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Year 4 - Cancer Care > 1.02 - Lung Cancer > Flashcards

1.02 - Lung Cancer Flashcards

1
Q

Risk factors for lung cancer.

A
  • tobacco smoking (incl. second hand smoke)
  • asbestos
  • outdoor air pollution
  • COPD
  • tuberculosis
  • exposure to radiation
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2
Q

How does smoking tobacco cause lung cancer?

A

Tobacco carcinogens (e.g. nitrosamines and polyaromatic hydrocarbons) form DNA adducts (ie. DNA and carcinogens bound together).

These DNA disturbances cause mutations within tumour suppressor genes, interrupting repair and cell cycle regulation mechanisms.

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3
Q

What are the two broad divisions of lung cancer?

A
  • small cell lung cancer (SCLC) (15%)
  • non-small cell lung cancer (NSMLC) (85%)

Mesothelioma and neuroendocrine tumours make up a minority of diagnoses.

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4
Q

Divisions of NSCLC.

A
  • squamous cell carcinoma
  • adenocarcinoma
  • large cell carcinoma
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5
Q

Which type of lung cancer is most closely associated with smoking?

A

Squamous cell carcinoma - non small cell lung cancer.

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6
Q

Prognosis of squamous cell carcinoma of the lung.

A

Slow growing tumour

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7
Q

Which type of lung cancer is most closely associated with non-smokers?

A

Adenocarcinoma - precursor is atypical alveolar hyperplasia.

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8
Q

Prognosis of adenocarcinoma of the lung.

A
  • faster doubling time than SCC
  • early metastasis
  • worse prognosis than SCC
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9
Q

Prognosis of large cell carcinoma.

A
  • caviating lesions
  • early metastasis (often to GI tract)
  • prognosis similar to adenocarcinoma
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10
Q

Features of SCLC.

A
  • 10-15%
  • lesions usually centrally located
  • aggressive tumour with distant metastasis at time of diagnosis
  • more responsive to NSCLC to chemotherapy and radiotherapy, but prognosis is still poor
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11
Q

Signs and symptoms of lung cancer.

A
  • cough (>3 weeks)
  • shortness of breath
  • wheeze
  • chest pain
  • hoarseness of voice
  • headache
  • swelling of face, arms and/or neck
  • arm, shoulder and/or neck pain
  • fever
  • night sweats
  • weight loss
  • decreased appetite
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12
Q

Why does dyspnoea occur in lung cancer?

A
  • mass effect of tumour pressing on the bronchi or trachea
  • tumour induces fluid to flow in around the lungs, heart or chest cavity
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13
Q

Why does wheeze occur in lung cancer?

A
  • mass effects of the tumour pressing on the bronchi or trachea
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14
Q

Why does hoarseness of voice occur in lung cancer?

A
  • mass effects of tumour compressing the recurrent laryngeal nerve that innervates the vocal cords
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15
Q

Why does swelling of the head / neck / arms occur in lung cancer?

A
  • mass effect of tumour compressing the superior vena cava
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16
Q

What are the common sites of metastasis for lung cancer?

A

Lung cancer mets to A BBL:

  • adrenal glands
  • bones
  • brain
  • liver
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17
Q

Diagnostic workup for lung cancer (imaging).

A
  • chest xray
  • CT
  • biopsy
  • PET (?lymph node involvement)
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18
Q

Diagnostic workup for lung cancer (laboratory investigations).

A
  • FBC (?anaemia, leukocytosis, thrombocytosis)
  • Ca (elevated)
  • LFTs (?raised ALP)
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19
Q

Techniques that can be used to sample lung cancer pathology specimens.

A
  • sputum sample
  • FNA
  • bronchoscopy
  • mediastinoscopy
  • throascopy
  • surgical thoracotomy
20
Q

How is NSCLC staged?

A

TNM staging:

Tumour size
Nodal involvement
Metastases

21
Q

How is SCLC staged?

A
  • limited disease: cancer only present in one side of the chest
  • extensive disease: cancer is present bilaterally in the chest, pleural effusion or distant metastases
22
Q

Surgical treatment of NSCLC.

A
  • thoracotomy with lobectomy for curative or palliative treatment
  • mediastinal lymph node resection
  • lymph node sampling
23
Q

PFTs prior to surgical lobectomy.

A
  • FEV1 >1.2
  • DLCO > 60% predicted

Indicators of good outcome post-surgery.

24
Q

Role of radiotherapy in NSCLC.

A
  • kills cancer cells by causing DNA damage
  • external beam radiation therapy
  • brachytherapy
  • used alongside chemotherapy
25
Q

Role of chemotherapy in NSCLC.

A
  • shrink tumour prior to surgery or radiation
  • kill cancer cells not removed during surgery to reduce risk of recurrence
  • primary treatment for those unable to have surgery
  • relieve pain of advanced cancer
  • maintenance therapy in those in advanced cancer that is responsive to chemotherapy
26
Q

Targeted therapies in NSCLC.

A

Utilise specific molecular mutations present in NSCLC to stop growth and spread of cancer cells. Mutations targeted are:

  • EGFR
  • ALK
  • BRAF
  • ROS1
27
Q

Role of surgery in SCLC.

A

Not useful in the treatment of most cases of SCLC.

28
Q

Role of chemotherapy in SCLC.

A

Primary treatment used to treat limited stage disease.

80% of SCLC tumours are responsive to chemotherapy, but overall survival rates are still low.

29
Q

Role of radiotherapy in SCLC.

A

Can be used in conjunction with chemotherapy.

Radiation to the brain is recommended for patients with limited stage disease, even when there is no evidence of spread to the brain. This is to decrease the chance of developing brain metastases.

30
Q

Lung cancer 10 year survival in England.

A

9.5%

ie. prognosis is poor - NSCLC better prognosis than SCLC.

31
Q

When are patients referred to the 2WW for lung cancer?

A
  • CXR finding suggestive of lung cancer
  • aged >40 with unexplained haemoptysis
32
Q

Signs of lung cancer.

A
  • clubbing
  • cachexia
  • anaemia
  • lymphadenopathy
  • pleural effusion
  • unexplained DVT
  • lung collapse
  • SVCO
  • horner’s syndrome
33
Q

What is the cause of Horner’s syndrome?

A

Pancoast tumour causes compression of the sympathetic ganglion:
- miosis
- anhydrosis
- ptosis

34
Q

Which structures may a pancoast tumour compress?

A
  • brachiocephalic vein
  • subclavian artery
  • phrenic nerve
  • recurrent laryngeal nerve
  • vagus nerve
  • sympathetic ganglion
35
Q

A patient diagnosed with inoperable SCC of the right lung 2-12 ago presents with escalating chest pain. what are the possible cancer related causes of this pain?

A
  • chest wall invasion
  • bone mets
  • metastatic spinal cord compression
36
Q

A patient diagnosed with inoperable SCC of the right lung 2-12 ago presents with escalating chest pain. what are the possible treatment related causes of this pain?

A
  • oesophagitis
  • local reaction to radiotherapy
37
Q

A patient diagnosed with inoperable SCC of the right lung 2-12 ago presents with escalating chest pain. what are the possible non-cancer/treatment related causes of this pain?

A
  • CAP
  • PE
  • pneumothorax
  • MI
  • anxiety
  • MSK
38
Q

What are the three types of lung cancer surgery?

A
39
Q

What supportive care can you offer for breathlessness in lung cancer?

A
  • stent
  • radiotherapy
  • home oxygen
  • LOROS breathlessness service
  • oramorph
40
Q

What supportive care can you offer for the pain in lung cancer?

A
  • analgesia
  • nerve blocks
  • radiotherapy
41
Q

How lung must an unexplained cough be persistent for to warrant a CXR?

A

3 weeks

42
Q

What is the only cancer of the pleural space in the lungs where you can consider curative treatment?

A

Mesothelioma - by definition it is a cancer affecting the pleura primarily.

Otherwise this is a poor prognostic indicator of metastatic spread.

43
Q

81 year old male with stage IV lung cancer presents with confusion, nausea and weakness.

What urgent blood test would you do and what drug would you give them?

A

Blood test: calcium

Drug: bisphosphonate
(causes more calcium to go into bone and out of blood)

Keep patient hydrated with IV fluids for 48 hours after starting bisphosphonate

44
Q

a patient with lung cancer presents with SVCO.

What is your immediate management?

A
  • Oxygen
  • Analgesia
  • Sit patient upright (reduces venous pressure)
  • Urgent CT
  • Urgent steroids
45
Q

What do you do for a patient with lung cancer if you suspect brain mets (vomiting, confusion, headaches…)?

A
  • CT / MRI brain
  • dexamethasone 4mg BD with weaning plan
  • brain radiotherapy
  • keppra for seizures
  • inform they cannot drive
46
Q

Within how many days should a definitive diagnosis be made of lung cancer?

A

31 days for diagnosis

62 days for treatment to start

Year 4 - Cancer Care (13 decks)

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