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Respiratory > Lecture 20- Lung cancer > Flashcards

Lecture 20- Lung cancer Flashcards

1
Q

80% of lung cancers related to

A

previous smoking

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2
Q

epidemiology of lung cancer

A
  • Highest cancer related deaths world wide
  • 35,000 deaths per year-UK
  • >600 new cases per year in Leicester
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3
Q

proportion of patients surviving one year after dianosis

A
  • Survival in people with stage 1= 83%
  • Stage IV = 17%
    • Early diagnosis increases prognosis
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4
Q

incidence of lung cancer is also correlarted with

A

least affluent in society

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5
Q

when are most people diagosed with lung csancer

A

70-80

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6
Q

risk factors

A
  • smoking
  • astbestos
  • radon
  • occupational carcinogens e.g. chromium, nickel, arsenic
  • genetic familial factors
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7
Q

smoking

A
  • Causes approx. 80/90% of death
    • 20% of lung cancer cases in non-smokers
      • 5000 cases a year never smoked
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8
Q

symptoms of primary lung tumour

A
  • Cough
  • Dyspnoea
  • Wheezing
  • Haemoptysis
  • Lung infection
  • Chest /shoulder pain
  • Weight loss
  • Lethargy
  • Malaise
  • Commonest presentation = no symptoms
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9
Q

symptoms of regional metastases

A
  • Bloated face (SVC obstruction)
  • Hoarseness (left recurrent laryngeal nerve palsy)
  • Dyspnoea (anaemia, pleural or pericardial effusions)
  • Dyspahoa (oesophageal compression)
  • Chest pain (parietal pleural involvement)
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10
Q

symptoms of Distant metastases

A
  • Bone pain/fractures
  • CNS symptoms (headaches, double vison, confusion)
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11
Q

metabolic symptoms

A
  • Thirst (hypercalcaemia)
  • Constipation (hypercalcaemia)
  • Seizures (hyponatraemia- SIADH, small cell)
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12
Q
  • Signs of lung cancer
A
  • Cachexia- extreme weight loss and muscle wastign
  • Pale conjunctiva- anaemia
  • Cervical lymphadenopathy
  • Horner’s syndrome (H+N)
  • Finger clubbing
  • Superior vena cava obstruction
  • Consolidation
  • Signs of pleural effusion
  • Muffled heart sounds
  • Liver enlargement
  • Skin metastases
  • Neurological long tract signs
  • NO SIGNS- vast majority
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13
Q

lung cancer paraneoplastic syndromes

A
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14
Q

Staging of lung cancer uses

A

TNM classification

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15
Q

TNM classification

A
  • Tumour
    • Size
    • Location
    • Relation to important structures
  • Nodal
    • N1- hila lymph nodes
    • N2- mediastinal
    • N3 – supra-clavicular lymph nodes
  • Metastasis
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16
Q

the lower the stage of cancer

A

the longer a pt survives

17
Q

most patients have

A

advanced lung disease on diagnosis

18
Q

the later the stage

A

the less treatment options

19
Q

lung cancer: local and distant spread

A
  • brain
  • draining lymph nodes
  • pericardium
  • lung
  • pleura
  • liver
  • adrenals
  • bone
20
Q

staging tests carried out by

A

imaging and tissue sampling

21
Q

staging tests: imaging

A
  • CXR
  • CT scan
  • PET scan
  • MRI
  • USS
  • Bone scan
  • ECHO
22
Q

staging tests: tissue sampling

A
  • (to be sure it is lung cancer and what sort of lung cancer)
    • Bronchoscopy
      • Endobronchial Bx, wash, EBUS, radial EBUS, EUS
    • USS
      • Neck nodes, lung/chest wall mass, pleural fluid, liver
    • CT biopsy
      • Lung, pleura
    • Thoroscopy
      • medical
    • Surgical
      • Mediastinoscopy, VATS pleural bx, rigid bronchoscopy, neck and axillary nodal excision, VATs excisionbx, adrenal bx, brain bx, bone, bx
23
Q

diagnosing lung cancer

A
24
Q
  • Who would you not biopsy
A
    • people who have a very poor performance status or if they don’t want treatment
      • Person may die of biopsy and not the cancer
25
Q

main types of lung cancer

A

Carcinoma is an invasive malignant epithelial tumour

  • Non-small cell lung cancer
    • Squamous >40%
    • Adenocarcinoma >40%
    • Large cell carcinoma 5-10%
  • Small cell carcinoma 10%
  • Rare rumours (Carcinoid) <5%
26
Q

Molecular makers?

A

Mutations can be found to predict sensitivity to chemotherapy

  • EGFR mutation
  • ALK mutation
  • KRAS mutations
  • ROS mutations
  • PD1 mutations
  • PDL 1 mutation
27
Q

treatment overview

A

may involve

  • surgery
  • radiotherapy
  • combination chemotherapy
  • combination therapy
  • biological targeted therapy
  • palliative care and other treatment
28
Q

surgery

A

mostly for non small cell- best chance of cure

29
Q

radiotherapy

A

radical- curative intent

palliative- symptom control

30
Q

combination chemo

A
  • small cell- potentially curative in minority
  • non small cell- modest survival increase , symptom control

neoadjuvant- chemo before surgery - to downstage tumour

adjuvent- chemo after surgery (no benefit if <stage></stage>

31
Q

combination therapy

A

combination chemo radiotherapy- potentially curvative

32
Q

biological targeted therapies

A

a potential game changer

based on mutational analysis

33
Q

palliative care and other treatments

A

active symptom control: analgesia, radiotherapy, airway stents,m anxiolytics, nutritional supportm, patient support groups

  • treeatment for tobacco addition, CHD etc
34
Q

prevention of lung diagnosis when advanced lung disease

A

screening

35
Q

screening criteria- does lung cancer meet this?

A
  • Disease with serious consequence
  • High prevalence of detectable disease
  • Test detect little pseudo-disease (over diagnosis)
  • Test detects disease before the critical point
  • Test causes little morbidity, affordable and available
  • Treatment exists
  • Treatment more effective when applied before symptomatic detection
  • Treatment not too risk or toxic
  • Decrease in disease specific mortality

Does lung cancer meet this? Yes meets all this criteria

36
Q

mass media campaigns

A

aimed at reducing the stage at which lung cancer is diagnosed

37
Q

Small cell carcinoma can produce which ectopic endocrine effects

A

SIADH (ectopic ADH)

Cushings syndrome (ACTH)

38
Q

Squamous cell carcinoma can produce which ectopic endocrine effects

A

Parathyroid hormone-related protein (or PTHrP)

  • hypercalcemia

Respiratory (27 decks)

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