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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
How is a PET scan useful?
Can see if a mass is benign or malignant Benign cells not metabolically active so dont show up brightly on PET
26
What are some symptoms of lung cancer from the primary tumour?
Cough Dyspnoea Wheezing Haemoptysis Lung infection Chest/shoulder pain Weight loss Lethargy/malaise Clubbing NO SYMPTOMS
27
How can a primary lung tumour cause lung infections?
Tumour preventing airway mucus clearance so infection occurs
28
How may a primary lung tumour cause shoulder pain?
May irritate the phrenic nerve
29
What are some symptoms of the regional metastases from lung cancer?
Bloated face from SVC obstruction Hoarseness Dyspnoae Dysphagia Chest pain
30
How can a lung metastasis cause hoarseness of voice?
Compress left laryngeal nerve supplying the vocal cords (left laryngeal nerve palsy)
31
How can a lung metastasis cause Dysphagia?
Oesophageal compression
32
How can a lung metastasis cause dyspnoea?
Anaemia Pleural or pericardial effusion
33
How can a lung cancer cause seizures?
hyponatraemia due to SIADH or small cell carcinoma
34
What are some signs of lung cancer?
Cachexia (weakness/body wasting) Cervical lymphadenopathy HORNERS SYNDROME Consolidation Neurological long tract sings Finger clubbing
35
What are some paraneoplastic endocrine syndromes of lung cancer?
Hypercalcaemia Cushing’s syndrome SIADH (syndrome of inappropriate ADH secretion)
36
What are some paraneoplastic neurological syndromes of lung cancer?
Pancoast syndrome Encephalopathy Peripheral neuropathy
37
What is a Pancoast tumour?
Tumour of the apex of the lungs
38
What is Pancoast syndrome?
Horners syndrome + persistent shoulder and arm pain + wastage of intrinsic hand muscles
39
What is Horner’s syndrome?
Partial Ptosis Miosis Anhydrosis
40
What causes the partial Ptosis in Pancoast syndrome?
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
What is misosis and how is it caused in Pancoast syndrome?
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
What is misosis and how is it caused in Pancoast syndrome?
Constriction of pupil The Pancoast tumour compresses the sympathetic chain ascending to the head so innervation to dialtor papillae lost so pupil constricted
43
What leads to small muscle waste in the hand (intrinsic muscles) in Pancoast syndrome? What dermatomes are lost?
Tumour compresses ulnar nerve in brachial plexus C8, T1 dermatomes affected
44
What imaging do you do on all lung cancers?
CXR Staging CT
45
Why may you not do a biopsy for lung cancer?
Person doesnt want treatment The biopsy might kill off the patient
46
What are some biopsy methods for lung cancer?
Bronchoscopy Pleural fluid aspiration Adrenal biopsy Bone biopsy Brain biopsy Cervical lymph node fine needle aspiration
47
Why do we want to biopsy a lung cancer?
To determine what type of cancer it is
48
What is a carcinoma?
Invasive malignant epithelial tumour
49
What are the 2 main types of lung cancer?
Non-small cell lung cancer Small cell carcinoma
50
What are some nonsmal cell lung cancers?
Squamous cell carcinoma Adenocarnioma Large cell carcinoma
51
What are some molecular markers of lung cancer?
EGFR ALK KRAS PD1 PDL-1
52
What are the main differences between small cell and non-small cell lung carcinoma?
Small cell = rapidly growing/aggressive + metastasises
53
What are some clinical features causes y small cell caricinoma blocking the SVC?
Raised JVP and all vein distension around neck Stridor compress airways Dyspnoea Facial plethora
54
What can cause Hypercalcaemia in a patient with squamous cell carcinoma of the lung?
Ectopic PTH production PTH related peptide production
55
Whta are some clinical signs of Hypercalcaemia?
Extraskeletal calcification Muscle weakness Confusion Fragile bones Thirsty + freq urination

Y2 - Resp (23 decks)

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