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Respiratory Unit > 10.2 Lung Cancer > Flashcards

10.2 Lung Cancer Flashcards

1
Q

What is the commonest cause of cancer in males and females?

A

Lung cancer

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2
Q

What are risk factors for lung cancer?

A

SMOKING - proportional to the duration of the habit and the number of cigarettes smoked.
Exposure to asbestos (electricians/builders)
Exposure to radon (miners)
Genetic factors
Dietary factors
Lower socioeconomic group

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3
Q

How is lung cancer diagnosed?

A

Bronchoscope and needle biopsy of the lung or pleura used to obtain tissue sample for microscopy

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4
Q

Why is histological diagnosis essential for lung cancer patients?

A

Confirmation of lung cancer
Decide the cell type
Determine prognosis and treatment

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5
Q

Why is imaging of lung cancer useful?

A

Useful for:
Diagnosis
Staging (Assessment of the extent of the disease)
Determining the treatment and prognosis

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6
Q

When is surgery considered to treat lung cancer?

A

Non-small cell (20-25% operable)

Localised tumour

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7
Q

What is radical radiotherapy?

A

Radiotherapy done with curative intent (includes stereotactic RT)

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8
Q

What is palliative radiotherapy?

A

Radiotherapy done for symptom control

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9
Q

How is chemotherapy used to treat lung cancers? (4 ways)

A

– Small Cell - potentially curative in a minority
– Non-Small Cell - modest survival increase, symptom control
– ‘Neoadjuvant’ therapy- chemo before surgery (to ‘downstage’ the tumour to allow subsequent surgery))
– ‘Adjuvant’- chemo after surgery (no benefit if < stage 2)

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10
Q

What is combination therapy?

A

A combination of chemotherapy and radiotherapy. Potentially curative

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11
Q

What palliative care treatment is given to lung cancer patients?

A

Active symptom control eg analgesia, radiotherapy, airway stents, anxiolytics, nutritional support, patient support groups.
Treatment of tobacco addiction, coronary heart disease & other conditions

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12
Q

What 6 broad treatments are considered for lung cancer?

A 
Surgery
Radiotherapy
Combination chemotherapy
Combined therapy
Biological (targeted) therapies
Palliative care and other treatments
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13
Q

What cancer has the highest cancer related deaths world wide?

A

Lung cancer

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14
Q

What is the 1 year survival rate of stage 1 lung cancer after diagnosis?

A

83%

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15
Q

What is the median age to diagnose with lung cancer?

A

70 years

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16
Q

What criteria must be fulfilled to have a screening process?

A

• Disease with serious consequences
• High prevalence of detectable disease
• Test detects little pseudo-disease (overdiagnosis)
• Test detects disease before the critical point
• Test causes little morbidity
• Test affordable and available
• Treatment exists
• Treatment more effective when applied before symptomatic detection
• Treatment not too risky or toxic
Screening must lead to a decrease in disease specific mortality

17
Q

What is the secondary prevention for lung cancer?

A

National lung cancer screening trail - Low dose chest CT.
Is currently in trails, involve screening high risk patients (smokers/COPD/older)
Mass media campaigns - ‘be clear on cancer’

18
Q

What tests can be done to stage lung cancers?

A

Imaging - CXR, CT scan, Pet Scan, MRI, USS, Bone scan, ECHO

Tissue sampling - bronchoscopy, uss, Ct biopsy, thorocoscopy, surgical

19
Q

What are symptoms of a primary lung tumour?

A
  • Cough
  • Dyspnoea
  • Wheezing
  • Haemoptysis
  • Lung infection
  • Chest / shoulder pain
  • Weight Loss
  • Lethargy/Malaise
  • NO SYMPTOMS
20
Q

What are symptoms of regional Metastases of a lung cancer?

A
  • Bloated face (SVC obstruction)
  • Hoarseness (left recurrent laryngeal nerve palsy)
  • Dyspnoea (anaemia, pleural or pericardial effusions) • Dysphagia (oesophageal compression)
  • Chest pain (parietal pleural involvement)
21
Q

What are symptoms of distant Metastases of a lung cancer?

A
  • Bone pain/fractures

* CNS symptoms (headache, double vision, confusion etc.)

22
Q

What are metabolic symptoms caused by lung cancers?

A
  • Thirst (hypercalcaemia)
  • Constipation (hypercalcaemia)
  • Seizures (hyponatraemia – SIADH, small cell)
23
Q

What clinical signs might a patient with lung cancer present with?

A
  • Cachexia
  • Pale conjunctiva
  • Cervical lymphadenopathy
  • Horners Syndrome
  • Finger clubbing
  • Superior vena cava obstruction
  • Consolidation
  • Signs of pleural effusion
  • Muffled heart sounds
  • Liver enlargement
  • Skin metastases
  • Neurological long tract signs
  • NO SIGNS
24
Q

What is meant by staging of cancer?

A

Spread of cancer

Cell type

25
Q

What classification is used to stage lung cancers?

A

TNM classification
(Tumour, regional lymph nodes, Metastases)
Tumour - size, location and number of tumours
Nodes - number and location of metastasis within lymph nodes
Metastases - location of the Metastases in the body including other organs, and number around the body.

26
Q

Where do lung cancers commonly metastasise to?

A 
Brain
Draining lymph nodes
Pericardium
Lung
Pleura
Liver
Adrenals
Bone
27
Q

At what stage to the majority of lung cancer patients present?

A

Stage 4

Followed by stage 3 B

28
Q

What treatment is offered to the majority of lung cancer patients?

A

Palliative treatment. Most patients present too late (stage III3 and IV)

29
Q

Why is a PET scan done in lung cancer patients?

A

To pick up metastasis around the body. Detects the activity levels across the body

30
Q

What is cachexia?

A

Extreme weight loss and muscle wasting - common symptom of chronic conditions

31
Q

What is paraneoplastic syndrome?

A

A set of signs and symptoms that is a consequence of cancer in the body producing chemical signalling molecules (hormones or cytokines).
Can also be cause due to an immune response to the tumour.

32
Q

What endocrine signs of paraneoplastic syndromes can result from a lung cancer?

A

Secretion of PTHrP = hypercalcaemia,
Secretion of ACTH = Cushing’s syndrome,
Secretion of ADH = SIADH

33
Q

What imaging is conducted in all lung cancer patients?

A

CXR

Staging chest CT

34
Q

When is biopsy not done in suspected lung cancer?

A

Patients with poor performance status
Patients that dont want treatment
- biopsies are uncomfortable and have risk factors, should only be done if there is sufficient benefit

35
Q

What is carcinoma?

A

A invasive malignant epithelial tumour

36
Q

What are the main types of lung cancers?

A

Non-small cell lung cancer ( squamous cell and adenocarcinoma )
Small cell carcinoma
Carcinoid (benign)

37
Q

What are molecular markers? What do we use them for?

A

Gene mutations that the cancers have. Can be used to predict whether a tumour is susceptible to anti-cancer therapies. Helps improve successfulness of treatment

38
Q

What factors influence the treatment available to the patient?

A
  • Staging ( radiological diagnosis and tissue diagnosis )
  • Performance status and co-morbidity (ECHO,Spirometry,perfusion scan,symptom severity)
  • patient wishes
  • molecular markers

Respiratory Unit (12 decks)

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