18. Clinical Features and Staging of Lung Cancer Flashcards
1
Q
Is lung cancer the LEADING cause of cancer death for both men and women?
A
Yes
2
Q
What are 3 top biggest killers in the UK?
A
- cancers
- COPD
- heart disease
3
Q
Approximately how many cancer deaths in the UK are caused by lung cancer?
A
1 in 5 (22%)
4
Q
What percentage of lung cancers are caused by smoking?
A
> 85% (most preventable lung cancer)
5
Q
What is the general lung cancer trend among gender and age?
A
- more women diagnosed with lung cancer than before due to more women smoking (catching up)
- more older people suffering from lung cancer as more co-morbiditeis and people are living longer
6
Q
What are the 3 top risk factors for lung cancer?
A
- Smoking (>85%)
- Passive smoking
- Exposure to asbestos, radon, air pollution and diesel exhaust
7
Q
How many times more likely is someone more prone to develop lung cancer who is among passive smoking than someone who isn’t exposed to tobacco smoke?
A
3-4 times more likely
8
Q
What are the 10 top signs and symptoms of lung cancer? (which should never be ignored)
A
- Chronic cough
- Haemoptysis
- Wheezing
- Chest and bone pains
- Chest infections
- Difficulty swallowing
- Raspy hoarse voice
- Dyspnea (SOB)
- Unexplained weight loss
- Nail Clubbing
9
Q
If someone has a persistent chronic cough for how many weeks, should they see their GP?
A
Approximately 3 weeks
10
Q
Are clinical signs difficult to detect in early stages of lung cancer?
A
Yes; difficult to diagnose if not advanced
11
Q
What are common advanced disease METASTATIC symptoms for lung cancer? (4)
A
- bone pain
- spinal cord compression
- cerebral metastases
- thrombosis
12
Q
What symptoms can spinal cord compression cause as a result of metastasis? (3)
A
- limb weakness
- paraesthesia (tingling,numbness,tickling)
- bladder/bowel dysfunction
13
Q
What symptoms can cerebral metastases cause as a result of metastasis in lung cancer? (5)
A
- headache
- vomiting
- dizziness
- ataxia (lack of voluntary coordination of muscle movements)
- focal weakness
14
Q
What are common advanced disease PARANEOPLASMIC symptoms in lung cancer? (7)
A
- hyponatraemia (low Na)
- anaemia
- hypercalcaemia
- dermatomyositis/ polymyositis
- Eaton-Lambert syndrome
- Cerebellar ataxia
- Sensorimotor neuropathy
15
Q
What is meant by hypercalcaemia?
A
- high Ca
- parathyroid hormone related protein
- bone metastasis)
16
Q
What syndrome is associated with hyponatraemia?
A
SIADH: Syndrome of Inappropriate antidiuretic hormone secretion
17
Q
What occurs in dermatomyositis/ polymyositis?
A
proximal muscle weakness
18
Q
What occurs in Eaton-Lambert Syndrome?
A
upper limb weakness
19
Q
What are common clinical signs for lung cancer? (8)
A
- chest signs
- clubbing
- lymphadenopathy
- Horner’s syndrome
- Pancoast tumour
- Superior vena cava obstruction
- hepatomegaly
- skin nodules (metastases)
20
Q
What are the initial investigations for lung cancer which should be done by the GP?(5)
A
- chest x ray (the FIRST test)
- full blood count (FBC)
- renal, liver functions and Ca
- clotting screen
- spirometry (assesses lung function)
21
Q
What causes abnormal calcium levels?
A
hormonal changes due to tumour growth
22
Q
What investigations are carried out for “tissue diagnosis” of lung cancer? (9)
A
- bronchoscopy
- EBUS
- image guided biopsy
- image guided liver biopsy
- FNA of neck node or skin metastasis
- excision of cerebral metastasis
- bone biopsy
- mediastinoscopy/ otomy
- surgical excision biopsy
23
Q
What are some common types of lung cancer masses caused by ?
A
- hilar mass (in hilar lymph nodes)
- peripheral mass
- lobar tumour
- cavitating lung cancer
24
Q
Describe how bronchoscopy works and what anaesthesia is used.
A
- performed under sedation (e.g. midazolam) and topical anaesthesia ( e.g. lidocaine) to vocal cords and airways
- bronchoscope passed through nose to oropharynx and into vocals cords down trachea and image is displaced on eye screen
- 2/3 of lung cancers are visible through bronchoscope
25
Why is EBUS used? (endobronchial ultrasound)
- transbronchial needle aspiration can be performed to obtain tissue and fluid samples from lungs and surrounding lymph nodes without performing surgery
- no incisions are necessary
- performed under moderate sedation and general anaesthesia
26
What are the most common types of lung cancer by histology? (which can tell us about prognosis and treatment) (5)
1. adenocarcinoma (40%); develops from mucus making cells lining the airways
2. squamous cell carcinoma (30%); develops from flat, surface covering cells in the airways, mainly due to smoking
3. small cell carcinoma (15%); mainly affects smokers
4. large cell carcinoma (10%); cells look big and rounded and tend to grow quckly
5. other (3%)
27
What are 3 main types of NON-SMALL cell carcinomas?
1. adenocarcinoma
2. squamous cell carcinoma
3. large cell carcinoma
28
What does T staging represent?
tumour SIZE
29
What is T1 staging in lung cancer in terms of
- diameter
- scopy/ visual exam
- atelectasis/ collapse of lung, resulting in reduced or absent gas exchange
- invasion
- nodules affected
diameter: T1a<2cm, T1b: 2-3cm
scopy: no invasion, lobar bronchus
atelectasis: no atelectasis
no invasion or nodules affected
30
What is T2 staging in lung cancer in terms of
- diameter
- scopy/ visual exam
- atelectasis/ collapse of lung, resulting in reduced or absent gas exchange
- invasion
- nodules affected
diameter: T2a:3-5cm, T2b: 5-7cm
scopy: >2cm to carina
atelectasis: lobar atelectasis or obstructive pulmonary pneumonia to hilus
no invasion or nodules affected
31
What is T3 staging in lung cancer in terms of
- diameter
- scopy/ visual exam
- atelectasis/ collapse of lung, resulting in reduced or absent gas exchange
- invasion
- nodules affected
diameter: >7cm
scopy: <2cm to carina
atelectasis: whole lung
invasion: chest wall, diaphragm, mediast pleura, pericard
nodules: nodules in same lobe affected
32
What is T4 staging in lung cancer in terms of
- diameter
- scopy/ visual exam
- atelectasis/ collapse of lung, resulting in reduced or absent gas exchange
- invasion
- nodules affected
diameter: no restrictions
scopy: tumour to carina
atelectasis; no restrictions
invasion: heart, great vessels, trachea, oesophagus and spine
nodules: nodules in other ipsilateral lobes affected
33
What does N staging represent?
Nodal involvement
34
What does M staging represent?
Metastasis
35
What is N0 stage?
No regional node involvement
36
What is N1 stage?
Involvement of ipsilateral hilar or ipsilateral peribronchial nodes
37
What is N2 stage?
Involvement in ipsilateral mediastinal or subcarinal nodes
38
What is N3 stage?
Involvement of contralateral mediastinal or hilar nodes OR ipsilateral or contralateral scalene or supraclavicular nodes
39
What is M0 stage?
Distant metastasis absent
40
What is M1 stage?
Distant metastasis present
41
What is the TNM system used to establish?
Stage of lung cancer (1-4)
42
What is prognosis of lung cancer made according to? (2)
1. staging
| 2. cell type
43
Which stages of lung cancer are offered curative treatment?
Stages 1 (90% will be alive)and 2 (70-80% will be alive)
44
What is offered to patients with stage 3 and 4 lung cancer?
treatment to prolong life rather than curative as patients don't respond well to treatment
45
Does adenocarcinomas or small cell cancer have a better prognosis?
small cell cancer
46
What happens to lung cancer prognosis as staging of lung cancer increases from 1 to 4?
prognosis decreases
47
When is PET scan used in lung cancer patients?
- mandatory in later staging
| - used to detect tiny tumours in the body especially before patient undergoes surgery
48
What factors need to be taken into account for treatment decisions? (5)
1. performance status
2. patient wishes
3. histological type and stage
4. multidisciplinary team
5. aims of treatment (radical or palliative)
49
What is performance status of 0?
- fully active
50
What is performance status of 1?
- symptoms but ambulatory (outpatient care)
| - lead normal life
51
What is performance status of 2?
- "up and about" >50%
| - unable to work
52
What is performance status of 3?
- "up and about"<50%
| - limited self care
53
What is performance status of 4>
-bed or chair bound
54
What are the main treatment options for lung cancer patients?
1. Surgery (18% of patients)
2. Radiotherapy
3. Chemotherapy
4. Best supportive care
5. Co-ordination; lung cancer specialist nurse
55
What are 3 most common surgical procedures done in lung cancer patients?
1. wedge resection
2. lobectomy
3. pneumonectomy
56
What are 3 types of radiotherapy treatment?
1. radical (aims to cure rather than just relieve)
2. pallative (relieves symptoms and improves quality of life but not cure)
3. stereotactic (aims to preserve healthy tissue)
57
How is chemotherapy used in lung cancer patients?
- part of radical or pallative treatment
- can be given alone. combined with radiotherapy or as adjuvant (after surgery)
- contains target agents
58
What are the targeted agents used in chemotherapy?
Tyrosine kinase inhibitors and monoclonal antibodies:
- epothilone
- gemcitabine
- cytarabine
59
What 2 chemotherapy agents are used for small cell lung cancer?
1. cisplatin
| 2. etoposide
60
What 2 chemotherapy agents are used for adenocarcinoma lung cancer?
1. cisplatin
| 2. pemetrexed
61
What 2 chemotherapy agents are used for squamous lung cancer?
1. cisplatin
| 3. gemcitabine
62
What are palliative management options for lung cancer patients? (5)
1. symptoms control
2. quality of life
3. community support
4. decisions, planning, resuscitation status, end of life care
5. multidisciplinary team including lung cancer nurse and hospice
63
What is meant by "symptom control" in palliative management of lung cancer? (4)
- may include chemotherapy
- may include radiotherapy e.g. pain, haemoptysis
- opiates, biphosphates, benzodiazepines
- treatment of hypercalcaemia, dehydration, hyponatraemia
64
What are the biggest prevention measures for lung cancer which should be taken?
- role of public health
- education
- smoking cessation
- CT screening for lung cancer?
65
What does overall lung cancer treatment depend on? (4)
1. diagnosis
2. staging
3. fitness assessment
4. patient wishes
66
What is important in good management of lung cancer?
- patient and family support
- symptom relief
- multidisciplinary team working together
67
Why is radiotherapy is aggressive?
Because small cell cancers often have tumours reappearing quickly
68
PET scan usually detects small mets in which body region?
around the lungs
