Lung Cancer Flashcards
1
Q
What is the epidemiology for Lung cancer?
A
- Lung Cancer is the biggest cause of cancer related death worldwide and in the UK
- 38,000 new cases/year in the UK
- Number of cases in women continue to rise
- 5 year survival approximately 13%
- 85% of LC occurs in smokers or ex-smokers
2
Q
What is the most common finding for Long cancer?
A
Asymptomatic
3
Q
What are symptoms of lung cancer?
A
- Cough
- Breathlessness
- Haemoptysis
- Chest Pain
- Wheeze
- Hoarse Voice
- Recurrent infection
- Horner’s syndrome
- Superior Vena Caval obstruction
- Invasion of Phrenic nerve
- Metastases
- Paraneoplastic
4
Q
What are symptoms of Horner’s Syndrome?
A
- Nerve compression due to growth of Pancoast tumour.
- Miosis, Anhydosis and Ptosis
Investigated through CT chest
5
Q
What is the result of invasion of Phrenic Nerve?
A
- Causes paralysis of ipsilateral hemidiaphragm
- Can compress oesophagus leading to progressive dysphagia, can involve pericardium as well leading to pericardial effusion and malignant dysrhythmias
6
Q
What are some Paraneoplastic syndromes?
A
- Clubbing
- Hypercalcaemia
- Anaemia
- SIADH
- Cushing’s syndrome
- Lambert-Eaton Myasthenic syndrome
- Thrombo-embolic disease
7
Q
Where can lung cancer spread?
A
- Liver
- Bone
- Adrenal Gland
- Brain
- Malignant Pleural effusion
8
Q
What are risk factors for development of lung cancer?
A
- Large number of smoking pack years
- Airflow obstruction
- Increasing age
- Family history of lung cancer
- Exposure to other carcinogens, e.g. asbestos
9
Q
What are diagnostic tests for Lung Cancer?
A
- MDT approach vital (Physicians, Oncologists, Surgeons, Radiologists, Pathologists, Palliative Care Team, Specialist Nurses, Primary Care)
- Bloods: FBC, U&E’s, Calcium, LFT’s, INR
- CXR
- Staging CT: Spiral CT Thorax and Upper Abdomen which helps to stratify TNM stage
- Histology
- PET Scan
10
Q
What are histological options for investigations?
A
- US guided neck node FNA for cytology if lymphadenopathy
- Bronchoscopy: endobronchial, transbronchial, endobronchial ultrasound (if mediastinal lymphadenopathy)
- CT Biopsy: Thoracoscopy if pleural effusion present
11
Q
When is a PET scan useful?
A
- MDT Decision if patient is a surgical candidate and initial CT suggestive of low stage
- Helps to detect small metastases not seen on staging CT
12
Q
How can lung cancer be histologically classified?
A
- Small cell (oat cell) lung cancer (SCLC)
- Non-small cell lung cancer (NSCLC)
- Others - bronchial gland ca, carcinoid tumour
13
Q
What are the sub categories of Non Small Cell Lung Cancer?
A
- Squamous cell (most common)
- Adenocarcinoma
- Large cell carcinoma
- Bronchoalveolar cancer
14
Q
What are treatment options for Lung cancer?
A
- Curative surgery for stages I & II – assuming fit for surgery
- Surgery & Adjuvant Chemotherapy clinical trial for stage IIIa – assuming fit for surgery & chemo
- Chemotherapy – consider in patients with stage III/IV disease and PS 0-2
- Radiotherapy – curative (CHART = continuous hyperfractionated accelerated radiotherapy) for people not fit for surgery OR palliative
- Palliative Care
15
Q
What are treatment options for SCLC and prognosis?
A
Management
- Rapid growth rate and almost always too extensive for surgery at time of diagnosis
- Mainstay of treatment is chemotherapy. Also, palliative radiotherapy
Prognosis
- Untreated – median survival is 4-12 weeks
- Combination chemotherapy – median survival 6- 15 months
