Lung Cancer Flashcards
How common is lung cancer?
- 3rd most common (UK)
- leading cause of death
Who is most likely to have lung cancer?
- 75-90yrs old
- males
- low socioeconomic status
- smoking
What are the causes of lung cancer?
- smoking
- passive smoking
- asbestos (x2)
- radon
- indoor cooking fumes
- chronic lung disease (COPD, Fibrosis)
- Immunodeficiency
- genetics/family history
What are the 4 different types of lung cancer?
- squamous cell carcinoma
- adenocarcinoma
- large cell lung cancer
- small cell lung cancer
What is squamous cell carcinoma?
- 30% of cases
- originates @ bronchial epithelium
- centrally located
What is adenocarcinoma?
- 40% of cases
- possible link to tar cigarettes
- originates from mucus producing glandular tissue
- located peripherally
What is large cell lung carcinoma?
- 15%
- heterogenous group
- undifferentiated
What is small cell lung cancer?
- 15%
- originates at pulmonary neuroendocrine cells
- highly malignant
What cancers make up Non-Small Cell Lung Cancer?
- squamous cell carcinoma
- adenocarcinoma
- large cell lung cancer
What histology can be seen in early lung cancer development?
hyperplasia, followed by squamous metaplasia
What histology can be seen in intermediate lung cell cancer development?
dysplasia
What histology can be seen in late lung cell cancer development?
carcinoma in situ followed by an invasive carcinoma
What is metaplasia?
reversible change in which one adult cell type replaced by another adult cell type; adaptive
What is dysplasia?
abnormal pattern of growth in which some of the cellular and architectural features of malignancy are present; pre-invasive stage with INTACT basement membrane
What is an oncogene?
genetic mutations that predisposes someone to a particular cancer, important to inform treatment/prevention
What is impact of Epidermal Growth Factor Receptor (EGFR) Tyrosine Kinase mutation?
- 15-30% adenocarcinoma seen in: - women - asian ethnicity - never-smokers
What is the impact of Anaplastic Lymphoma Kinase (ALK) Tyrosine Kinase mutation?
- 2-7% of non-small cell lung cancer
seen in: - youth
- never-smokers
What is the impact of a mutation in c-ROS Oncogene 1 (ROS-1) Receptor Tyrosine Kinase?
- 1-2% of non-small cell lung cancer
seen in: - youth
- never-smokers
What is the impact of a mutation in BRAF (downstream cell-cycle signalling mediator)?
- 1-3% of non-small cell lung cancer
seen in: - smokers
What are the key symptoms of lung cancer?
- cough
- weight loss
- breathlessness
- fatigue
- chest pain
- haemoptysis
OFTEN ASYMPTOMATIC
What are the features of advanced/metastatic disease?
neurological features - focal weakness - seizures - spinal cord compression bone pain paraneoplastic syndromes: - clubbing - hypercalcaemia - hyponatraemia - cushing's
What are the common signs seen with lung cancer?
- clubbing
- cachexia
- Horner’s syndrome
- Pemberton’s sign
What is Pemberton’s sign?
Superior vena cava obstruction
What is Horner’s syndrome?
- contracted pupil
- drooping upper eyelid
- loss of sweating on one side of the face
What is the most useful form of imaging to see occult metastases?
PET scan
What types of imaging are used to diagnose lung cancer?
- Chest x-ray
- Staging CT (chest+abdomen)
- PET scan
When should a bronchoscopy be used in lung cancer?
- tumours of the central airway
- no need for tissue staging