Lung Cancer Flashcards
Epidemiology of lung cancer?
3rd common cancer
Leading cause of cancer death
in both male + female
What factors affect who gets lung cancer?
Age (75-90)
Male > Female
Smoking history - affected by duration, intensity, when stopped
Lower socioeconomic (healthcare access)
What may cause lung cancer in the 10-15% of ppl with lung cancer who have never smoked
Passive smoking
Aetiological causes
10-15% of ppl with lung cancer have never smoked
What are Aetiological causes of lung cancer?
Asbestos - exposure increases risk X2 Radon - miners in germany Indoor cooking fumes - e.g. indian wood smoke + poor ventilation Chronic lung diseases immumodefiency familial
What pathophysiologies of lung cancer are there?
Squamous cell carcinomas
Adenocarcinomas (mucous secreting)
Large cell lung cancer
Small cell lung cancer
Where does squamous cell carcinoma originate?
Bronchial epithelium - centrally located
Where does adenocarcinomas originate?
Most common now due to low tar cigarettes, inhaled more deeply and retained longer
Mucus produding glandular tissue, periperally located
Describe the stages from normal epithelium to invasive carcinoma?
Normal epithelium --> hyperplasia --> squamous metaplasia--> ( becomes non reversible from there ) dysplasia--> carcinoma in situ invasive carcinoma
What mutations in specific oncogenes are involved (and can be targeted for directed treatment)
- Epidermal growth factor receptor (seen in adenocarcinomas)
- anaplastic lymphoma kinase (in non smokers)
- c-ROS oncogene 1 (non-small cell lung cancer)
- BRAF
What are the symptoms of lung cancer?
Cough weight loss breathlessness fatigue chest pain haemoptysis
Why does lung cancer kill so many?
- frequently asymptomatic *ppl who have other lung diseases may not go to dr for these symptoms
What are the features of advanced or metastatic lung cancer?
Neurological features : focal weakness, seizures, spinal cord compression
Bone pain
Paraneoplastic syndromes
What are paraneoplastic syndromes?
Clubbing, hypercalcaemia, hyponatraemia, cushings
Because lungs can secrete hormones
What is the pembertons sign?
lung cancer sign
shows superior vena cava obstruction, reduces veous return
- redness and swelling in face, if px put arms up this makes it worse
What is Horner’s syndrome?
Lung cancer sign
compresses thoracic outlet, reducing sympathetic supply to face. present with ptosis, myosis, hydrosis
What clinical signs are there of lung cancer?
Clubbing ( most ppl will die before it presents this advanced
cachexia
horners
pembetons
What imaging is done to exclude occult metastases?
PET (tumour will show up brightly to show active tumour)
and also shows normal but active lymph nodes
What is a bronchoscopy?
for tumours of central airway
where tissue staging is not important
biopsy method
What is an endobronchial ultrasound and transbronchial needle aspiration used for?
Done on the mediastinal lymph nodes as a biopsy
To stage mediastinum/get a tissue diagnosis
What is a CT-guided lung biopsy?
Through chest wall
tissue sample
biopsy method
How are lung cancer stages determined with TNM?
T1-4 = tumour size and location
N0-3 = lymph node involvement
M0-1c = metastases
- late stage at diagnosis if common
What is a three fold way of staging lung cancer?
Early
Locally-advanced
Metastatic
What factors affect treatment given?
px fitness cancer histology cancer stage px preference health service factors
How does the WHO summarises performance status? from 0-5
0 - asymptomatic 1 - symptomatic but completey ambulatory 2 - symptomatic <50% bed during the day 3 - 0 symptomatic >50% bed 4 - bed bound 5 - death
