Clinical Features and Staging of Lung Cancer Flashcards
What percentage of cancer deaths are lung cancer?
20%
What percentage of lung cancers are related to smoking?
85%
What other environmental risk factors of lung cancer are there?
- Exposure to carcinogens such as asbestos and radon
What is a “synergistic effect” with reference to lung cancer?
- 1 + 1 = 3
- If you are exposed to 2 antigens you have a far more increased chance of developing lung cancer than just the one
What are some symptoms of advanced metastatic lung cancer?
- Bone pain
- Spinal compression and parasthesia
- Cerebral metastasis
- Thrombosis
What main symptoms will elicit from cerebral metastasis?
- Vomiting
- Ataxia
What are the symptoms of the paraneoplastic form?
- Hyponatraemia
- Anaemia
- Hypercalcaemia
- Dermatomyositis
- Eaton lambert
- Cerebellar ataxia
- Neuropathy
What is hyponatraemia?
Low blood sodium
What is eaton lambert?
Autoimmune disease that causes muscle weakness in the limbs (similar to myasthenia gravis)
What are some of the general signs of lung cancer?
- Clubbing
- Chest signs
- Cervical lymphadenopathy
- Horner’s syndrome
- Pancoast tumour
- Obstruction of the superior vena cava
- Hepatomegaly
- Skin nodules
What is Horner’s Syndrome?
Damage to the sympathetic trunk
What is a pancoast tumour?
- Tumour of the lung apex
- Can put pressure on vessels around there
When lung cancer is suspected, what are the initial investigations that should be carried out?
- Chest Xray
- Full blood count
- Renal and liver function (calcium level)
- Clotting screen
- Spirometry
What further investigations could be performed to get a diagnosis of lung cancer?
- Bronchoscopy
- EBUS
- Lung and liver biopsy
- Cervical lymph node sampling
- Bone biopsy
- Mediastinoscopy
What is EBUS?
Endobronchial Ultrasound Guided Transbronchial Aspiration
When would a lymph node sample or a lung, liver and a bone biopsy be performed?
When metastasis is suspected
How many T stages are there in lung cancer?
4
What is a T1 tumour?
- Diameter 0-3cm
- No invasion
What is a T2 tumour?
- Diameter 3-7cm
- > 2cm away from the carina
- Lobar atelectasis
What is lobar atelectasis?
Diminished lung lobe volume
What is a T3 tumour?
- Diameter >7cm
- <2cm away from the carina
- Atelectasis of the whole lung
- Invasion of any of chest wall, diaphragm, mediastinum, pleura, pericardium
What is a T4 tumour?
- Tumour in carina
- Invasion of heart, great vessels, trachea, oesophagus, spine
What is N staging?
Staging involving lymph node spread
What is the N0 stage?
No lymph spread
N1?
Ipsilateral hilar/peribronchial nodes involved
N2?
Ipsilateral mediastinal/subcarinal nodes
N3?
- Controlateral mediastinal/hilar nodes
- Ipsilateral/controlateral scalene or subclavicular nodes
What is M staging?
If the cancer has metastasised to distant structures
What are M0 and M1?
- M0 means no distant spread
- M1 means distant spread
What happens to prognosis as staging increases?
Prognosis gets worse
What is the treatment pathway used based on?
- Performance
- Patient wish
- Histological type due to some cancers being more aggressive
- The aim of the treatment
What are the two aims that treatment can be used for?
- Cure
- Palliative
What is meant by performance of a patient?
- How active they are from the illnesses symptoms
What is a performance grading score of 0?
- Fully active patient
What is a performance grading score of 1?
- Symptoms present but still mostly active
What is a performance grading score of 2?
- Up and about more than 50% of the time
- Unable to work
What is a performance grading score of 3?
- Up and about less than 50% of the time
- Limited self care
What is a performance grading score of 4?
Bed or chair bound
What are the surgical options for lung cancer?
- Wedge resection
- Lobectomy
- Pneumonectomy
What is a wedge resection?
- A less invasive technique that resects a small part of the lung
What is a lobectomy?
Complete removal of a lobe
What is a pneumonectomy?
Complete removal of a lung
What are the three types of radiotherapy that can be administered for lung cancer?
- Radical (cure)
- Palliative (reduce suffering)
- Sterotactic (directly at the tumour)
When can chemotherapy be used in lung cancer?
- As a direct treatment
- As an adjuvant
What specialised monoclonal antibodies are used in lung cancer chemo?
- Erlotinib
- Gefitinib
What cancer are cisplatin and pemetrexed used for?
Adenocarcinoma
What cancer are cisplatin and etoposide used for?
Small cell
What cancer are cisplatin and gemcitabine used for?
Squamous
