to reduce risk of recurrence.

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18
Q

What is the average X-ray exposure across the UK?

A

2.2 milliSieverts (Sm)

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19
Q

What is the biggest contributor of X-rays?

A

Radon gas from rocks

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20
Q

What dose of X-ray does a simple CXR count for?

A

0.04 mSv (1 week)

21
Q

What dose of X-ray does a normal CT count for?

A

8 mSv (4 years)

22
Q

What dose of X-ray does a low-res CT count for?

A

1 mSv (men) - 6 months

1.4 mSv (women)

23
Q

What is the incidence of lung cancer annually?

A

40,000

24
Q

What % of SCLC presentations are already found to be disseminated?

A

70%

25
Q

With certain occupational history, what other lung cancer should be excluded?

A

Malignant mesothelioma

26
Q

What signs may indicate malignant mesothelioma?

A

General pleural thickening
Pleural effusion

Similar to lung cancer symptoms.

27
Q

How do you treat malignant mesothelioma?

A

Chemotherapy - Permetrexed.

28
Q

What are the general symptoms of lung cancer?

And the % occurrence of each symptom?

A

Cough - 80%
Haemoptysis - 70%
Dyspnoea - 60%
Chest pain - 40%

29
Q

What 3 general signs indicate lung cancer?

A

1) Cachexia
2) Anaemia
3) Clubbing

30
Q

What 3 chest signs might be present in lung cancer presentation?

A

1) Pleural effusion
2) Lung collapse
3) Focal consolidation

31
Q

What 4 signs may indicate metastatic status?

A
  • Bone tenderness
  • Fits
  • Peripheral neuropathy
  • Proximal myopathy
32
Q

Name 4 local complications of lung tumours?

A

Recurrent laryngeal compression
Phrenic nerve palsy
SVC obstruction
Horner’s syndrome

33
Q

Name 4 metastatic locations of lung cancer?

A

Brain
Bone (i.e. Increased calcium, tenderness, anaemia)
Liver
Adrenals (addison’s)

34
Q

What is the triad of Horner’s syndrome?

A

Ptosis - lid drooping
Miosis - pupil constriction
Anhydrosis - lack of facial sweat

35
Q

Why does Horner’s syndrome present with that triad? What’s the cause?

A

Pancoast tumour

Compressing sympathetic fibres responsible for controlling eye lids, pupil constriction and sweat glands of the face.

36
Q

What are the 4 ways in which lung tumours can spread?

A

Local invasion (extends into lung tissue)

Transcelomic spread (tumours migrates along pleural space)

Lymphatic spread (tumour extends along pulmonary lymphatic vessels into hilar nodes)

Blood-borne spread (tumour enters draining veins and cells enter systemic circulation)

37
Q

How are small NSCLCs ideally treated?

A

Lobectomy

38
Q

How are stage I, II and III NSCLCs treated?

A

Radical radiotherapy

39
Q

How are more advanced NSCLCs treated?

A

Chemotherapy + Radiotherapy

40
Q

Treatment regiments may in platinum. What does this mean?

A

Requires monoclonal antibodies that target epidermal growth factor receptor

41
Q

Give an example of a platinum regimen?

A

Cetuximab

42
Q

In limited SCLC, what treatment option is offered?

A

Surgery

43
Q

If well enough, besides surgery, what may be offered as an adjuvant in SCLC?

A

Chemo

Radio

44
Q

What treatment is offered in patients with the following symptoms: SVC obstruction, bronchial obstruction, haemoptysis, cerebral metastasis?

A

Radiotherapy

45
Q

Give examples of other drugs that could be used in lung cancer treatment?

A

Analgesia
Steroids
Anti-emetics
Bronchodilators

46
Q

What is the prognosis of NSCLC without spread? (% and years)

A

50% last 2 years

47
Q

What is the prognosis of NSCLC with spread? (% and years)

A

10% last 2 years

48
Q

What is the median survival for SCLC if untreated?

A

3 months

49
Q

What is the median survival for SCLC if treated?

A

1-1.5 years

AASM (8 decks)

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