Lecture 18: Lung cancer Flashcards
How many deaths are there worldwide due to lung cancer?
Highest cancer related deaths worldwide
35,000 deaths per year
Does social class effect lung cancer incidence?
Yes, lower socioeconomic groups have a higher prevalence
- occupation
- smoking rates
- access to healthcare/screening
What is the median age for lung cancer diagnosis?
70yo
How does smoking relate to lung cancer?
Smoking causes:
-90% of lung cancer deaths in men
-80% of lung cancer deaths in women
1/3 of all cancer deaths
What are the risk factors for lung cancer?
- smoking
- asbestos
- radon
- occupational carcinogens
- genetic/familial factors
What factors determine whether a disease should be screened for?
- disease with serious consequences
- high prevalence of detectable disease
- test detects little overdiagnosis
- test detects disease before the critical point
- test causes little mortality
- test is affordable and available
- treatment exists
- treatment more effective when applied before symptomatic detection
- treatment not too risky/toxic
e.g. low dose chest CT (screening): reduce mortaility of lung cancer
Where are the common site for metastases in lung cancer?
- liver
- adrenal glands
- brain
- bone
- draining lymph nodes
- pericardium
- lung and pleura
- vertebra
What imaging do you do if you detect lung cancer?
- CXR
- CT (detect staging)
- PET scan (as CT has limited ability to pick up metastases, and it also shows us the activity)
- MRI (brain metastases)
- sometimes ultrasound
- bone scan (bone metastases)
- ECHO (look at cardiac function to see if heart is ok for an op)
What test do we need todo after imaging for lung cancer?
Tissue sampling
- bronchoscopy
- CT biopsy
- thorocoscopy
- surgical biopsies but these require anaesthesia
What are the symptoms for lung cancer?
Usually no symptoms
- cough
- dyspnoea
- wheezing
- haemoptysis
- lung infection
- chest/shoulder pain
- weight loss
- lethargy/malaise
What signs can we see if patient has lung cancer?
- cachexia
- pale conjunctiva (anaemic)
- cervical lymphadenopathy
- Horner’s syndrome
- finger clubbing
- superior vena cava obstruction: bloated face
- consolidation
- signs of pleural effusion
- liver enlargement from metastases
- muffled heart sounds
What are some paraneoplastic syndromes associated with lung cancer?
Endocrine: hypercalcaemia, Cushing’s syndrome, SIADH
Neurological: pancoast syndrome, encephalopathy, peripheral neuropathy
Haematological: anaemia, thrombocytosis
Cutaenous: dermatomyositis
Skeletal: finger clubbing
Who would you not biopsy if they had a suspected lung cancer?
- people who don’t want any treatment
- people who have poor performance status
What is a carcinoma?
Invasive malignant epithelial tumour
What are the main types of lung cancer?
Non-small cell lung cancer: squamous cell, adenocarcinoma, large cell carcinoma
Small cell carcinoma
Rare tumours (carcinoid)
