Lecture 20- Lung cancer Flashcards
80% of lung cancers related to
previous smoking
epidemiology of lung cancer
- Highest cancer related deaths world wide
- 35,000 deaths per year-UK
- >600 new cases per year in Leicester
proportion of patients surviving one year after dianosis
- Survival in people with stage 1= 83%
- Stage IV = 17%
- Early diagnosis increases prognosis
incidence of lung cancer is also correlarted with
least affluent in society
when are most people diagosed with lung csancer
70-80
risk factors
- smoking
- astbestos
- radon
- occupational carcinogens e.g. chromium, nickel, arsenic
- genetic familial factors
smoking
- Causes approx. 80/90% of death
- 20% of lung cancer cases in non-smokers
- 5000 cases a year never smoked
- 20% of lung cancer cases in non-smokers
symptoms of primary lung tumour
- Cough
- Dyspnoea
- Wheezing
- Haemoptysis
- Lung infection
- Chest /shoulder pain
- Weight loss
- Lethargy
- Malaise
- Commonest presentation = no symptoms
symptoms of regional metastases
- Bloated face (SVC obstruction)
- Hoarseness (left recurrent laryngeal nerve palsy)
- Dyspnoea (anaemia, pleural or pericardial effusions)
- Dyspahoa (oesophageal compression)
- Chest pain (parietal pleural involvement)
symptoms of Distant metastases
- Bone pain/fractures
- CNS symptoms (headaches, double vison, confusion)
metabolic symptoms
- Thirst (hypercalcaemia)
- Constipation (hypercalcaemia)
- Seizures (hyponatraemia- SIADH, small cell)
- Signs of lung cancer
- 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
lung cancer paraneoplastic syndromes
Staging of lung cancer uses
TNM classification
TNM classification
- Tumour
- Size
- Location
- Relation to important structures
- Nodal
- N1- hila lymph nodes
- N2- mediastinal
- N3 – supra-clavicular lymph nodes
- Metastasis
the lower the stage of cancer
the longer a pt survives
most patients have
advanced lung disease on diagnosis
the later the stage
the less treatment options
lung cancer: local and distant spread
- brain
- draining lymph nodes
- pericardium
- lung
- pleura
- liver
- adrenals
- bone
staging tests carried out by
imaging and tissue sampling
staging tests: imaging
- CXR
- CT scan
- PET scan
- MRI
- USS
- Bone scan
- ECHO
staging tests: tissue sampling
-
(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
- Bronchoscopy
diagnosing lung cancer
- Who would you not biopsy
- people who have a very poor performance status or if they don’t want treatment
- Person may die of biopsy and not the cancer
- people who have a very poor performance status or if they don’t want treatment
main types of lung cancer
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%
Molecular makers?
Mutations can be found to predict sensitivity to chemotherapy
- EGFR mutation
- ALK mutation
- KRAS mutations
- ROS mutations
- PD1 mutations
- PDL 1 mutation
treatment overview
may involve
- surgery
- radiotherapy
- combination chemotherapy
- combination therapy
- biological targeted therapy
- palliative care and other treatment
surgery
mostly for non small cell- best chance of cure
radiotherapy
radical- curative intent
palliative- symptom control
combination chemo
- 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>
combination therapy
combination chemo radiotherapy- potentially curvative
biological targeted therapies
a potential game changer
based on mutational analysis
palliative care and other treatments
active symptom control: analgesia, radiotherapy, airway stents,m anxiolytics, nutritional supportm, patient support groups
- treeatment for tobacco addition, CHD etc
prevention of lung diagnosis when advanced lung disease
screening
screening criteria- does lung cancer meet this?
- 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
mass media campaigns
aimed at reducing the stage at which lung cancer is diagnosed
Small cell carcinoma can produce which ectopic endocrine effects
SIADH (ectopic ADH)
Cushings syndrome (ACTH)
Squamous cell carcinoma can produce which ectopic endocrine effects
Parathyroid hormone-related protein (or PTHrP)
- hypercalcemia
