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Year 3 Academic Weeks > A2- Lung cancer > Flashcards

A2- Lung cancer Flashcards

1
Q

There three ways in which lung cancer present what are they?

A

Symptoms

Incidental pickup

Screening programme

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2
Q

What are the symptoms of lung cancer?

A

lung

Systemic

Metastases

Paraneiplastic syndromes

Complications

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3
Q

What are some lung related symptoms

A

Wheeze

Chest pain

Breathlessness

Hamoptysis

Cough

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4
Q

Systemic symptoms?

A

Weight loss

Lethargy

Loss of appetite

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5
Q

Symptoms of metastases?

A

Pain

confusion

weakness

balance problems

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6
Q

Symptoms of paraneoplastic syndromes?

A

Confusion

lethargy

pain

nausea and vomiting

thirst

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7
Q

There are two types of paraneoplastic syndromes?

What are they?

A
  • Lung cancer can produce pTH related peptide which leads to hypercalcaemia
  • SiADH syndrome leading to hyponatremia
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8
Q

Symptoms related to complications with lung cancer?

A

SVC obstruction could lead to:

Face swelling

Arm swelling

Dilated chest wall veins

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9
Q

WHat is the horners syndrome

A

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

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10
Q

Horners syndrome triad?

A
  • Mitosis (constricted pupils)
  • partial ptosis
  • Loss of hemifacial sweating (anhidrosis)
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11
Q

What kind of lung tumours are related to horners syndrome?

A

Apical

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12
Q

WHat imaging do you use to help diagnose lung cancer?

A
  • CXR
  • CT staging (chest + abdomen)
  • MRI- brain/adrenal/liver

PET positron emission tomography- FDG uptake (fluorodeoxyglucose)

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13
Q

How do you tissue diagnose depending on the lesion?

A

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

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14
Q

WHat is EBUS

A

EBUS (endobronchial ultrasound) bronchoscopy

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15
Q

Which biopsy type is the least invasive

A

US guided FNA pf lymph node

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16
Q

Why is tissue diagnoses important?

A

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

17
Q

An MDT meeting can be split into two?

A

Diagnostic MDT- looking at imaging

Treatment MDT

18
Q

Who are the members of a lung MDT?

A
19
Q

Role of resp physician in MDT

A
  • 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
20
Q

Role of Clinical Nurse Specialist in MDT

A
  • Patients voice
  • patients advocacy
  • holistic needs
  • updates and communication with patietns and familes in between OPA (outside outpaitent appointments)
21
Q

Role of Radiologists in MDT

A

Interpret scans

  • CXR
  • CT
  • US (eg supraclavicular LN)
  • PET-CT
  • MRI

Radiological staging

Advice regarding feasibilty of biopsy

22
Q

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
A

FEV1 0.75 litres

23
Q

Role of Pathologists in MDT

A
  • cytology + histology specimens
  • pathologist specialises in one area
  • cell type
  • origin- immunohistochemistry
  • Receptor status:
  • eGFR/ALK/ROS-1?PDL-1
  • NGS panel
24
Q

Role of Clinical oncologists in MDT

A
  • Advice on radiotherapy
  • convention fractionated
  • SABR (stereotactic Ablative Body Radiotherapy)
  • Technical factors
25
Q

Role of Medical oncologists in MDT

A
  • 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
26
Q

Which of these MDT members would give radiotherapy?

  • Radiologist
  • Medical oncologist
  • Clinical oncologist
A

Clinical oncologist

27
Q

Role of Thoracic surgeons in MDT

A
  • 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
28
Q

Role of Palliative Care Team in MDT

A
  • 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.
29
Q

Role of Specialist Pharmacists in MDT

A
  • Suport with chemo and immunotherapy
  • patient information and advice about their medications
  • Lead patient consultationas part of oncology team
30
Q

Role of Holistic Care in MDT

A
  • Treating the whole and not just part of it
  • Care for the whole person
  • Centres on the patient
  • Holistic Needs Assessment (HNA)
31
Q

What is the holistic needs Assessment?

A

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
32
Q

What are the different aspects of holistic needs assessment?

A
  • 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)
33
Q

What does palliative care involve?

A

-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
33
Q

What does palliative care involve?

A

•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
34
Q

Palliative care also discusses end of life care.

What does this involve?

A
  • 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
35
Q

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
A

Gold Standards Framework

36
Q

What is the largest study for lung screening?

A

MELSON Trial published 2020

37
Q

What is the headline results from MELSON Trial published in 2020

A
  • Screening group: 2.50 deaths per 1000 person-years
  • Control group: 3.30 deaths per 1000 person-years
38
Q

What is the Lung Health Check Programme

A
  • 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

Year 3 Academic Weeks (40 decks)

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