Lecture 10.1: Lung Cancer Flashcards
What are some Risk Factors of Lung Cancer? (8)
- Smoking
- Exposure to secondhand smoke
- Previous radiation therapy
- Exposure to radon gas
- Exposure to asbestos and other carcinogens
- Inhaled dusts-uranium and silica
- Others-nickel chromates, coal tar distilleries,
arsenic - Family history of lung cancer/Genetics
Signs and Symptoms of Lung Cancer (8)
- A new cough that doesn’t go away
- Coughing up blood, even a small amount
- Shortness of breath
- Chest pain
- Hoarseness
- Losing weight without trying
- Bone pain
- Headache
- Nail Clubbing
- Wheezing
Clinical Features of Regional Spread of Lung Cancer: Phrenic Nerve Paralysis (Palsy)
- Elevated Hemidiaphragm
- Breathlessness
Clinical Features of Regional Spread of Lung Cancer: Left Recurrent Laryngeal Nerve Palsy
- Hoarseness/ Weak Voice
- Eating Difficulties
- Poor Cough
- Repeated Chest Infections because of
aspiration pneumonia
Clinical Features of Regional Spread of Lung Cancer: Sympathetic Chain Involvement
Horner’s Syndrome characterised by:
* Constricted pupil (miosis)
* Drooping of the upper eyelid (ptosis)
* Absence of sweating of the face (anhidrosis)
* Sinking of the eyeball into the bony cavity that
protects the eye (enophthalmos)
Clinical Features of Regional Spread of Lung Cancer: Brachial Plexus (Pancoast Tumour)
- Pain in the inner arm and shoulder
- Swelling in the upper arm
Clinical Features of Regional Spread of Lung Cancer: Compression of Oesophagus (effect)
Dysphagia
Clinical Features of Regional Spread of Lung Cancer: Pericardial Involvement (effect)
Difficulty Breathing
Clinical Features of Regional Spread of Lung Cancer: Pleural Involvement (effect)
Difficulty Breathing
Clinical Features of Regional Spread of Lung Cancer: Chest Wall Invasion (effect)
Chest Pain
Clinical Features of Distant Metastasis (7)
- Bone pain secondary to fractures
- CNS signs and symptoms
- Seizures (due to brain mets)
- Personality Changes (due to brain mets)
- Abdominal Pain
- Liver capsular pain from liver metastasis and
elevated LFTs - Lymphadenopathy in the neck
What are Paraneoplastic Syndromes?
A group of rare disorders that are triggered by an abnormal immune system response to a cancerous tumour
Paraneoplastic Syndromes: Endocrine (3)
- Hypercalcaemia (PTH squamous cell
carcinoma) - Cushing’s syndrome (ectopic ACTH secretion)
- Inappropriate ADH secretion (small cell
carcinomas)
Paraneoplastic Syndromes: Haematological (2)
- Anaemia
- Thrombocytosis
Paraneoplastic Syndromes: Cutaneous (1)
- Dermatomyositis
Paraneoplastic Syndromes: Skeletal (1)
- Finger clubbing (Hypertrophic
osteoarthopathy)
Investigations for Lung Cancer (6)
- CT Scan
- Bronchoscopy
- Biopsy
- MRI
- PET CT
- Isotope Bone scan
How do clinicians get lung tissue in a biopsy? (6 Steps)
1) Transbronchial biopsy
2) Trans thoracic CT guided biopsy for peripheral
tumours
3) Fine needle aspirates of lymph nodes
4) EBUS for staging purposes and for initial
diagnosis
5) Pleural tap and Pleural biopsy
6) Mediastinal biopsy
Why are tissue samples so important?
Sampling allows staging and pathological sub-typing (immunohistochemical and
molecular analysis)
What is Cytology?
The analysis of a single cell type, as often found in fluid specimens
Where are Cytology samples (for lung cancer) collected from? (5)
- Sputum
- Bronchial lavage
- Fine needle aspirate of lymph nodes
- EBUS aspirates of lymph nodes
- Pleural fluid
What are the different types of tissue biopsies (for lung cancer)? (3)
- Trans bronchial biopsy
- Transthoracic biopsy
- Biopsy of metastasis (lymph nodes, liver or
bone)
Investigations to assess patient suitability for
major resections (2)
- Pulmonary function tests incl. transfer capacity
- ECHO cardiogram
What are Major Resections?
Surgery to remove part or all of a damaged or diseased lung
Blood Tests for Lung Cancer (4)
- No specific tests
- Sodium
- Calcium
- Liver function tests
- TBC
What are the 3 Main Types of Lung Cancer?
- Non-Small Cell Carcinoma (75%)
- Small Cell Carcinoma (15-20%)
- Unusual tumours e.g. neuroendocrine tumour
(5%)
What are the subtypes Non-Small Cell Carcinoma and their percentage incidence?
- Squamous cell carcinoma (20-30%)
- Adenocarcinoma (30-40%)
- Large cell carcinoma (10-15%)
Features of Lung Squamous Cell Carcinoma (7)
- Often central tumours
- Angulate cells
- Eosinophilic cytoplasm
- Keratinisation
- Intercellular bridges (prickles)
- Keratin pearls
- Immunocytochemistry (CK 5/6 &p63+)
Features of Lung Adenocarcinoma (7)
- Often peripheral
- Columnar/cuboidal cells
- Form glands (acini)
- Papillary structures
- May line alveoli (bronchioalveolar carcinoma)
- Some produce mucin
- Immunocytochemistry [Most TTF-1+ (about 70%
of cases)]
Features of Lung Small Cell Carcinoma (7)
- “oat cell carcinoma”
- Very cellular
- Small nuclei
- Little cytoplasm
- Nuclear moulding
- Often necrosis and lots of mitoses
- Immunocytochemistry (CD56, Synaptophysin +)
Where are Lung Metastasis often found (secondary tumours)? (8)
- Breast
- Colon
- Endometrial
- Melanoma
- Sarcoma
- Pharyngeal
- Prostate
- Kidney
Why is tissue diagnosis important? (4)
- Benign versus malignant
- Is it a primary or secondary tumour
- Is it small cell or non small cell carcinoma
as treatment is different - Adenocarcinomas can be assessed for specific
molecular alterations to guide further treatment
Consequences of Spread of Lung Cancer Locally in the Lung? (4)
- Necrosis –> cavitation)
- Ulceration (occurs in 50%) –> haemoptysis
- Infection –> abscess formation
- Bronchial obstruction –> collapse, consolidation
Consequences of Spread of Lung Cancer Locally in the Thorax? (5)
- Direct spread or metastasis
- Pleural/pericardial effusions
- Mediastinal structures –> SVC obstruction,
dysphagia - Recurrent laryngeal nerve –> Vocal chord palsy
- Phrenic nerve –> Diaphragm palsy
Staging of Lung Cancer: T0
No tumours
Staging of Lung Cancer: T1
Tumours ≤ 3cm
Staging of Lung Cancer: T2 (4)
- 3cm < Tumour ≤ 7cm
OR TUMOUR WITH ANY OF FOLLOWING - Tumour that invades visceral pleura
- Involves main bronchus ≥ 2cm distal to carina
- Atelectasis/obstructive pneumonia extending to
hilum but not involving entire lung
Staging of Lung Cancer: T3 (6)
- Tumour > 7cm
- Or there is more than one tumour in the same
lobe of the lung
OR CANCER HAS SPREAD INTO: - The chest wall
- The outer lining of the chest cavity (the parietal
pleura) - The nerve close to the lung (phrenic nerve)
- The outer covering of the heart (the
pericardium)
Staging of Lung Cancer: T4 (8)
Tumour of any size with invasion of:
* Heart
* Great Vessels
* Trachea
* Recurrent Laryngeal Nerve
* Oesophagus
* Vertebral Body
* Carina
* Separate tumour nodules in a different
ipsilateral lobe
