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A - MSRA Cancer Care [1] > [3] Lung Cancer > Flashcards

[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

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2
Q

Of what type are most primary lung cancers?

A

Carcinomas

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3
Q

What is a carcinoma?

A

A malignancy that arises from epithelial cells

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4
Q

What are the two main types of primary lung cancer?

A
  • Small cell lung cancer
  • Non-small cell lung cancer
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5
Q

Where is the histological type important in lung cancer?

A

In determining the management and predicting outcomes in lung cancer

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6
Q

What are the 3 main subtypes of non-small-cell lung cancer?

A
  • Adenocarcinoma
  • Squamous-cell carcinoma
  • Large cell carcinoma
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7
Q

What % of lung cancers are adenocarcinomas?

A

40%

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8
Q

Where do adenocarcinomas usually arise from?

A

Peripheral lung tissue

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9
Q

What are most cases of adenocarcinoma associated with?

A

Smoking

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10
Q

What % of lung cancer cases are squamous cell carcinomas?

A

30%

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11
Q

Where do squamous cell carcinomas typically occur close to?

A

Large airways

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12
Q

What is commonly found at the centre of a squamous cell carcinoma?

A

Hollow cavity and associated cell death

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13
Q

What % of lung cancers are large cell carcinomas?

A

9%

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14
Q

Describe the cells in large-cell carcinomas

A

Large (obviously), with excess cytoplasm, large nuclei, and conspicuous nucleoli

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15
Q

Where do most cases of small-cell lung cancer arise from?

A

Larger airways (primary and secondary bronchi

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16
Q

What do the cells contain in small-cell carcinoma?

A

Dense neurosecretory granules

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17
Q

What results from the presence of dense neuro-secretory granules in small-cell carcinoma?

A

An endocrine/paraneoplastic syndrome association

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18
Q

What % of patients with small-cell lung cancer have extensive disease at presentation?

A

60-70%

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19
Q

Can cancers contain a combination of different subtypes?

A

Yes, for example adenosquamous carcinoma

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20
Q

What are the rare subtypes of lung cancer?

A
  • Carcinoid tumours
  • Bronchial gland tumours
  • Sarcomatoid carcinomas
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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
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22
Q

What % of cases of lung cancer are due to smoking?

A

80-90%

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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)
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24
Q

What % of lung cancer cases occur in never-smokers?

A

<10%

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25
Q

Is lung cancer in never-smokers more common in men or women?

A

Women

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26
Q

What % of the UK adult population smokes?

A

30%

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27
Q

How has tobacco use been changing recently?

A

It has been reducing in men, perhaps due to health education, but increasing in women and adolescents

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28
Q

What options do the NHS provide to people wanting to stop smoking?

A

​Provides free stop smoking services, inclduing medications, one-on-one group stop smoking sessions, and preventing relapse

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29
Q

What medications can be given to help stop smoking?

A
  • Varenicline
  • Bupropion
  • Nicotine replacement therapy
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30
Q

When did the UK ban smoking in public and work-places?

A

2007

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31
Q

How may the smoking ban impact health?

A

It may in the long run decrease cancer rates from passive smoking

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32
Q

By how much does family history of lung cancer increase the risk?

A

2.5%, even when smoking is taken into account

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33
Q

What are the likely mechanisms through which family history contributes to increased risk of lung cancer?

A
  • Genetic variation in the enzymes responsible for carcinogen metabolism and detoxification and DNA repair
  • Germline mutation of Rb or p53 (rare)
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34
Q

What are the signs and symptoms of primary lung cancer?

A
  • Cough
  • Dyspnoea
  • Wheezing
  • Haemoptysis
  • Chest pain
  • Post-obstructive pneumonia
  • Weight loss
  • Lethargy
  • Malaise
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35
Q

What are the signs and symptoms of regional metastases of lung cancer?

A
  • Superior vena cava obstruction
  • Hoarseness
  • Dysphagia
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36
Q

What causes hoarseness in regional metastases of lung cancer?

A

Left recurrent laryngeal nerve palsy

37
Q

What causes dysphagia in regional metastases of lung cancer?

A

Phrenic nerve palsy

38
Q

What are the signs and symptoms of distant metastases of lung cancer?

A
  • Bone pain/fractures
  • Headaches
  • Double vision
  • Confusion
39
Q

What investigations are done into lung cancer?

A
  • 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
Q

What might CXR show in lung cancer?

A
  • Mass
  • Consolidation
41
Q

What are the potential biopsy methods in lung cancer?

A
  • 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
Q

What does a performance status of 0 mean in lung cancer?

A

Asymptomatic

43
Q

What does a performance status of 1 mean in lung cancer?

A

Symptomatic, but ambulatory (able to carry out light work)

44
Q

What does a performance status of 2 mean in lung cancer?

A

In bed <50% of day. Unable to work, but can live at home with some assistance

45
Q

What does a performance status of 3 mean in lung cancer?

A

In bed >50% of day, unable to care for self

46
Q

What does a performance status of 4 mean in lung cancer?

A

Bedridden

47
Q

What does a performance status of 5 mean in lung cancer?

A

Dead

48
Q

What is stage 1 lung cancer?

A

Small cancer, localised to one area of the lung

49
Q

What is stage 2 and 3 lung cancer?

A

Larger cancer, may have grown into surrounding tissues

50
Q

What is stage 4 lung cancer?

A

Metastatic lung cancer

51
Q

What should be given to patients who smoke with non-small cell lung cancer be told? q

A

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
Q

Should surgery be postponed until a person with NSCLC stops smoking?

A

No

53
Q

What is the treatement of choice for patients with stage 1 and 2 NSCLC?

A

Lobar resection

54
Q

Give two reasons that patients may not be able to tolerate lobar resection

A
  • Co-morbid disease
  • Pulmonary compromise
55
Q

How are patients with stage 1 or 2 NSCLC treated if they cannot tolerate lobar resection?

A

Limited resection or radical radiotherapy

56
Q

When should more extensive surgery be performed in stage 1 and 2 NSCLC?

A

Only if it is necessary to obtain tumour-free margins

57
Q

Which NSCLC patients should be offered radiotherapy?

A

All those with stage 1-3 disease who are not suitable for surgery

58
Q

Who is radical radiotherapy indicated for in NSCLC?

A

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
Q

Should patients who have poor lung function but are otherwise suitable be offered radiotherapy?

A

Yes, providing the volume to be irradiated is small

60
Q

Which NSCLC patients should be offered chemotherapy?

A

All patients with stage 3 or 4 disease and a good performance status

61
Q

What is the purpose of chemotherapy in NSCLC?

A

To improve surviva, disease control, and QoL

62
Q

What chemotherapeutic agents can be used in the management of lung cancer?

A

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
Q

What should chemotherapy for advanced NSCLC involve?

A

A combination of a single third-generation drug alongside a platinum drug

64
Q

What should patients with SCLC be encouraged to do?

A

Stop smoking

65
Q

Which SCLC patients should be offered multi-drug regimes?

A

All

66
Q

Why should all patients with SCLC be offered multi-drug regimes?

A

Because they are more effective and have a lower toxicity than single-agent regimes

67
Q

What chemotherapy regime should be used in patients with limited stage SCLC?

A

4-6 cycles of cisplatin based combination chemotherapy

68
Q

What should be given alongside chemotherapy in patients with limited-stage SCLC?

A

Thoracic irradiation

69
Q

What chemotherapy regime should be offered to people with extensive SCLC?

A

Platinum-based combination chemotherapy up to a maximum of 6 cycles

70
Q

When should thoracic irradiation be considered following chemotherapy in patients with extensive SCLC?

A

If there has been complete response at distant sites, and at least a good partial response within the thorax

71
Q

What do biological therapies do in lung cancer?

A

Target molecular pathways

72
Q

Where are biological therapies particuarly commonly used in lung cancer?

A

For treatment of advanced disease

73
Q

Give two examples of biological therapies used in lung cancer

A
  • Erlotinib
  • Gefitinib
74
Q

What is the mechanism of action of erlotinib and gefitinib?

A

They inhibit tyrosine kinase at the EDGF receptor

75
Q

What is palliative care aimed at in lung cancer?

A

Symptom control

76
Q

What are the options in palliative care in lung cancer?

A
  • Analgesia
  • Radiotherapy
  • Airway stents
  • Anxiolytics
  • Nutritional support
  • Patient support groups
77
Q

Are the lungs a common place for spread of tumours from other parts of the body?

A

Yes

78
Q

What is classification of secondary lung cancers based on?

A

The site of origin

79
Q

Where do primary lung cancers commonly metastasise to?

A
  • Brain
  • Bones
  • Liver
  • Adrenal glands
80
Q

What is a paraneoplastic syndrome?

A

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
Q

What mediates paraneoplastic syndromes?

A

Humoral factors (cytokines and hormones) secreted by tumour cells, or immune responses against tumour cells

82
Q

What are the potential endocrine paraneoplastic syndromes arising in lung cancer?

A
  • Hypercalcaemia
  • Cushing’s syndrome
83
Q

What are the potential neurological paraneoplastic syndromes arising in lung cancer?

A
  • Encephalopathy
  • Peripheral neuropathy
84
Q

What are the potential skeletal paraneoplastic syndromes arising in lung cancer?

A

Finger clubbing

85
Q

What are the potential haemotological paraneoplastic syndromes in lung cancer?

A
  • Anaemia
  • Thrombocytopenia
  • Disseminated intravascular coagulation
86
Q

What are the potential renal paraneoplastic syndromes in lung cancer?

A

Nephrotic syndrome

87
Q

Has screening with CXRs and sputum cytology been shown to reduce mortality from lung cancer?

A

No

88
Q

What are clinical trials currently looking into with regard to lung cancer?

A

If regular spiral CT scans of the chest may be a useful screening tool for lung cancer

A - MSRA Cancer Care [1] (47 decks)

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