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Y2 - Resp > Lecture 17 - Lung Cancer > Flashcards

Lecture 17 - Lung Cancer Flashcards

1
Q

What is the main risk factor for lung cancer?

A

Smoking

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2
Q

How quickly do we aim to test people for lung cancer following referral?

A

2weeks

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3
Q

Why may an electrician be at increased risk of lung cancer?

A

Likely exposure to asbestos

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4
Q

What is a sign that may indicate lung cancer?

A

Persistence of cough even after infection treatments

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5
Q

Why does lung cancer have the highest related deaths worldwide?

A

Lots of people smoke

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6
Q

Why does lung cancer have a low survival rate?

A

Most people who present with lung cancer are at a later stage so have a poorer prognosis

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7
Q

What is the median estimate survival for lung cancer patients?

A

316 days

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8
Q

Why do patients who are older have poorer lung cancer survival rates?

A

Smoking likely lead to more Co-morbidities:
-COPD
-Cardiovascular issues

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9
Q

What are the top 4 causes of cancer death in the uK?

A

Lung
Colorectal
Breast
Prostate

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10
Q

What are other risk factors for lung cancer that aren’t smoking?

A

Asbestos
Background radiation (rado in rocks in Cornwall)
Occupational carcinogens (chromium, nickel,arsenic)
Genetics (Asian)

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11
Q

Why is lung cancer screening useful?

A

Detects lung cancer before symptomatic so gives patient better prognosis

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12
Q

What conditions does a disease need to meet to be eligible for a screening programme?

A

Disease serious consqeunces
High prevalence of detectable disease
Little overdiagnosis
Test causes little morbidity
Test affordable and available
Treatment exists
Treatment not too risky or toxic

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13
Q

What is the point of cancer staging?

A

May determine treatment options (surgery early stage, chemo late)
Determine prognosis

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14
Q

What is the staging system for lung cancer?

A

TNM staging

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15
Q

What is TNM staging?
What do the letters stand for?

A

Staging system for solid cancers

T = tumour
N = nodes
M = metastases

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16
Q

What is the goal of screening?

What is stage shift?

A

We want more people to present at earlier stages since they have a better prognosis

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17
Q

What is meant by T in the TNM staging system?

A

Tumor

Depends on:
How big
Where it is
How many nodules

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18
Q

What is meant by N nodes in the TNM staging system?

N0
N1
N2
N3

A

N0 = no regional lymph node metastases
N1 = metastases in 1 lymph nodes on same side
N2 = metastasis in mediastinum lymph nodes
N3 = lymph node metastasis in opposite lung

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19
Q

Look at slide 23:
Which colour indicates N1 and then N2?

A

N1 = red
N2 = blue

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20
Q

Where are the most common locations for lung cancer to metastasise to?

A

Brain
Liver
Adrenals
Bone

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21
Q

What special imaging is done for lung cancer?

What is this?

A

Staging CT

Imaging done all the way down to the kidneys

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22
Q

What stage of cancer do we consider curable?

A

Up to stage 2

Onwards not currently operable or treatable

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23
Q

What are some imaging methods done for lung cancer staging?

A

CXR
CT scan
PET scan
US
Echocardiogram
MRI

24
Q

What is a PET scan?

A

Positron emission testing

Give radioactive glucose
Rapidly metabolising tissues like malignancies will take it up and show up brightly

25
Q

How is a PET scan useful?

A

Can see if a mass is benign or malignant

Benign cells not metabolically active so dont show up brightly on PET

26
Q

What are some symptoms of lung cancer from the primary tumour?

A

Cough
Dyspnoea
Wheezing
Haemoptysis
Lung infection
Chest/shoulder pain
Weight loss
Lethargy/malaise
Clubbing

NO SYMPTOMS

27
Q

How can a primary lung tumour cause lung infections?

A

Tumour preventing airway mucus clearance so infection occurs

28
Q

How may a primary lung tumour cause shoulder pain?

A

May irritate the phrenic nerve

29
Q

What are some symptoms of the regional metastases from lung cancer?

A

Bloated face from SVC obstruction
Hoarseness
Dyspnoae
Dysphagia
Chest pain

30
Q

How can a lung metastasis cause hoarseness of voice?

A

Compress left laryngeal nerve supplying the vocal cords (left laryngeal nerve palsy)

31
Q

How can a lung metastasis cause Dysphagia?

A

Oesophageal compression

32
Q

How can a lung metastasis cause dyspnoea?

A

Anaemia
Pleural or pericardial effusion

33
Q

How can a lung cancer cause seizures?

A

hyponatraemia due to SIADH or small cell carcinoma

34
Q

What are some signs of lung cancer?

A

Cachexia (weakness/body wasting)
Cervical lymphadenopathy
HORNERS SYNDROME
Consolidation
Neurological long tract sings
Finger clubbing

35
Q

What are some paraneoplastic endocrine syndromes of lung cancer?

A

Hypercalcaemia
Cushing’s syndrome
SIADH (syndrome of inappropriate ADH secretion)

36
Q

What are some paraneoplastic neurological syndromes of lung cancer?

A

Pancoast syndrome
Encephalopathy
Peripheral neuropathy

37
Q

What is a Pancoast tumour?

A

Tumour of the apex of the lungs

38
Q

What is Pancoast syndrome?

A

Horners syndrome + persistent shoulder and arm pain + wastage of intrinsic hand muscles

39
Q

What is Horner’s syndrome?

A

Partial Ptosis
Miosis
Anhydrosis

40
Q

What causes the partial Ptosis in Pancoast syndrome?

A

The tumour compresses the sympathetic chain ascending to the neck leading to loss of innervation to the smooth muscle part of levator palpebrae superioris

41
Q

What is misosis and how is it caused in Pancoast syndrome?

A

Constriction of pupil

The Pancoast tumour compresses the sympathetic chain ascending to the head so innervation to dialtor papillae lost so pupil constricted (no impulses sent from the superior cervical ganglion)

42
Q

What is misosis and how is it caused in Pancoast syndrome?

A

Constriction of pupil

The Pancoast tumour compresses the sympathetic chain ascending to the head so innervation to dialtor papillae lost so pupil constricted

43
Q

What leads to small muscle waste in the hand (intrinsic muscles) in Pancoast syndrome?
What dermatomes are lost?

A

Tumour compresses ulnar nerve in brachial plexus

C8, T1 dermatomes affected

44
Q

What imaging do you do on all lung cancers?

A

CXR
Staging CT

45
Q

Why may you not do a biopsy for lung cancer?

A

Person doesnt want treatment
The biopsy might kill off the patient

46
Q

What are some biopsy methods for lung cancer?

A

Bronchoscopy
Pleural fluid aspiration
Adrenal biopsy
Bone biopsy
Brain biopsy
Cervical lymph node fine needle aspiration

47
Q

Why do we want to biopsy a lung cancer?

A

To determine what type of cancer it is

48
Q

What is a carcinoma?

A

Invasive malignant epithelial tumour

49
Q

What are the 2 main types of lung cancer?

A

Non-small cell lung cancer

Small cell carcinoma

50
Q

What are some nonsmal cell lung cancers?

A

Squamous cell carcinoma
Adenocarnioma
Large cell carcinoma

51
Q

What are some molecular markers of lung cancer?

A

EGFR
ALK
KRAS
PD1
PDL-1

52
Q

What are the main differences between small cell and non-small cell lung carcinoma?

A

Small cell = rapidly growing/aggressive + metastasises

53
Q

What are some clinical features causes y small cell caricinoma blocking the SVC?

A

Raised JVP and all vein distension around neck
Stridor compress airways
Dyspnoea
Facial plethora

54
Q

What can cause Hypercalcaemia in a patient with squamous cell carcinoma of the lung?

A

Ectopic PTH production
PTH related peptide production

55
Q

Whta are some clinical signs of Hypercalcaemia?

A

Extraskeletal calcification
Muscle weakness
Confusion
Fragile bones
Thirsty + freq urination

Y2 - Resp (23 decks)

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