1b Lung Cancer Flashcards
What is the biggest modifiable risk factor for lung cancer?
Smoking (85%)
What can cause lung cancer other than smoking?
Chronic lung diseases (COPD, fibrosis)
Immunodeficiency
Familial/ genetic – several loci identified
passive smoking
asbestos
radon
indoor cooking fumes
air pollution
What is a DNA adduct?
pieces of DNA covalently bound to a cancer-causing chemical
How do DNA adducts form?
The interaction between inhaled carcinogens and the epithelium of upper and lower airways leads to the formation of DNA adducts
What do adducts lead to the formation of?
They can result in a mutation or genomic alteration
Which cancer originates from the bronchial epithelium and is generally centrally located?
Squamous Cell Carcinoma (30%)
Which lung cancer arises from the mucus producing glandular tissue, and is more peripherally located?
Adenocarcinoma (40%)
Which cancer type originates from pulmonary neuroendocrine cells and is highly malignant?
Small cell lung cancer (15%)
Which cancer type is from heterogenous group and is undifferentiated?
Large cell lung cancer (15%)
What is NSCLC?
Non Small Cell Lung Cancer
Mutations in which oncogene are important for directed treatment in women, asian ethnicity and never smokers?
epidermal growth factor receptor (EGFR) tyrosine kinase
Mutations in which oncogene are important for directed treatment in younger patients and never smokers?
Anaplastic lymphoma kinas3 (ALK) tyrosine kinase
c-ROS oncogene 1 (ROS1) receptor tyrosine kinase
Mutations in which oncogene are important for directed treatment in smokers especially?
BRAF
What are the clinical features of lung cancer?
Cough
Weight loss
Breathlessness
Fatigue
Chest pain
Haemoptysis
What are some features of advanced / metastatic disease?
Focal weakness
Seizures
Bone Pain
Paraneoplastic syndromes
What are some paraneoplastic symptoms?
clubbing, hypercalaemia, hyponatraemia, Cushing’s
What is pembertons sign?
Facial Redness and Congestion for One minute when the patient is asked to raise their hands above their head
What is horners syndrome?
constricted pupil (miosis)
drooping of the upper eyelid (ptosis)
absence of sweating of the face (anhidrosis), and sinking of the eyeball into the bony cavity that protects the eye (enophthalmos).
What imaging is done for a definitive staging process?
PET-CT (fluorodeoxyglucose)
When would a bronchoscopy be performed?
For tumours of the central airway, where staging the tissue is not important
Which biopsy technique is used to stage mediastinum and achieve tissue diagnosis?
Endobronchial ultrasound and transbronchial-needle aspiration of mediastinal lymph nodes (EBUS [TBNA])