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Week 8 - Respiratory > CBL - Lung Cancer > Flashcards

CBL - Lung Cancer Flashcards

1
Q

What are the symptoms that are suggestive of lung cancer? [7]

A
  1. Cough that doesn’t go away or a long standing cough gets worse
  2. Recurrent infections
  3. Breathlessness – lobar/lung collapse (co-existing COPD)
  4. Haemoptysis
  5. Unexplained weight loss
  6. Chest and/or shoulder pains
  7. Hoarse voice
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2
Q

What are the clinical signs that may be associated with lung cancer? [10]

A
  1. Finger clubbing
  2. Signs of lobar collapse or a pleural effusion
  3. From metastases
    • hepatomegaly,
    • cervical lymphadenopathy,
    • bony tenderness
  4. Cachexia
  5. Horner’s syndrome (Pancoast tumour)
  6. Evidence of superior vena cava obstruction (SVCO) or spinal cord compression (SCC)
  7. Cushingoid
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3
Q

What are the risk factors for lung cancer? [5]

A
  1. Smoking in 85%
  2. Passive smoking,
  3. Occupational asbestos,
  4. Silica and nickel exposure,
  5. Pulmonary fibrosis
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4
Q

What are the typical CXR changes in a patient with lung cancer? [5]

A
  1. Mass lesion
  2. Lobar or lung collapse
  3. Pleural effusion
  4. Mediastinal widening or hilar lymph nodes
  5. Slowly resolving consolidation
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5
Q

What are the most common investigations done on a patient with suspected lung cancer? [7]

A
  1. Routine bloods
    • FBC,
    • U&Es,
    • LFTs,
    • serum calcium,
    • CRP
  2. CT chest and upper abdomen looking for:
    • lymph nodes,
    • evidence of liver or adrenal metastases
  3. Bronchoscopy
    • will detect more central lesions
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6
Q

A patient is diagnosed with lung cancer that can be treated with surgical resection. What investigations must be carried out to assess fitness for treatment and why? [5]

A
  1. Full lung function tests
    • If considering surgery (need an FEV1 >1.5L)
  2. ECG & Echo
    • To investigate evidence of cardiac disease
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7
Q

Name the 3 subtypes of non-small cell carcinoma (NSCLC) [3]

A
  1. squamous cell carcinoma
  2. adenocarcinoma
  3. large cell carcinoma
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8
Q

Describe the typical features of a squamous cell carcinoma [4]

A
  1. closely linked to smoking history,
  2. keratinization and/or intercellular bridges on histology,
  3. central airways,
  4. high frequency of p53 mutations
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9
Q

Describe the typical features of an adenocarcinoma [5]

A
  1. glandular differentiation or mucin production,
  2. most common form in women and non-smokers,
  3. more peripherally located,
  4. TTF-1 positive,
  5. if EGFR mutations present may benefit from treatment with EGFR inhibitors
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10
Q

What is a large cell carcinoma? [1]

A

undifferentiated epithelial tumour

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11
Q

Describe the TMN staging system used for non-small cell carcinomas [3]

A
  1. T – tumour size
  2. N – regional lymph node involvement
  3. M – presence or absence of distant metastases
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12
Q

Describe the treatment options for non-small cell carcinoma [6]

A
  1. Surgery
    • early stages (Stage I or II)
  2. Radiotherapy
    • Curative intent (radical radiotherapy) in some with early stages if not thought to be fit for surgery
      • Side effects:
        • radiation pneumonitis in 10-15% (acute infiltrate <3 months after treatment),
        • radiation fibrosis around 1yr after
    • For symptom control (palliative radiotherapy)
      • good for:
        • bone and chest wall pain,
        • haemoptysis,
        • occluded bronchi,
        • superior vena cava obstruction (SVCO)
  3. Chemotherapy
    • Platinum-based chemotherapy (cisplatin/carbplatin) in combination with paclitaxel or gemcitibine
    • Can be used to down-stage tumours for surgery or to palliate symptoms
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13
Q

What are the histological features of small cell carcinoma? [5]

A
  1. small epithelial cells,
  2. scanty cytoplasm,
  3. ill-defined cell borders,
  4. finely granular nuclear chromatin (salt & pepper pattern),
  5. high mitotic count
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14
Q

Describe the 2 stages of small cell carcinoma [4]

A
  1. Limited disease
    • confined to one hemithorax and the ipsilateral supraclavicular fossa (30%)
  2. Extensive disease
    • all other patients (70%)
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15
Q

What are the other treatment/management options for both NSCLC and SCLC (other than surgery/chemo/radiotherapy)? [2]

A
  1. Endobronchial treatments
    • laser,
    • stents to deal with tumour obstructing large airways
  2. Palliative care
    • opiates to treat pain and breathlessness
      • (important as lung cancer often diagnosed at an advanced stage in patients with other health problems e.g. COPD, IHD)
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16
Q

What are the common sites that a lung cancer can metastasise to? [6]

A
  1. Lymph nodes
    • Mediastinal lymph nodes (causing superior vena caval obstruction),
    • Cervical lymph nodes
    • Axillary lymph nodes
  2. Pleura (causing a pleural effusion)
  3. Liver
  4. Bone
    • Bone pain
    • May cause spinal cord compression
  5. Brain
  6. Adrenals
17
Q

List the common non-metastatic manifestations of lung cancer under the following headings:

  1. metabolic [3]
  2. endocrine [3]
  3. neurological [1]
  4. skeletal [2]
A
  1. Metabolic:
    • weight loss,
    • anorexia,
    • lassitude (lack of energy)
  2. Endocrine:
    • ectopic ACTH – Cushingoid appearance
    • SIADH – hyponatraemia
    • Hypercalcaemia – parathyroid-related peptide, bony metastases
  3. Neurological:
    • Eaton-Lambert Syndrome
  4. Skeletal:
    • finger clubbing,
    • hypertrophic osteoarthropathy
18
Q

What are the 2 emergencies associated with lung cancer? [2]

A
  1. superior vena cava obstruction
    • due to mediastinal lymph nodes compressing SVC
  2. spinal cord compression
19
Q

What are the signs [2] and symptoms [4] of superior vena cava obstruction due to lung cancer?

A
  • Symptoms
    1. breathless,
    2. dysphagia,
    3. stridor,
    4. swollen oedematous face and right arm
  • Signs
    1. venous congestion in the neck,
    2. dilated veins in the arm
20
Q

How do you treat superior vena cava obstruction? [4]

A
  1. high dose steroids,
  2. vascular stents,
  3. anti-coagulation,
  4. radiotherapy or chemotherapy
21
Q

What are the signs [1] and symptoms [4] of spinal cord compression due to lung cancer?

A
  • Symptoms
    1. leg weakness and numbness,
    2. reduced bladder and bowel control
  • Signs
    1. upper motor neurone signs in legs at sensory level
22
Q

How do you treat spinal cord compression? [3]

A
  1. high dose steroids,
  2. urgent oncology input (radiotherapy) and/or neurosurgical input

Week 8 - Respiratory (14 decks)

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