Clinical Features and Staging of Lung Cancer Flashcards
What is the leading cause of cancer death in men and women
Lung cancer
How many cancer deaths in the UK are due to lung cancer
1 in 5
22%
How many lung cancers are due to smoking
Over 85%
Which cancer is most preventable
Lung
What are the risk factors for lung cancer
Smoking
Passive smoking
Exposure to asbestos, radon, air pollution and diesel exhaust
What are 10 signs and symptoms of lung cancer
Chronic coughing Coughing up blood Wheezing Chest and bone pain Chest infections Difficulty swallowing Raspy, hoarse voice Shortness of breath Unexplained weight loss Nail clubbing
Name 4 symptoms of advanced metastatic disease
Bone pain
Spinal cord compression
Cerebral metastases
Thrombosis
What are the signs of spinal cord compression
Limb weakness
Paraesthesia
Bladder/bowel dysfunction
What are the signs of cerebral metastases
Headache Vomiting Dizziness Ataxia Focal weakness
Name 7 symptoms of advanced paraneoplastic disease
Hyponatraemia Anaemia Hypercalcaemia Dermatomyositis/polymositis Eaton-lambert syndrome Cerebella ataxia Sensorimotor neuropathy
What are the signs of hyponatraemia
SIADH
What are the signs of hypercalcaemia
Parathyroid hormone related protein
Bone metastases
What are the signs of dermatomyositis/polymositis
Proximal muscle weakness
What are the signs of Eaton-lambert syndrome
Upper limb weakness
What are the clinical signs of lung cancer
Chest signs Clubbing Lymphadenopathy Horner’s syndrome Pancoast tumour Superior vena cava obstruction Lymphadenopathy Hepatomegaly Skin nodules (metastases)
What are the initial investigations conducted through the GP
Chest X-Ray Full blood count Renal, liver functions and calcium Clotting screen Spirometry
What type of imaging is used for staging
CT of thorax and abdomen
What investigations can be done for tissue diagnosis
Bronchoscopy EBUS Image guided lung biopsy Image guided liver biopsy FNA of neck node or skin metastasis Excision of cerebral metastasis! Bone biopsy Mediastinoscopy/otomy Surgical excision biopsy
How is bronchoscopy conducted
A bronchoscope is used to view the airways and check for any abnormalities
How of lung cancer does small cell carcinoma account for by histology
15%
How of lung cancer does adenocarcinoma account for by histology
40%
How of lung cancer does squamous cell carcinoma account for by histology
30%
How of lung cancer does large cell carcinoma account for by histology
10%
What is the diameter of a T1 tumour
T1a is under 2cm
T1b is between 2-3cm
What is the diameter of a T2 tumour
T2a is between 3-5cm
T2b is between 5-7cm
What is the diameter of a T3 tumour
Over 7cm
What will the scopy of a T1 tumour show
No invasion
Lobar bronchus
What will the scopy of a T2 tumour show
Over 2cm to the carina
What will the scopy of a T3 tumour show
Under 2cm to the carina
What will the scopy of a T4 tumour show
Tumour in carina
What type of atelectasis will a T2 tumour show
Lobar atelectasis or obstructive pneumonia to hilus
What type of atelectasis will a T3 tumour show
Whole lung
State 5 things that should be considered when deciding on treatment
Performance status Patient wishes Histological type and stage Multidisciplinary team Aims of treatment (e.g. radical or palliative)
State the different performance status types
0 = fully active 1 = symptoms but ambulatory 2 = “up and about” over 50%, unable to work 3 = “up and about” under 50%, limited self-care 4 = bed or chair bound
What treatments are available for patients
Surgery (18% of patients) Radiotherapy Chemotherapy Best supportive care Co-ordination (lung cancer specialist nurse)
What type of surgery could be preformed
Wedge resection
Lobectomy
Pneumonectomy
What type of radiotherapy is available
Radical
Palliative
Stereotactic
What type of chemotherapy is available
Part of radical or palliative treatment
Alone, combined with radiotherapy or adjuvant (after surgery)
Targeted agents (e.g. Tyrosine Kinase Inhibitors and monoclonal antibodies)
Small cell e.g. cisplatin/etoposide
Adenocarcinoma e.g. cisplatin/pemetrexed
Squamous e.g. cisplatin/gemcitabine
What are the 5 aspects of palliative management
Symptom control
Quality of life
Community support
Decisions and planning, resuscitation status, end of life care
Multidisciplinary team including lung cancer nurse and hospice
What are the methods of symptom control
Chemotherapy
Radiotherapy (e.g. pain, haemoptysis)
Opiates, bisphosphonates, benzodiazepines
Treatment of hypercalcaemia, dehydration and hyponatraemia
