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Systems: Resp. WK > 18. Clinical Features and Staging of Lung Cancer > Flashcards

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

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2
Q

What are 3 top biggest killers in the UK?

A
  • cancers
  • COPD
  • heart disease
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3
Q

Approximately how many cancer deaths in the UK are caused by lung cancer?

A

1 in 5 (22%)

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4
Q

What percentage of lung cancers are caused by smoking?

A

> 85% (most preventable lung cancer)

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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
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6
Q

What are the 3 top risk factors for lung cancer?

A
  1. Smoking (>85%)
  2. Passive smoking
  3. Exposure to asbestos, radon, air pollution and diesel exhaust
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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

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8
Q

What are the 10 top signs and symptoms of lung cancer? (which should never be ignored)

A
  1. Chronic cough
  2. Haemoptysis
  3. Wheezing
  4. Chest and bone pains
  5. Chest infections
  6. Difficulty swallowing
  7. Raspy hoarse voice
  8. Dyspnea (SOB)
  9. Unexplained weight loss
  10. Nail Clubbing
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9
Q

If someone has a persistent chronic cough for how many weeks, should they see their GP?

A

Approximately 3 weeks

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10
Q

Are clinical signs difficult to detect in early stages of lung cancer?

A

Yes; difficult to diagnose if not advanced

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11
Q

What are common advanced disease METASTATIC symptoms for lung cancer? (4)

A
  1. bone pain
  2. spinal cord compression
  3. cerebral metastases
  4. thrombosis
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12
Q

What symptoms can spinal cord compression cause as a result of metastasis? (3)

A
  1. limb weakness
  2. paraesthesia (tingling,numbness,tickling)
  3. bladder/bowel dysfunction
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13
Q

What symptoms can cerebral metastases cause as a result of metastasis in lung cancer? (5)

A
  1. headache
  2. vomiting
  3. dizziness
  4. ataxia (lack of voluntary coordination of muscle movements)
  5. focal weakness
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14
Q

What are common advanced disease PARANEOPLASMIC symptoms in lung cancer? (7)

A
  1. hyponatraemia (low Na)
  2. anaemia
  3. hypercalcaemia
  4. dermatomyositis/ polymyositis
  5. Eaton-Lambert syndrome
  6. Cerebellar ataxia
  7. Sensorimotor neuropathy
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15
Q

What is meant by hypercalcaemia?

A
  • high Ca
  • parathyroid hormone related protein
  • bone metastasis)
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16
Q

What syndrome is associated with hyponatraemia?

A

SIADH: Syndrome of Inappropriate antidiuretic hormone secretion

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17
Q

What occurs in dermatomyositis/ polymyositis?

A

proximal muscle weakness

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18
Q

What occurs in Eaton-Lambert Syndrome?

A

upper limb weakness

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19
Q

What are common clinical signs for lung cancer? (8)

A
  1. chest signs
  2. clubbing
  3. lymphadenopathy
  4. Horner’s syndrome
  5. Pancoast tumour
  6. Superior vena cava obstruction
  7. hepatomegaly
  8. skin nodules (metastases)
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20
Q

What are the initial investigations for lung cancer which should be done by the GP?(5)

A
  1. chest x ray (the FIRST test)
  2. full blood count (FBC)
  3. renal, liver functions and Ca
  4. clotting screen
  5. spirometry (assesses lung function)
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21
Q

What causes abnormal calcium levels?

A

hormonal changes due to tumour growth

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22
Q

What investigations are carried out for “tissue diagnosis” of lung cancer? (9)

A
  1. bronchoscopy
  2. EBUS
  3. image guided biopsy
  4. image guided liver biopsy
  5. FNA of neck node or skin metastasis
  6. excision of cerebral metastasis
  7. bone biopsy
  8. mediastinoscopy/ otomy
  9. surgical excision biopsy
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23
Q

What are some common types of lung cancer masses caused by ?

A
  1. hilar mass (in hilar lymph nodes)
  2. peripheral mass
  3. lobar tumour
  4. cavitating lung cancer
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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
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25
Q

Why is EBUS used? (endobronchial ultrasound)

A
  • 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
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26
Q

What are the most common types of lung cancer by histology? (which can tell us about prognosis and treatment) (5)

A
  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%)
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27
Q

What are 3 main types of NON-SMALL cell carcinomas?

A
  1. adenocarcinoma
  2. squamous cell carcinoma
  3. large cell carcinoma
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28
Q

What does T staging represent?

A

tumour SIZE

29
Q

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
A

diameter: T1a<2cm, T1b: 2-3cm
scopy: no invasion, lobar bronchus
atelectasis: no atelectasis

no invasion or nodules affected

30
Q

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
A

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
Q

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
A

diameter: >7cm
scopy: <2cm to carina
atelectasis: whole lung
invasion: chest wall, diaphragm, mediast pleura, pericard
nodules: nodules in same lobe affected

32
Q

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
A

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
Q

What does N staging represent?

A

Nodal involvement

34
Q

What does M staging represent?

A

Metastasis

35
Q

What is N0 stage?

A

No regional node involvement

36
Q

What is N1 stage?

A

Involvement of ipsilateral hilar or ipsilateral peribronchial nodes

37
Q

What is N2 stage?

A

Involvement in ipsilateral mediastinal or subcarinal nodes

38
Q

What is N3 stage?

A

Involvement of contralateral mediastinal or hilar nodes OR ipsilateral or contralateral scalene or supraclavicular nodes

39
Q

What is M0 stage?

A

Distant metastasis absent

40
Q

What is M1 stage?

A

Distant metastasis present

41
Q

What is the TNM system used to establish?

A

Stage of lung cancer (1-4)

42
Q

What is prognosis of lung cancer made according to? (2)

A
  1. staging

2. cell type

43
Q

Which stages of lung cancer are offered curative treatment?

A

Stages 1 (90% will be alive)and 2 (70-80% will be alive)

44
Q

What is offered to patients with stage 3 and 4 lung cancer?

A

treatment to prolong life rather than curative as patients don’t respond well to treatment

45
Q

Does adenocarcinomas or small cell cancer have a better prognosis?

A

small cell cancer

46
Q

What happens to lung cancer prognosis as staging of lung cancer increases from 1 to 4?

A

prognosis decreases

47
Q

When is PET scan used in lung cancer patients?

A
  • mandatory in later staging

- used to detect tiny tumours in the body especially before patient undergoes surgery

48
Q

What factors need to be taken into account for treatment decisions? (5)

A
  1. performance status
  2. patient wishes
  3. histological type and stage
  4. multidisciplinary team
  5. aims of treatment (radical or palliative)
49
Q

What is performance status of 0?

A
  • fully active
50
Q

What is performance status of 1?

A
  • symptoms but ambulatory (outpatient care)

- lead normal life

51
Q

What is performance status of 2?

A
  • “up and about” >50%

- unable to work

52
Q

What is performance status of 3?

A
  • “up and about”<50%

- limited self care

53
Q

What is performance status of 4>

A

-bed or chair bound

54
Q

What are the main treatment options for lung cancer patients?

A
  1. Surgery (18% of patients)
  2. Radiotherapy
  3. Chemotherapy
  4. Best supportive care
  5. Co-ordination; lung cancer specialist nurse
55
Q

What are 3 most common surgical procedures done in lung cancer patients?

A
  1. wedge resection
  2. lobectomy
  3. pneumonectomy
56
Q

What are 3 types of radiotherapy treatment?

A
  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
Q

How is chemotherapy used in lung cancer patients?

A
  • part of radical or pallative treatment
  • can be given alone. combined with radiotherapy or as adjuvant (after surgery)
  • contains target agents
58
Q

What are the targeted agents used in chemotherapy?

A

Tyrosine kinase inhibitors and monoclonal antibodies:

  • epothilone
  • gemcitabine
  • cytarabine
59
Q

What 2 chemotherapy agents are used for small cell lung cancer?

A
  1. cisplatin

2. etoposide

60
Q

What 2 chemotherapy agents are used for adenocarcinoma lung cancer?

A
  1. cisplatin

2. pemetrexed

61
Q

What 2 chemotherapy agents are used for squamous lung cancer?

A
  1. cisplatin

3. gemcitabine

62
Q

What are palliative management options for lung cancer patients? (5)

A
  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
Q

What is meant by “symptom control” in palliative management of lung cancer? (4)

A
  • may include chemotherapy
  • may include radiotherapy e.g. pain, haemoptysis
  • opiates, biphosphates, benzodiazepines
  • treatment of hypercalcaemia, dehydration, hyponatraemia
64
Q

What are the biggest prevention measures for lung cancer which should be taken?

A
  • role of public health
  • education
  • smoking cessation
  • CT screening for lung cancer?
65
Q

What does overall lung cancer treatment depend on? (4)

A
  1. diagnosis
  2. staging
  3. fitness assessment
  4. patient wishes
66
Q

What is important in good management of lung cancer?

A
  • patient and family support
  • symptom relief
  • multidisciplinary team working together
67
Q

Why is radiotherapy is aggressive?

A

Because small cell cancers often have tumours reappearing quickly

68
Q

PET scan usually detects small mets in which body region?

A

around the lungs

Systems: Resp. WK (40 decks)

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