Lung Cancer Flashcards
What are the three most common cancers?
1) prostate
2) breast
3) Lung
What are the three main types of Non-small cell lung cancers?
1) Adenocarcinoma (most common)
2) Squamous cell carcinoma
3) Large-cell carcinoma
What are small cell carcinomas?
- Cancer cells contain neurosecretory granules which release neuroendocrine hormones
- They are the cause for multiple paraneoplastic syndromes
What are the signs/symptoms of lung cancer?
- Shortness of breath
- Cough
- Haemoptysis
- Finger clubbing
- Recurrent pneumonia
- Weight loss
- Lymphadenopathy
What is the first line investigation procedure for lung cancer?
CXR
- Hilar enlargement
- Peripheral opacity
- Pleural effusion
- Collapse
What investigations can be done to assess lung cancer?
- CXR
- Staging CT scan
- PET-CT
- Bronchoscopy
- Histological diagnosis
What can a Staging CT tell you about lung cancer?
- Used to assess metastasis especially lymph nodes
- CT is contrast enhanced to give more detail
How do PET-CT scans work?
- Inject radioactive tracer
- Images are taken using a CT scanner and gamma ray detector
- used to assess how metabolically active tissues are
- increased metabolic activity in an area suggests cancer
How is bronchoscopy used to assess lung cancer?
- endoscopy of bronchial with ultrasound at the end of the scope
- ovation an ultrasound guided biopsy which can then be assessed to find cancer cell type
What are the treatment options for long cancer?
1) Surgery
2) Radiotherapy
3) Chemotherapy
4) Endobronchial treatment
What is the first line treatment for small cell carcinomas?
- Chemotherapy and radiotherapy
- prognosis usually worse than non-small cell
What is the first line treatment option for non-small cell carcinomas?
Surgery
- used to cure cancer
- Can either do a lobectomy (Removal of lobe) or segmentectomy (removal of segment)
When are radiotherapy and chemotherapy used in non-small cell carcinomas?
- Radiotherapy for early stage non-small cell carcinoma to cure cancer
- Chemotherapy used as addition to Radiotherapy or surgery to improve outcomes or as palliative care to improve survival and quality of life in non-small cell
What is endobronchial treatment and what’s the purpose?
- palliative treatment to relieve bronchial obstruction
- stents or debulking used to reduce obstruction
What are some of the extra pulmonary manifestations caused by lung cancer and what are they caused by?
- Recurrent laryngeal nerve palsy (tumour pressing on Laryngeal nerve)
- Phrenic nerve palsy (nerve compression causes diaphragm weakness presents as breathlessness)
- Superior vena cava obstruction (tumour compresses SVC)
- Horners syndrome (Pancoast tumour presses on sympathetic ganglion)
What are the paraneoplastic syndromes caused by lung cancer?
- Hypercalcaemia (caused by parathyroid secretion by squamous cell tumour)
- Cushing syndrome (caused by ectopic ACTH secreting small cell tumour)
- Syndrome of inappropriate ADH (ectopic ADH secreting small cell tumour, present with hyponatremia)
- Limbic encephalitis (caused by small cell lung cancer)
- Lambert-Eaton Myasthenic Syndrome
How will Superior Vena Cave obstruction present?
- Facial Swelling
- Difficulty breathing
- distended veins in the neck and upper chest
- Pemberton’s sign (raising hand over head causes facial congestion and cyanosis)
How will Horners syndrome present?
- Partial ptosis
- Anhidrosis
- Miosis
What is Limbic Encephalitis?
- Small cell Lung caner causes immune system to make antibodies which act on brain tissues
- cause inflammation in the limbic system
- Symptoms: short term memory impairment, hallucinations, confusion and seizures
- associated with anti-Hu antibodies
What is Lambert-Eaton Myasthenic Syndrome?
- antibodies are produced by immune system against the small cell lung cancer cells
- Antibodies target voltage-gated calcium channels on presynaptic terminals of motor neurones
What muscles are affected by Lambert-Eaton Myasthenic Syndrome?
- proximal muscles
- introcular (causing diplopia)
- Levator in eyelid (causing ptosis)
- Pharyngeal (slurred speech and dysphasia)
What are the symptoms of Lambert-Eaton Myasthenic Syndrome?
- Diplopia
- Ptosis
- Slurred speech
- Dysphagia
(caused by autonomic dysfunction:) - Dry mouth
- Blurred vision
- Impotence
- Dizziness
- Reduced tendon reflexes which improves after periods of strong muscle contraction (post-tetanic potentiation)
What is a mesothelioma?
- Lung malignancy affecting mesothelial cells of pleura
What is the cause and prognosis of mesotheliomas?
- Asbestos, Latent period can be over 50 years
- Poor prognosis treated with chemotherapy (usually palliative)
