A2- Lung cancer Flashcards
There three ways in which lung cancer present what are they?
Symptoms
Incidental pickup
Screening programme
What are the symptoms of lung cancer?
lung
Systemic
Metastases
Paraneiplastic syndromes
Complications
What are some lung related symptoms
Wheeze
Chest pain
Breathlessness
Hamoptysis
Cough
Systemic symptoms?
Weight loss
Lethargy
Loss of appetite
Symptoms of metastases?
Pain
confusion
weakness
balance problems
Symptoms of paraneoplastic syndromes?
Confusion
lethargy
pain
nausea and vomiting
thirst
There are two types of paraneoplastic syndromes?
What are they?
- Lung cancer can produce pTH related peptide which leads to hypercalcaemia
- SiADH syndrome leading to hyponatremia
Symptoms related to complications with lung cancer?
SVC obstruction could lead to:
Face swelling
Arm swelling
Dilated chest wall veins
WHat is the horners syndrome
Horner syndrome is a combination of signs and symptoms caused by the disruption of a nerve pathway from the brain to the face and eye on one side of the body. Typically, Horner syndrome results in a decreased pupil size, a drooping eyelid and decreased sweating on the affected side of your face
Horners syndrome triad?
- Mitosis (constricted pupils)
- partial ptosis
- Loss of hemifacial sweating (anhidrosis)
What kind of lung tumours are related to horners syndrome?
Apical
WHat imaging do you use to help diagnose lung cancer?
- CXR
- CT staging (chest + abdomen)
- MRI- brain/adrenal/liver
PET positron emission tomography- FDG uptake (fluorodeoxyglucose)
How do you tissue diagnose depending on the lesion?
If lesion is:
Central in airways- bronchoscopy
Lymph nodes- US guided FNA/biopsy OR EBUS
Peripheral- CT guided lung biopsy
Lesion distal from the centre- miniprobe bronchoscopy (radial EBUS)
Mediastinal lymph nodes- mediastinoscopy
WHat is EBUS
EBUS (endobronchial ultrasound) bronchoscopy
Which biopsy type is the least invasive
US guided FNA pf lymph node
Why is tissue diagnoses important?
Primary lung cancer vs metastases
small cell vs non small cell
adenocarcionoma vs squamous cell carcinoma
^all these tumours will be tested for PDL-1 (helps to assess when tumour will respond to immunotherapy) +adeno testing eg eGFR,ALK,ROS-1
An MDT meeting can be split into two?
Diagnostic MDT- looking at imaging
Treatment MDT
Who are the members of a lung MDT?
Role of resp physician in MDT
- present new patients/diagnostic phase
- Sumarise case so they:
- present key symptoms
- pmhx
- smoking history/other risk factors
- performance status
- lung function
- results of other key tests such as echo/CPEX
Role of Clinical Nurse Specialist in MDT
- Patients voice
- patients advocacy
- holistic needs
- updates and communication with patietns and familes in between OPA (outside outpaitent appointments)
Role of Radiologists in MDT
Interpret scans
- CXR
- CT
- US (eg supraclavicular LN)
- PET-CT
- MRI
Radiological staging
Advice regarding feasibilty of biopsy
Which of these factors would be a relative contraindication to CT guided lung biopsy?
- Peripheral lung lesion
- FEV1 0.75 litres
- Platelet count 160
- Haemoglobin 110 g/L
FEV1 0.75 litres
Role of Pathologists in MDT
- cytology + histology specimens
- pathologist specialises in one area
- cell type
- origin- immunohistochemistry
- Receptor status:
- eGFR/ALK/ROS-1?PDL-1
- NGS panel
Role of Clinical oncologists in MDT
- Advice on radiotherapy
- convention fractionated
- SABR (stereotactic Ablative Body Radiotherapy)
- Technical factors
Role of Medical oncologists in MDT
- Subspecialty in chemo and immunotherapy
- particular expertise in patients with driver mutairons eg eGFR, ALK
- Disccusion (with clinical oncologists) about combined or sequential Tx
- Trial opportunites e.g new treatments or new pathways such as adjuvant chemotherapy
Which of these MDT members would give radiotherapy?
- Radiologist
- Medical oncologist
- Clinical oncologist
Clinical oncologist
Role of Thoracic surgeons in MDT
- Technical factos- is the lesion resectable
- fitness for surgery - high risk MDT
- Risk of postoperative complication
- Staging for some patients- mediastinoscop y
- diagnostic wedge biopsy
Role of Palliative Care Team in MDT
- Consultant
- Clinical Nurse specialits
- Management of symtoms in parallel with active treatment
- Palliation of symtoms- patients
- Support with end of life care and planning for that.
Role of Specialist Pharmacists in MDT
- Suport with chemo and immunotherapy
- patient information and advice about their medications
- Lead patient consultationas part of oncology team
Role of Holistic Care in MDT
- Treating the whole and not just part of it
- Care for the whole person
- Centres on the patient
- Holistic Needs Assessment (HNA)
What is the holistic needs Assessment?
Can be done by CNS or Community Team
- Simple patient questionnaire
- Done at any stage of the cancer pathway
- Helps identify a patient’s concerns
- Starts a conversation about needs
- Helps develop a Personalised Care and Support Plan
- Facilitates signposting to relevant services
What are the different aspects of holistic needs assessment?
- Physical concerns (symptom management)
- Emotional concerns (such as anxiety, guilt)
- Practical concerns (such as benefits, care, transport)
- Family or relationship concerns
- Spiritual concerns
- Information and support (such as exercise advice)
What does palliative care involve?
-Symptom control
- Related to the illness
- Related to treatment
- Emotional support
- Patient & supporters such as family, friends
- Medical and complementary therapies
- Any stage of treatment
What does palliative care involve?
•Symptom control
- Related to the illness
- Related to treatment
- Emotional support
- Patient & supporters such as family, friends
- Medical and complementary therapies
- Any stage of treatment
Palliative care also discusses end of life care.
What does this involve?
- Discussions about uncertainty
- Recognising when patient is approaching end of life
- Personalised planning (end of life care plan)
- Gold Standards Framework: evidence based systematic approach to formalising best practice through improving the organisation and coordination of care for all people with any condition in any setting in the final year or so of life
Which of these is used to plan and formalise best practice in a patient’s final year of life?
- End of Life Care Planclose
- Holistic Needs Assessment
- Gold Standards Framework
Gold Standards Framework
What is the largest study for lung screening?
MELSON Trial published 2020
What is the headline results from MELSON Trial published in 2020
- Screening group: 2.50 deaths per 1000 person-years
- Control group: 3.30 deaths per 1000 person-years
What is the Lung Health Check Programme
- Nationwide – NHS Long Term Plan
- 55-74 year olds with history of smoking
- Letter sent to patients – call to make appointment
- 30-45 min conversation with specialist nurse
- Questions assess risk of lung cancer
- If at risk, a CT is performed
