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respiratory system year 1 > clinical features of lung cancer > Flashcards

clinical features of lung cancer Flashcards

1
Q

what type of cancer is the leading cause of cancer death in both men and women

A

lung

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2
Q

how many cancer deaths in the UK are due to lung cancer

A

1/5

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3
Q

what % of lung cancers does smoking account for

A

85%

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4
Q

risk factors for lung cancer

A

smoking (>85%)
passive smoking
exposure to asbestos, radon, air pollution and diesel exhaust
chemicals have a synergistic effect with smoking

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5
Q

symptoms of lung cancer

A 
chronic coughing
haemoptysis 
wheezing sound 
chest and bone pain 
chest infections 
dysphagia 
raspy, hoarse voice
SOB
unexplained weight loss
nail clubbing
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6
Q

symptoms of metastatic disease

A

bone pain
spinal cord compression
cerebral metastases
thrombosis

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7
Q

spinal cord compression symptoms

A

limb weakness
paraesthesia
bladder/bowel dysfunction

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8
Q

cerebral mets symptoms

A 
headache
vomiting
dizziness
ataxia
focal weakness
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9
Q

paraneoplastic symptoms

A 
causes systemic problems w/o mets
hyponatraemia
ANAEMIA
HYPERCALCAEMIA 
dermatomyositis/polymyositis
eaton-lambert syndrome
cerebellar ataxia
sensorimotor neuropathy
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10
Q

clinical signs of lung disease

A 
chest signs 
clubbing 
lymphadenopathy 
Horner's syndrome
Pancoast tumour 
SVC obstruction - facial oedema and dilated neck veins
hepatomegaly 
skin nodules (mets)
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11
Q

1y care investigations

A 
CXR 
FBC
renal, LFTs, Ca
clotting screen 
spirometry
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12
Q

how is lung cancer staged

A

CT thorax and abdo
look for signs of lung cancer
central or peripheral
look for mets

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13
Q

tissue diagnosis

A

bronchoscopy - biopsy central tumours
EBUS - sample lymph nodes around airway
imaged guided lung/liver biopsy
FNA of neck node/skin mets

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14
Q

types of lung cancer by histology

A 
adenocarcinoma 40% - more common in non-smokers and women 
squamous cell carcinoma 30% 
small cell carcinoma 15%
large cell carcinoma 10%
other 3%
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15
Q

tumour staging - imaging

A

based on CT scan

PET scan if CT shows localised tumour

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16
Q

TX

A

1y tumour can’t be assessed

presence of malignant cells

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17
Q

T0

A

no evidence of 1y tumour

18
Q

T1

A

T1a <2CM
T1b 2-3cm
no invasion
lobar bronchus

19
Q

T2

A

T2a 3-5cm
T2b 5-7cm
>2cm to carina
lobar atelectasis or obstructive pneumonia to hilus

20
Q

Atelectasis

A

is the collapse or closure of a lung resulting in reduced or absent gas exchange

21
Q

T3

A 
>7cm
<2cm to carina
whole lung atelectasis 
invasion: chest wall, diaphragm, mediastinum, pleura, pericardium
nodules in same lobe
22
Q

T4

A

tumour in carina
invasion: heart, great vessels, trachea, oesophagus, spine
nodules in other ipsilateral lobes

23
Q

NO

A

no regional node involvement

24
Q

N1

A

involvement of ipsilateral hilar or peribronchial nodes

25
Q

N2

A

involvement of ipsilateral mediastinal or subcarinal nodes

26
Q

N3

A

involvement of contralateral mediastinal or hilar nodes OR ipsilateral or contralateral scalene or supraclavicular nodes

27
Q

M0

A

distant mets absent

28
Q

M1

A

distant mets present

29
Q

prognosis for stage 4 lung cancer vs stage 1

A

stage 1 - 10% die within 1yr

stage 4 - 80% die within 1yr

30
Q

what influences treatment decisions

A 
performance status 
patient wishes
histological subtype and stage 
MDT 
aims of treatment e.g. radical or palliative
31
Q

performance status stages

A

0 = fully active, no symptoms
1 = functional w/ some symptoms
2 = symptoms and debilitated but >50% up and about, unable to work
3 = <50% up and about, limited self care
4 = chair or bed bound
0-1 offered radical treatment

32
Q

surgical treatment options

A 
around 18% of pts
stage I and II pts
wedge resection 
lobectomy
pneumonectomy
33
Q

radiotherapy

A

radical - localised disease but not fit enough for surgery, high dose, curative intention
palliative
stereotactic - reduces normal tissue damage

34
Q

chemotherapy

A

part of radical or palliative treatment
alone, combined w/ radiotherapy or adjuvant
targeted agents

35
Q

chemotherapy for small cell

A

cisplatin

eteposide

36
Q

targeted agents in chemotherapy

A

tyrosine kinase inhibitors
monoclonal antibodies
e.g. erlotnib, gefitibin, crizotinib

37
Q

chemotherapy for adenocarcinoma

A

cisplatin

pemetrexed

38
Q

chemotherapy for squamous cell carcinoma

A

cisplatin

gemcitabine

39
Q

when is best supportive care offered

A

when treatment is not in their best interest

symptom control and support

40
Q

palliative care components

A 
symptom control 
QOL 
community support
decisions and planning 
end of life care and resuscitation status 
MDT
41
Q

symptom control in palliative management

A

may include chemotherapy
may include radiotherapy (pain, haemoptysis)
opiates, bisphosphonates, benzodiazepines
treatment of hypercalcaemia, dehydration, hyponatraemia

respiratory system year 1 (25 decks)

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