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Oncology > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

What is the first line investigation for suspected lung cancer

A

CXR

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2
Q

List the investigation carried out to diganose lung cancer

A

CXR - first line
CT chest, abdo, pelvis - for staging and checks for node involvement and mets
PET scan - good at identifying mets
Bronchoscopy - can take biopsy at ime this t

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3
Q

How do you tell if a CXR has appropriate inspiration

A

Should show at least the 10th or 11th posterior rib

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4
Q

How much of the chest should the heart take up on CXR

A

Less than 50% of the total diameter of the chest

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5
Q

What is the most common lung cancer

A

Adenocarcinoma

Followed by squamous cell

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6
Q

Which is more common small cell or non-small cell lung cancer

A

Non-small cell

Makes up 85% of lung cancer cases

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7
Q

Which lung cancers are associated with smokers

A

Adenocarcinoma - smoking and asbestos are risk factors
Squamous cell - smoking is main cause
Small cell - almost exclusively smokers

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8
Q

Which lung cancers tend to metastasise early

A

Small cell - poor prognosis as aggressive

Large cell

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9
Q

Which lung cancers tend to metastasise early

A

Small cell - poor prognosis as aggressive

Large cell

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10
Q

Squamous cell cancers tend to develop in which part of the lung

A

Central areas

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11
Q

What is the main treatment for small cell lung cancer

A

Chemotherapy with platinum-based drugs usually forms the mainstay of treatment
Surgery is usually not an option

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12
Q

Surgery is a treatment option in which lung cancer patients

A

Stage I or Stage II disease
Dependent on performance status, prognosis + likelihood of
success.
Can be used alongside chemo

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13
Q

Which type of immunotherapy is used in lung cancer

A

Immune checkpoint inhibitors
When these checkpoints are turned on they signal T cells to not mount an immune
response.
Checkpoint inhibitor immunotherapy works by blocking the binding of checkpoints to their partner proteins, thus preventing the ‘turning off’ of T cells.
This aids the immune system in mounting an immune response against the cancer

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14
Q

Immunotherapy can cause what side effects

A 
Fatigue
Nausea & vomiting
Rash
Diarrhoea 
Shortness of breath

Although typically better tolerated than traditional chemo

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15
Q

Which paraneoplastic syndrome is associated with squamous cell carcinoma of the lung

A

Ectopic parathyroid related peptide production

This acts like parathyroid hormone and leads to hypercalcaemia

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16
Q

What are the symptoms of hypercalcaemia

A

Stones, bones, abdominal moans
and psychic groans

Renal stones, and also diabetes insipidus.
Bone problems e.g. osteoporosis and pathological fractures.
Abdominal moans meaning abdominal pain, constipation,
nausea and vomiting.
Psychic groans referring to depression, anxiety, irritability
and psychosis.

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17
Q

Hypercalcaemia of malignancy can be caused by which cancers

A

Squamous cell lung cancer

Bone mets - common with lung, breast and prostate

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18
Q

How do you treat hypercalcaemia in malignancy

A

If severe or symptomatic, the patient can be admitted to hospital
and treated with IV fluids and IV bisphosphonate therapy.
If mild and asymptomatic the blood tests can just be monitored.

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19
Q

Which paraneoplastic syndromes are associated with small cell lung cancer

A 
Lambert-Eaton Syndrome 
Cushing's Syndrome 
Syndrome of inappropriate ADH secretion 
Cerebellar ataxia 
Limbic encephalitis 
Dermatological
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20
Q

What are the unmodifiable risk factors for lung cancer

A

Age

Genetics - risk increases if 1st degree relative had it

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21
Q

List some modifiable risk factors for lung cancer

A 
Smoking  - mainly small cell and squamous 
Occupational exposure 
Air pollution 
Ionising radiation exposure 
Poor diet
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22
Q

List some of the intrathoracic symptoms of lung cancer

A 
Cough
Dyspnoea
Chest pain
Haemoptysis
Chest infection
Hoarseness
Pleural effusion
Superior Vena Cava Obstruction
Pancoast tumour/syndrome
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23
Q

List the common sites of mets from lung cancer and their symptoms

A

Liver - can cause pain if capsule stretched
Bone - lytic lesions, pain, can cord compression
Adrenal - asymptomatic
Brain - mass symptoms (ICP)

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24
Q

List some of the paraneoplastic syndromes associated with lung cancer

A 
Hypercalcaemia
SIADH secretion
Neurologic manifestations
Haematological manifestations
Hypertrophic osteoarthropathy
Dermatomyositis, polymyositis
Cushing’s syndrom
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25
Q

What surgical treatments are available for lung cancer

A

Wedge resection
Segmentectomy
Lobectomy
Pneumonectomy

Can also do hilar and mediastinal node sampling
Palliative procedures such as stenting and debulking

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26
Q

What is the prupose of adjuvatn chemo and radiotherapy following lung surgery

A 
Chemo = improves survival 
Radio = prevents local recurrence
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27
Q

What is the best option for cure in lung cancer

A

Surgery - treatment of choice if curative

Radiotherapy is the next best

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28
Q

How is radiotherapy used palliatively in lung cancer

A

Used to treat bony mets and cord compression

Palliative radiotherapy is at a lower dose and fewer fractions

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29
Q

What is the typical dose for conventional external beam radiotherapy for lung cancer

A

55 Gray in 20 fractions

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30
Q

What prophylactic treatment is used in small cell lung cancer

A

Prophylactic cranial irradiation due to high risk of brain mets
20% have them at diagnosis, 80% by time of death
It halves the incidence

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31
Q

List some of the temporary side effects of lung radiotherapy

A 
Fatigue
Shortness of breath
Cough
Oesophagitis
Skin changes
After prophylatoc cranial radio - Headaches, nausea, hair loss
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32
Q

Side effects from radiation tend to peak when

A

After the completion of treatment

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33
Q

List some of the permanent effects of radiotherapy toxicity following lung treatment

A

Breathlessness due to fibrosis

After Stereotactic ablative body radiotherapy (SABR)

  • Brachial plexopathy
  • Myelopathy
  • Rib fractures

After prohylactoc cranial - memory/cognitive impairment

Secondary malignanc

34
Q

Which type of lung cancer is usually most chemo responsive

A

Small cell

35
Q

Are targeted therapies and immunoherapies used for curative or palliative treatment

A

They have no established role in curative regimes

Some targeted ones can be used as 1st line palliative

36
Q

Targeted therapies are mainly used for which types of lung cancer

A

Non-small cell

A number of mutations have been found in the molecular pathways which are involved in its development - EGFR, ALK, ROS1

37
Q

Targeted therapies are usually tolerated better than traditional chemotherapies - true or false

A

True

38
Q

List some of the adverse effects of targeted lung cancer therapy

A

Rash
Diarrhoea
Pulmonary toxicity
Hepatotoxicity

39
Q

List some of the adverse effects of lung cancer immunotherapy

A 
Immunosuppression
Fatigue
Skin changes
Mucositis
Diarrhoea 
Colitis,
Hepatotoxicity
Pneumonitis
Endocrinopathies
40
Q

What is the basis of immunotherapy

A

Based upon premise of immune system playing key role in defence against malignancy
Drugs act on the immune system to help it fight cancer cells

41
Q

What happens to the trachea position in lung consolidation

A

Nothing - it remains central

42
Q

What happens to the trachea position in lung collapse

A

It shifts towards the site of collapse

43
Q

What happens to the trachea position in pleural effusion

A

It moves away from the side of effusion

44
Q

What happens to the trachea position in pneumothorax

A

It moves away from the side of pneumothorax

45
Q

What happens to the trachea position in pulmonary fibrosis

A

Nothing - it remains central

46
Q

Which conditions can lead to decreased chest expansion

A

Lung consolidation, collapse, plueral effusion and pneumothorax will all lead to decreased expansion over the affected area

In pulmonary fibrosis expansion is decreased symetrically

47
Q

Which conditions can lead to dull percussion

A

Consolidation
Lung collapse
Will be stony and dull over an effusion

48
Q

What is percussion like over a pneumothorax

A

It is resonant

49
Q

What is percussion like over pulmonary fibrosis

A

It is normal

50
Q

How is air entry affected by lung consolidation

A

Reduced - bronchial sounds

51
Q

How is air entry affected by lung collapse

A

It is absent or reduced

52
Q

How is air entry affected by pleural effusion

A

It will be absent over the fluid

Bronchial sounding above

53
Q

How is air entry affected by pneumothorax

A

It is reduced

54
Q

How is air entry affected by pulmonary fibrosis

A

It is normal

55
Q

What are the features of Horner’s syndrome

A

Miosis
Enopthalmos - sunken eye
Ptosis - droopy eyelid
Unilateral loss of sweating

56
Q

What causes Horner’s syndrome

A

Invasion of cervical sympathetic plexus.and shoulder/arm pain-brachial invasion c8-t2
Can be cause by a pancoast lung tumour

57
Q

What causes Horner’s syndrome

A

Invasion of cervical sympathetic plexus.and shoulder/arm pain-brachial invasion c8-t2
Can be cause by a pancoast lung tumour

58
Q

What are the indication for CXR

A

Unexplained/persistent haemoptysis (urgent)

3 week history of the following unexplained:
Cough
Chest or shoulder pain
Dyspnoea
Weight loss
Hoarseness
Chest signs or finger clubbing
Persistent lymphadenopathy (cervical/supraclavicular)
Features suggestive of metastases
59
Q

List features which suggest lung cancer mets

A 
Confusion
Weight loss
Bone pain
Headache
Unsteady gait
60
Q

Which CXR abnormalities may be caused by an underlying lung cancer

A 
Mass lesions
Consolidation
Collapse
Pleural effusion
Pulmonary metastases
Erosion of ribs
61
Q

A normal chest x-ray excludes lung cancer - true or false

A

FALSE

Should still be referred to resp

62
Q

Which methods can be used to obtain a tissue biopsy/sample for lung cancer diagnosis

A

Image guided percutaneous biopsy (CT-guided biopsy)
Bronchoscopy
Mediastinoscopy - sample from mediastinum and hilum
Thoracoscopy - keyhole with ports through chest wall

63
Q

What checks are done prior to bronchoscopy

A 
Make sure there is informed consent 
Oxygen saturation on air 
Hb or platelets 
Coagulation (note, if LFT abnormal check coag)
FEV1  - should be >40% ideally
64
Q

Warfarin should be stopped prior to bronchoscopy - true or false

A

True

Patients should be switched to heparin 1 week before procedure

65
Q

When is sputum cytology used in the diagnosis of lung cancer

A

Only used in patients with large central lesions where bronchoscopy and other tests are unsafe

66
Q

Which technique is used for the diagnosis of peripheral lung tumours

A

Percutaneous CT-guided biopsy

66
Q

Which technique is used for the diagnosis of peripheral lung tumours

A

Percutaneous CT-guided biopsy

67
Q

Pneumothorax is a complication of percutaneous CT-guided biopsy - true or false

A

True

68
Q

How is lung cancer staged

A

Based on CT scans, MRI, US and PET
Non-small cell lung cancer is staged according to the TNM system

Small cell lung cancer is categorised as either limited disease (confined to a single radiation field) OR
Extensive disease

69
Q

According to T staging (from TNM) which lung cancers are resectable

A

T1 and 2 are
T3 tumours sometimes can be

However, T4 tumours invade vital structures and are non-resectable

70
Q

Describe the different N stages in lung cancer

A

N1 – ipsilateral hilar tumour spread
N2 – ipsilateral mediastinal tumour spread; not resectable
N3 – contralateral mediastinal tumour/ supraclavicular tumour spread; not resectable

71
Q

What is the best scan for detecting metastatic bone disease

A

Bone scan
This involves injection of radionuclides
Increased uptake at sites of metastases leading to ‘Hot spots’

72
Q

What is the most common cancer in non-smokers

A

Adenocarcinoma

73
Q

Smoking cessation is still beneficial in patients who already have lung cancer - true or false

A

True!
Continued smoking in lung cancer reduces life expectancy, increases risk of recurrence/metastases, reduces treatment efficacy and exacerbates treatment side-effects

74
Q

Which factors are taken into account when deciding if a patient can go for curative surgery

A 
Stage and type of cancer 
Age - morbidity increases with age 
Pulmonary function 
Co-morbidity 
Performance status
75
Q

Patients of which performance status are eligible for surgery

A

0, 1 and 2

76
Q

Which factors would make a lung cancer patient inoperable

A

Stage III or stage IV lung cancer
Poor respiratory reserve, i.e. poor FEV1
Multiple co-morbidities making them a high risk surgical candidate
WHO performance status 3 or 4

77
Q

Which type of chemo is used for NSCLC

A

Platinum-based combination chemotherapy is recommended for patients with stage IIIb and IV
Maximum of 4 cycles in patients with advanced NSCLC

78
Q

Which type of chemo is used for SCLC

A

A platinum agent and etoposide

Duration of 3-6 cycles of chemotherapy in SCLC

79
Q

Radiotherapy may be curative in some cases of NSCLC - true or false

A

True

If in stage 1 or 2 and not medically fit for or refusing surgery

Oncology (7 decks)

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