[3] Lung Cancer Flashcards
1
Q
What is lung cancer?
A
A malignant lung tumour characterised by uncontrolled cell growth in tissues of the lung
2
Q
Of what type are most primary lung cancers?
A
Carcinomas
3
Q
What is a carcinoma?
A
A malignancy that arises from epithelial cells
4
Q
What are the two main types of primary lung cancer?
A
- Small cell lung cancer
- Non-small cell lung cancer
5
Q
Where is the histological type important in lung cancer?
A
In determining the management and predicting outcomes in lung cancer
6
Q
What are the 3 main subtypes of non-small-cell lung cancer?
A
- Adenocarcinoma
- Squamous-cell carcinoma
- Large cell carcinoma
7
Q
What % of lung cancers are adenocarcinomas?
A
40%
8
Q
Where do adenocarcinomas usually arise from?
A
Peripheral lung tissue
9
Q
What are most cases of adenocarcinoma associated with?
A
Smoking
10
Q
What % of lung cancer cases are squamous cell carcinomas?
A
30%
11
Q
Where do squamous cell carcinomas typically occur close to?
A
Large airways
12
Q
What is commonly found at the centre of a squamous cell carcinoma?
A
Hollow cavity and associated cell death
13
Q
What % of lung cancers are large cell carcinomas?
A
9%
14
Q
Describe the cells in large-cell carcinomas
A
Large (obviously), with excess cytoplasm, large nuclei, and conspicuous nucleoli
15
Q
Where do most cases of small-cell lung cancer arise from?
A
Larger airways (primary and secondary bronchi
16
Q
What do the cells contain in small-cell carcinoma?
A
Dense neurosecretory granules
17
Q
What results from the presence of dense neuro-secretory granules in small-cell carcinoma?
A
An endocrine/paraneoplastic syndrome association
18
Q
What % of patients with small-cell lung cancer have extensive disease at presentation?
A
60-70%
19
Q
Can cancers contain a combination of different subtypes?
A
Yes, for example adenosquamous carcinoma
20
Q
What are the rare subtypes of lung cancer?
A
- Carcinoid tumours
- Bronchial gland tumours
- Sarcomatoid carcinomas
21
Q
What are the risk factors for lung cancer?
A
- Smoking, including passive smoking
- Asbestos
- Previous radiotherapy to chest
- Inhalation of gas, polycyclic aromatic hydrocarbons, nickel, chromate, or inorganic arsenical
- Genetic predisposition
22
Q
What % of cases of lung cancer are due to smoking?
A
80-90%
23
Q
What does the risk of lung cancer relate to, in terms of smoking?
A
- Number of cigarettes smoked
- Number of years smoking
- Early age of starting smoking
- Type of cigarette (filtered or unfiltered)
24
Q
What % of lung cancer cases occur in never-smokers?
A
<10%
25
Is lung cancer in never-smokers more common in men or women?
Women
26
What % of the UK adult population smokes?
30%
27
How has tobacco use been changing recently?
It has been reducing in men, perhaps due to health education, but increasing in women and adolescents
28
What options do the NHS provide to people wanting to stop smoking?
Provides free stop smoking services, inclduing medications, one-on-one group stop smoking sessions, and preventing relapse
29
What medications can be given to help stop smoking?
* Varenicline
* Bupropion
* Nicotine replacement therapy
30
When did the UK ban smoking in public and work-places?
2007
31
How may the smoking ban impact health?
It may in the long run decrease cancer rates from passive smoking
32
By how much does family history of lung cancer increase the risk?
2.5%, *even when smoking is taken into account*
33
What are the likely mechanisms through which family history contributes to increased risk of lung cancer?
* Genetic variation in the enzymes responsible for carcinogen metabolism and detoxification and DNA repair
* Germline mutation of Rb or p53 (rare)
34
What are the signs and symptoms of primary lung cancer?
* Cough
* Dyspnoea
* Wheezing
* Haemoptysis
* Chest pain
* Post-obstructive pneumonia
* Weight loss
* Lethargy
* Malaise
35
What are the signs and symptoms of regional metastases of lung cancer?
* Superior vena cava obstruction
* Hoarseness
* Dysphagia
36
What causes hoarseness in regional metastases of lung cancer?
Left recurrent laryngeal nerve palsy
37
What causes dysphagia in regional metastases of lung cancer?
Phrenic nerve palsy
38
What are the signs and symptoms of distant metastases of lung cancer?
* Bone pain/fractures
* Headaches
* Double vision
* Confusion
39
What investigations are done into lung cancer?
* Examination
* Chest x-ray
* CT scan of chest and abdomen, including liver and adrenals
* Tissue biopsy, obtained by least invasive route
* Performance status
* Pulmonary function tests
* FBC
40
What might CXR show in lung cancer?
* Mass
* Consolidation
41
What are the potential biopsy methods in lung cancer?
* Bronchoscopy
* Cervical lymph node fine needle aspiration
* Pleural fluid aspiration
* CT guided lung biopsy
* CT guided pleural biopsy
* CT/USS guided liver biopsy
* Skin biopsy
* Bone biopsy
* Brain biopsy
* Lymph node biopsies (axillary or abdominal)
42
What does a performance status of 0 mean in lung cancer?
Asymptomatic
43
What does a performance status of 1 mean in lung cancer?
Symptomatic, but ambulatory (able to carry out light work)
44
What does a performance status of 2 mean in lung cancer?
In bed \<50% of day. Unable to work, but can live at home with some assistance
45
What does a performance status of 3 mean in lung cancer?
In bed \>50% of day, unable to care for self
46
What does a performance status of 4 mean in lung cancer?
Bedridden
47
What does a performance status of 5 mean in lung cancer?
Dead
48
What is stage 1 lung cancer?
Small cancer, localised to one area of the lung
49
What is stage 2 and 3 lung cancer?
Larger cancer, may have grown into surrounding tissues
50
What is stage 4 lung cancer?
Metastatic lung cancer
51
What should be given to patients who smoke with non-small cell lung cancer be told? q
They should be encouraged to stop smoking, particularly if they have a better prognosis.
They should be advised that smoking cessation reduces post-surgery lung complications
52
Should surgery be postponed until a person with NSCLC stops smoking?
No
53
What is the treatement of choice for patients with stage 1 and 2 NSCLC?
Lobar resection
54
Give two reasons that patients may not be able to tolerate lobar resection
* Co-morbid disease
* Pulmonary compromise
55
How are patients with stage 1 or 2 NSCLC treated if they cannot tolerate lobar resection?
Limited resection or radical radiotherapy
56
When should more extensive surgery be performed in stage 1 and 2 NSCLC?
Only if it is necessary to obtain tumour-free margins
57
Which NSCLC patients should be offered radiotherapy?
All those with stage 1-3 disease who are not suitable for surgery
58
Who is radical radiotherapy indicated for in NSCLC?
Patients with stage 1-3 disease with a good performance status, and whose disease can be encompassed in radiotherapy treatment volume without undue risk of normal tissue damage
59
Should patients who have poor lung function but are otherwise suitable be offered radiotherapy?
Yes, providing the volume to be irradiated is small
60
Which NSCLC patients should be offered chemotherapy?
All patients with stage 3 or 4 disease and a good performance status
61
What is the purpose of chemotherapy in NSCLC?
To improve surviva, disease control, and QoL
62
What chemotherapeutic agents can be used in the management of lung cancer?
Second-generation chemotherapeutic agents, and more recently third-generation agents, which have been shown to significantly reduce activity against NSCLC, alone or in combination
63
What should chemotherapy for advanced NSCLC involve?
A combination of a single third-generation drug alongside a platinum drug
64
What should patients with SCLC be encouraged to do?
Stop smoking
65
Which SCLC patients should be offered multi-drug regimes?
All
66
Why should all patients with SCLC be offered multi-drug regimes?
Because they are more effective and have a lower toxicity than single-agent regimes
67
What chemotherapy regime should be used in patients with limited stage SCLC?
4-6 cycles of cisplatin based combination chemotherapy
68
What should be given alongside chemotherapy in patients with limited-stage SCLC?
Thoracic irradiation
69
What chemotherapy regime should be offered to people with extensive SCLC?
Platinum-based combination chemotherapy up to a maximum of 6 cycles
70
When should thoracic irradiation be considered following chemotherapy in patients with extensive SCLC?
If there has been complete response at distant sites, and at least a good partial response within the thorax
71
What do biological therapies do in lung cancer?
Target molecular pathways
72
Where are biological therapies particuarly commonly used in lung cancer?
For treatment of advanced disease
73
Give two examples of biological therapies used in lung cancer
* Erlotinib
* Gefitinib
74
What is the mechanism of action of erlotinib and gefitinib?
They inhibit tyrosine kinase at the EDGF receptor
75
What is palliative care aimed at in lung cancer?
Symptom control
76
What are the options in palliative care in lung cancer?
* Analgesia
* Radiotherapy
* Airway stents
* Anxiolytics
* Nutritional support
* Patient support groups
77
Are the lungs a common place for spread of tumours from other parts of the body?
Yes
78
What is classification of secondary lung cancers based on?
The site of origin
79
Where do primary lung cancers commonly metastasise to?
* Brain
* Bones
* Liver
* Adrenal glands
80
What is a paraneoplastic syndrome?
The presence of a symptom or disease due to the presence of cancer in the body, but not due to the local presence of cancer cells
81
What mediates paraneoplastic syndromes?
Humoral factors (cytokines and hormones) secreted by tumour cells, or immune responses against tumour cells
82
What are the potential endocrine paraneoplastic syndromes arising in lung cancer?
* Hypercalcaemia
* Cushing's syndrome
83
What are the potential neurological paraneoplastic syndromes arising in lung cancer?
* Encephalopathy
* Peripheral neuropathy
84
What are the potential skeletal paraneoplastic syndromes arising in lung cancer?
Finger clubbing
85
What are the potential haemotological paraneoplastic syndromes in lung cancer?
* Anaemia
* Thrombocytopenia
* Disseminated intravascular coagulation
86
What are the potential renal paraneoplastic syndromes in lung cancer?
Nephrotic syndrome
87
Has screening with CXRs and sputum cytology been shown to reduce mortality from lung cancer?
No
88
What are clinical trials currently looking into with regard to lung cancer?
If regular spiral CT scans of the chest may be a useful screening tool for lung cancer
