deck_1502664 Flashcards
Describe incidence of lung cancer in men
• Commonest male cancer• Mortality around 100 per 100,000• Incidence falling slowly due to reduction in smoking
Describe incidence of lung cancer in females
• Exceeds breast cancer as a cause of death in women• Mortality rate around 40 per 100,000 • Incidence rising
How does incidence of lung cancer vary according to socioeconomic group?
• Wide variation• Rate three times higher in lowest compared with highest
What is the main risk factor for lung cancer?
• Smoking • 90% lung cancers in men 80% lung cancer in women
Give four aeitological factors which influence lung cancer
• Asbestos exposure• Radon exposure• Genetic factors • Dietary factors
What are the main signs and symptoms of lung cancer?
• Relatively non-specific
What are the main symptoms of a primary lung cancer tumour?
• Cough• Dyspnoea• Wheezing • Haemoptysis • Chest pain • Post-obstructive pneumonia • Weight loss • Lethargy/malaise
What are the main four symptoms of regional mestastases?
• Superior vena cava obstruction • Hoarseness (left recurrent laryngeal nerve palsy)• Dypnoea (phrenic nerve palsy)• Dysphagia
What are the main two symptoms of distant metastases
• Bone pain/fractures• CNS symptoms (headache, double vision, confusion)
What is paraneoplastic syndrome?
• Presence of a symptom or a disease due to the presence of cancer in the body, but not due to the local presence of cancer cells
What are the symptoms of paraneoplastic syndrome mediated by?
• Humoral factors (hormones and cytokines) secreted by tumour cells, or the immune response against tumour cells
What are the four main categories of paraneoplastic syndrome?
• Endocrine• Neurological• Skeletal• Haematological
Give two diseases which occur as an endocrine result of paraneoplastic syndrome
• Hypercalcaemia• Cushing’s syndrome
Give two disease which occur as a neurological result of paraneoplastic syndrome
• Encephalopathy• Peripheral neuropathy
Give a skeletal disease which occurs as a result of paraneoplastic syndrome
• Finger clubbing
Give three diseases which occur as a a haemotolofical result of paraneoplastic syndrome
• Anaemia• Throbocytopenia • Disseminated Intravascular Coagulation
What are two other diseases which can come about as a result of paraneoplastic syndrome?
• Nephrotic syndrome• Anorexia or Cachexia
What occurs when lung cancer is first suspected in a patient in terms of investigations
○ Plain chest x-ray
What are three scans used for diagnosis and staging
• CT scan • PET scan• Isotope bone scan
What are the two staging systems for lung cancer?
• NumberTMN
What is a stage 1 cancer?
• Small cancer, localised to one area of the lung
What is a stage 2 and 3 cancer?
• Larger cancer, may have grown into surrounding tissues
What is stage 4 cancer?
Cancer has metastasised
What is the TMN staging system (Outline T, M and N) ?
• T - Size and position of tumour • N - Lymph node involvement• M - Metastases
What are the stages of T?
• T1 - T4
What is T1 in lung cancer
• T1 - cancer contained within the lung (
What is T2 in lung cancer
• Cancer has grown (3-7cm diameter)• Into main bronchus• Into the visceral pleura• Made parts of the lung collapse
What is T3 in lung cancer?
• Cancer has grown (>7cm diameter)• Invading chest wall, mediastinal pleura, diaphragm, pericardium• Complete lung collapse>1 cancer nodule in the same lob of lung
What is T4 in lung cancer
• Cancer invading mediastinum, heart, major blood vessel, trachea, carina, oesophagus, spine, recurrent laryngeal nerve • Cancer nodules in more than one lobe of the same lung
What is N0?
• No cancer in lymph nodes
What is N1?
• Cancer in lymph nodes nearest the affected lung
What is N2?
• Cancer in lymph node in mediastinum on the same side
What is N3?
Cancer in lymph nodes on the opposite side of the mediastinum/supraclavicular lymph nodes
What is M0?
• No evidence of distal cancer spread
What is M1?
• Lung cancer cells in distant parts of the body such as pleura, opposite lung, liver or bones
What are three ways in which tissue is biopsied in lung cancer?
• Bronchoscopy• Needle biopsy of the lung• Surgical biopsy
Why is biopsy important?
• To determine cell type, which can influence prognosis and treatment
What are the two main types of lung cancer?
• Non-small cell lung cancer• Small cell lung cancer
What is a feature of non-small cell carcinoma on presentation?
• More than 2/3rds have inoperable disease at presentation
What is a feature of small cell carcinoma on presentation?
• 3/4 have metastatic disease at presentation
What does prognosis of a lung cancer depend on?
• Cell type (small cell worse than non-small cell)• Stage of disease• Performance status • Biochemical markers• Co-morbidities ○ Cardiac or chronic respiratory disease
Give six different treatments for lung cancer
• Surgery• Radiotherapy• Chemotherapy• Combination therapy• Biological targeted therapies• Palliative care
When is surgery used for lung cancer?
• Mostly non-small cell
What is the difference between radical and palliative radiotherapy?
• Radical is curative• Palliative is symptom control
When is chemotherapy most effective, and when is it less so?
• Small cell - Potentially curative• Non small cell - Modest survival increase, symptom control
What is combination therapy?
• Combination of chemo and radiotherapy
What is a biological targeted therapy?
• EGFR and VEGF inhibition to prevent tymour growth
How is non-small cell lung cancer treated?
• Palliative radiotherapy for local symptoms • Chemotherapy -50 - 60% response rate• Combination therapy - Important in locally advanced diseaseTargeted agents - EGFR and VEGF
How is small cell cancer managed?
• Rarely operable• Combination therapy - Responds well, adding 1 year• Palliative Chemotherapy for symptoms• Death from cerebral metastases common
