Clinical Features of Lung Cancer and Staging Flashcards by Dua Khan

What cancer causes the most deaths?

Lung cancer

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How many cancer deaths are due to lung cancer?

1 in 5 (22%)

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What percentage of lung cancer does smoking account for?

>85%

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What are some risk factors for lung cancer?

Smoking (more than 85%)

Passive smoking

Asbestos

Radon

Air pollution

Diesel exhause

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What are some of the symptoms of lung cancer?

Chronic coughing

Coughing up blood

Wheezing sound

Chest infections

Difficulty swallowing

Rapsy, hoarse voice

Shortness of breath

Unexplained weight loss

Nail clubbing

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What is paraneoplastic syndrome?

Symptoms due to cancer but is not due to the local presence of cancer cells

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What are some metastatic symptoms of advanced lung cancer?

Bone pain

Spinal cord compression

Cerebral metastases

Thrombosis

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What do cerebral metastasis lead to?

Headache

Vomiting

Dizziness

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What does spinal cord compression lead to?

Limb weakness

Paraesthesia

Bladder/bowel dysfunction

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What is paraesthesia?

Burning or prickling sensation

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What is a burning or prickling sensation called?

Paraesthesia

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What paraneoplastic symptoms does advanced lung cancer have?

Hyponatraemia (decreased serum sodium concentration)

Anaemia

Hypercalcaemia (increase in serum calcium levels)

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What is hyponatraemia?

Decrease in serum sodium levels

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What is a decrease in serum sodium levels called?

Hyponatraemia

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What is hypercalcaemia?

Increase in serum calcium levels

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What is an increase in serum calcium levels called?

Hypercalcaemia

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What are some clinical signs of cancer?

Chest signs

Clubbing

Lymphadenopathy (abnormal size or number of lymph nodes)

Horner’s syndrome (damage to sympathetic nerves of the face)

Pancoast tumour (tumour of pulmonary apex)

Superior vena cava obstruction

Hepatomegaly (abnormal enlargement of the liver)

Skin nodules

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What is lymphadenopathy?

Abnormal size or number of lymph nodes

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What is abnormal size or number of lymph nodes called?

Lymphadenopathy

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What is Horner’s syndrome?

Damage to sympathetic nerves of the face

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What is a pancoast tumour?

Tumour of the pulmonary apex

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What is hepatomegaly?

Abnormal enlargement of the liver

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What is abnormal enlargement of the liver called?

Hepatomegaly

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What are some initial investigations done for lung cancer?

Chest X-ray

Full blood count

Renal, liver function and calcium

Clotting screen

Spirometry

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What is used to stage lung cancer?

CT of the thorax

What investigations of tissues are done for lung cancer?

Bronchoscopy Endobronchial ultrasound Image guided lung biopsy Image guided liver biopsy Fine needle aspiration of neck node or skin metastasis Excision of cerebral metastasis Mediastinoscopy Surgical excision biopsy

What is the most common type of lung cancer by histology?

Adenocarcinoma

What percentage of lung cancer are adenocarcinoma?

40%

What percentage of lung cancers are squamous cell carcinoma?

30%

What percentage of lung cancers are large cell carcinoma?

10%

What percentage of lung cancers are small cell carcinoma?

15%

What are the 3 aspects of lung cancer staging?

Tumour staging (T) Nodes staging (N) Metastasis staging (M)

What does tumour staging range from?

T1 - T4

What are the different categories withing T1?

T1a (\<2cm) T1b (2-3cm)

What does T1 mean?

\<3cm No invasion

What does T2 mean?

3-7cm

What are the different categories within T2?

T2a (3-5cm) T2b (5-7cm)

What does T3 mean?

\>7cm

During what tumour staging does invasion start?

What invasion occurs during T3?

Chest wall Diaphragm Pleura Pericardia Mediastinal

What invasion occurs in T4?

Heart Great valves Trachea Esophagus Spine

What is the difference between the nodules of T3 and T4?

T3 nodules are in the same lobe T4 nodules are in other ipsilateral lobes

What does nodes staging range from?

N0 - N3

What does N0 mean?

No regional nodes involvement

What does N1 mean?

Involvement of ipsilateral hilar or ipsilateral peribronchial nodes

What does N2 mean?

Involvement of ipsilateral mediastinal or subcarinal nodes

What does N3 mean?

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

What does metastasis staging range from?

M0 - M1

What does M0 mean?

Distant metastasis absent

What does M1 mean?

Distant metastasis present

What does overall lung tumour staging range from?

0 to IVb

When does lung cancer become stage IV?

When any metastasis are present (M1)

What sub groups of overall stage 1 lung cancer are there?

1A1 1A2 1A3 1B

What subgroups of overall stage 2 lung cancer are there?

2A 2B

When does lung cancer go from stage 1 to stage 2?

When T is 2b or greater Or when N is 1 then T can be T1a-T2b

What subgroups of overall stage 3 lung cancer are there?

3A 3B 3C

When does lung cancer go from overall stage 2 to 3?

When is N is greater than 0 or T is 4

When does overall lung staging go from 3 to 4?

When any metastasis are present (M1)

What subgroups of overall stage 4 lung cancer are there?

4A 4B

How does staging impact the prognosis?

Stage 1 80% survive 1 year Stage 2 75% survive 1 year Stage 3 50% survive 1 year Stage 4 20% survive 1 year

What is the treatment decision based on?

Performace status Patient wishes Histological type and stage Multidisciplinary team Aims of treatment (such as radical or palliative)

What does the performace status range from?

0 (fully active) 1 (symptoms but ambulatory) 2 (up and about, \>50% unable to work) 3 (up and about, \<50%, limited self-care) 4 (in bed or chair bound)

What are different categories of treatment options?

Surgery Radiotherapy Chemotherapy Supportive care

What are examples of surgery associated with lung cancer?

Wedge resection Lobectomy Pneumonectomy

What are some purposes of radiotherapy?

Radical Palliative Stereotactic (assists surgery, can see probes)

How can chemotherapy be used?

Alone, combined with radiotherapy or adjuvant (after surgery)

What are some examples of target agents for chemotherapy?

Tyrosine kinase inhibitors Monoclonal antibodies

What is used for small cell chemotherapy?

Cisplatin Etoposide

What is used for adenocarcinoma chemotherapy?

Cisplatin Pemetrexed

What is used for squamous cell chemotherapy?

Cisplatin Gemcitabine

What is involved in palliative management?

Symptom control Quality of life Community support Decisions and planning, resusication status, end of life care Multidisciplinary team

What is used for symptoms control?

Chemotherapy Radiotherapy Opiates, biphosphonates, benzodiazepines Treatment of hypercalcaemia, dehydration, hyponatraemia

Who is a very important member of the multidisciplinary team?

Lung cancer nurse