Lung Cancer Flashcards
How common is lung cancer in the UK?
Lung cancer is the third most common cancer in the UK behind breast and prostate.
One of the biggest cause of lung cancer is
Cigarette smoking
Non-small cell lung cancer accounts for about
80% of all lung cancers
Non-small cell lung cancer types include
Adenocarcinoma (around 40%)
Squamous cell carcinoma (around 20%)
Large-cell carcinoma (around 10%)
Other types (around 10%)
Small Cell Lung Cancer (SCLC) accounts for about
20% of all lung cancers
Small cell lung cancer cells contain ________ that can release _________ hormones. This makes SCLC responsible for multiple paraneoplastic syndromes.
neurosecretory granules; neuroendocrine
Signs and Symptoms of lung cancer include
- Shortness of breath
- Cough
- Haemoptysis
- Finger clubbing
- Recurrent pneumonia
- Weight loss
- Lymphadenopathy – often supraclavicular nodes are the first to be found on examination
Lung cancer investigations include:
- Chest x-ray
- Staging CT scan
- PET-CT (positron emission tomography)
- Bronchoscopy with endobronchial ultrasound (EBUS)
- Histological diagnosis
Chest x-ray is the first-line investigation in suspected lung cancer. Findings suggesting cancer include:
- Hilar enlargement
- “Peripheral opacity” – a visible lesion in the lung field
- Pleural effusion – usually unilateral in cancer
- Collapse
How should the Staging CT scan of chest, abdomen and pelvis be carried out?
This should be contrast enhanced using an injected contrast to give more detailed information about different tissues.
PET-CT (positron emission tomography) scans involve
injecting a radioactive tracer (usually attached to glucose molecules) and taking images using a combination of a CT scanner and a gamma ray detector to visualise how metabolically active various tissues are. They are useful in identifying areas that the cancer has spread to by showing areas of increased metabolic activity suggestive of cancer.
What does a Bronchoscopy with endobronchial ultrasound (EBUS) provide?
This allows for detailed assessment of the tumour and ultrasound guided biopsy.
What are some available treatment options for lung cancer?
- Surgery
- Radiotherapy
- Chemotherapy
- Endobronchial treatment
When is surgery for lung cancer offered?
Surgery is offered first line in non-small cell lung cancer to patients that have disease isolated to a single area with intention to cure the cancer.
What are the 2 types of lung cancer surgeries available?
- Lobectomy (removing the lung lobe containing the tumour) is first line.
- Segmentectomy or wedge resection (taking a segment or wedge of lung to remove the tumour).
When can radiotherapy be used?
Radiotherapy can also be curative in non-small cell lung cancer when early enough.
When can chemotherapy be used?
- Can be offered in addition to surgery or radiotherapy in certain patients to improve outcomes (“adjuvant chemotherapy”)
- As palliative treatment to improve survival and quality of life in later stages of non-small cell lung cancer.
Treatment for small cell lung cancer is usually
chemotherapy and radiotherapy
Prognosis is generally worse for
small cell lung cancer than non-small cell lung cancer
When can endobronchial treatment be used?
Endobronchial treatment with stents or debulking can be used as part of palliative treatment to relieve bronchial obstruction caused by lung cancer.
Lung cancer is associated with a lot of
extrapulmonary manifestations and paraneoplastic syndromes
Extrapulmonary Manifestations associated with lung cancer include
- Recurrent laryngeal nerve palsy
- Phrenic nerve palsy
- Superior vena cava obstruction
- Horner’s syndrome
- Syndrome of inappropriate ADH (SIADH)
- Cushing’s syndrome
- Hypercalcaemia
- Limbic encephalitis
- Lambert-Eaton myasthenic syndrome
What is Recurrent laryngeal nerve palsy?
Recurrent laryngeal nerve palsy presents with a hoarse voice. It is caused by the cancer pressing on or affecting the recurrent laryngeal nerve as it passes through the mediastinum.
Why does Phrenic nerve palsy occur?
Phrenic nerve palsy due to nerve compression causes diaphragm weakness and presents as shortness of breath.
What is Superior vena cava obstruction?
Superior vena cava obstruction is a complication of lung cancer. It is caused by direct compression of the tumour on the superior vena cava. It presents with facial swelling, difficulty breathing and distended veins in the neck and upper chest.
What is Pemberton’s sign?
“Pemberton’s sign” is where raising the hands over the head causes facial congestion and cyanosis. This is a medical emergency.
What is Horner’s syndrome?
Horner’s syndrome is a triad of partial ptosis, anhidrosis and miosis. It is caused by a Pancoast’s tumour (tumour in the pulmonary apex) pressing on the sympathetic ganglion.
Syndrome of inappropriate ADH (SIADH) is caused by
ectopic ADH secretion by a small cell lung cancer and presents with hyponatraemia
Cushing’s syndrome can be caused by
ectopic ACTH secretion by a small cell lung cancer
Hypercalcaemia is caused by
ectopic parathyroid hormone from a squamous cell carcinoma
What is Limbic encephalitis?
This is a paraneoplastic syndrome where the small cell lung cancer causes the immune system to make antibodies to tissues in the brain, specifically the limbic system, causing inflammation in these areas. This causes symptoms such as short-term memory impairment, hallucinations, confusion and seizures. It is associated with anti-Hu antibodies.
Lambert-Eaton myasthenic syndrome is a result of
antibodies produced by the immune system against small cell lung cancer cells
Lambert-Eaton myasthenic syndrome antibodies target and damage
voltage-gated calcium channels sited on the presynaptic terminals in motor neurones
Lambert-Eaton myasthenic syndrome
antibodies target and damage voltage-gated calcium channels sited on the presynaptic terminals in motor neurones leading to
weakness, particularly in the proximal muscles but can also affect intraocular muscles causing diplopia (double vision), levator muscles in the eyelid causing ptosis and pharyngeal muscles causing slurred speech and dysphagia (difficulty swallowing). Patients may also experience dry mouth, blurred vision, impotence and dizziness due to autonomic dysfunction.
Patients with Lambert-Eaton have reduced
tendon reflexes
In older smokers with symptoms of Lambert-Eaton syndrome consider
Small cell lung cancer
What is mesothelioma?
Mesothelioma is a lung malignancy affecting the mesothelial cells of the pleura. It is strongly linked to asbestos inhalation. There is a huge latent period between exposure to asbestos and the development of mesothelioma of up to 45 years. The prognosis is very poor. Chemotherapy can improve survival but it is essentially palliative.
