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6. Cancer > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

What are the two main types of lung cancer?

A
  1. Small-cell (neuroendocrine) lung cancers (SCLC) → tend to disseminate early in their development
  2. Non-small-cell lung cancers (NSCLC) → which are more likely to be diagnosed in a localised form
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2
Q

How is non-small lung cancer defined?

A

The vast majority (85 percent) of lung cancers fall into the category called non-small cell lung cancer.

NSCLCs are carcinomas, which are cancers of the cells lining the surface of the lung airways. These include the bronchi, bronchioles, and alveoli.

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3
Q

What causes non-small lung cancer?

A

Mainly cigarette smoking

Other risk factors include second-hand smoke, exposure to workplace carcinogens, radiation exposure, environmental pollution, family history of lung cancer and previous infection of HIV

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4
Q

What are the three types of non-small lung cancer?

A
  1. Adenocarcinoma
  2. Squamous cell carcinoma
  3. Large cell carcinoma
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5
Q

What is the key information regarding non-small cell adenocarcinoma?

A

Represents 40 percent of all NSCLC diagnoses

Adenocarcinoma affects both smokers and nonsmokers.

Adenocarcinoma tends to grow more slowly than other types of lung cancer, which can help lead to a better prognosis.

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6
Q

What is the key information regarding non-small cell squamous cell carcinoma?

A

Also called epidermoid carcinoma, is the second most common type of NSCLC, representing 25 to 30 percent of all NSCLC diagnoses

These cancers are more likely to spread to other areas of the body, making them more difficult to treat

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7
Q

What is the key information regarding non-small cell large cell carcinoma?

A

A rare form of NSCLC, accounting for only 10 to 15 percent of all diagnoses.

It can occur anywhere in the lung and tends to be aggressive.

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8
Q

What is the typical clinical presentation for non-small cell lung cancer?

A
  • Persistent cough
  • Coughing up blood
  • Clubbing
  • Chest pain or discomfort
  • Trouble breathing
  • Wheezing
  • Hoarseness
  • Loss of appetite
  • Weight loss for no reason
  • Fatigue
  • Trouble swallowing
  • Swelling in the face and/or veins in the neck
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9
Q

How is non-small cell carcinoma diagnosed?

A

CT or PET can confirm diagnosis

NSCLC and other lung cancers can be difficult to diagnose because, often, these cancers have symptoms that are mistaken for common illnesses or the effects of long-term smoking.

80 percent of people diagnosed with NSCLC have already progressed to advanced stages at diagnosis

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10
Q

What lymph nodes does lung cancer often spread to in the earliest stages?

A

Ipsilateral peribronchial nodes
Hilar nodes
Intrapulmonary nodes

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11
Q

What lymph nodes does lung cancer often spread to in the more advanced stages?

A

Ipsilateral mediastinal nodes

Subcarinal nodes

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12
Q

What lymph nodes does lung cancer often spread to in the most severe stages?

A

Contralateral mediastinal or hilar nodes

Supraclavilacular nodes

Nodes beyond

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13
Q

How would you manage non-small cell lung cancer?

A

Surgery can be curative in non-small-cell lung cancer but only 5–10% of all cases are suitable for resection; about 70% of these survive for 5 years.

Trial data suggest that neoadjuvant chemotherapy may downstage tumours to render them operable and may also improve 5-year survival in patients whose tumours are operable at presentation

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14
Q

In what cancer stages is surgery curative for non-small cell lung cancer?

A

T1, N0, M0

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15
Q

If surgery is not appropriate, how would you manage non-small cell lung cancer?

A

In patients who are fit and who have a stage 1 NSCLC, high-dose radiotherapy (65 Gy or 6500 rads) can result in a 27-month median survival and a 22% 5-year survival.

Poor lung function is a contraindication

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16
Q

In advanced disease, how would you manage non-small cell lung cancer?

A

In advanced disease, cisplatin or carboplatin (chemo) in combination with one other drug such as paclitaxel or gemcitabine (chemo) for 12 weeks, produces a symptomatic improvement in 40% and increases median survival from 6 to 10 months, compared with best supportive care, with 10–20% alive at 1 year

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17
Q

How is small cell lung cancer defined?

A

SCLC usually begins in the airways of the lung, and quickly spreads to other areas of your body.

SCLC is the most aggressive form of lung cancer.

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18
Q

What percentage of small cell lung cancers has spread by the time of diagnosis?

A

60% of SCLC cases

19
Q

What are common sites for metastasis for small cell lung cancer?

A

lymph nodes, liver, bones, adrenal glands and brain

20
Q

What is the main risk factor for small cell lung cancer?

A

Smoking tobacco is the leading risk factor for SCLC, responsible for 98 percent of all SCLC diagnoses.

The best preventive strategy is not to smoke, and if you do, to quit as soon as possible.

21
Q

What are the two main types of small cell lung cancer?

A
  1. small cell carcinoma (also known as oat cell cancer; majority of cases)
  2. combined small cell carcinoma.
22
Q

What is the typical clinical presentation for a small cell lung cancer case?

A

Nearly 25 percent of lung cancer cases do not produce any symptoms. However, symptoms of SCLC, which are also common to alllung cancers, include the following:

  • A cough that doesn’t go away or gets worse over time
  • Coughing up blood
  • Chest pain or discomfort
  • Trouble breathing
  • Wheezing
  • Hoarseness
  • Loss of appetite
  • Weight loss for no reason
  • Fatigue
  • Trouble swallowing
  • Swelling in the face and/or veins in the neck
23
Q

How is small cell lung cancer diagnosed?

A

Imaging can confirm a diagnosis:

  1. CT
  2. PET
  3. MRI
  4. Biopsy and histology
  5. Bronchoscopy
24
Q

How is small cell lung cancer staged?

A

Although numerical stages are used for SCLC as well as for other cancers, SCLC is often classified as either limited-stage disease (LD), where the cancer is confined to a reasonable radiation field within the chest, or extensive-stage disease (ED), where the cancer has spread outside the chest.

25
Q

How would you manage a patient with small cell lung cancer?

A

Limited disease is present in approximately 30% of patients

Best treated with concurrent chemo- and radiotherapy using a combination of cisplatin and etoposide or irinotecan

Much of the treatment whether symptomatic or anticancer is delivered with palliative intent

26
Q

Why can you not use PET scans to look for brain metastases?

A

Higher uptake of the reactive glucose by highly metabolically active tissues → cancer

Brain ALWAYS highly active

27
Q

What fitness tests would you do for a lung cancer patient to determine their eligibility?

A

lung function test, cardiac functioning, V/Q, CPEX

Need to be fit enough for lobectomy

May require adjuvant treatment depending on post-op staging

28
Q

What is chemotherapy based on? (element)

A

Platinum

29
Q

What is mesothelioma?

A

Pleural malignant tumour that is caused by exposure to asbestos

30
Q

How would you treat mesothelioma?

A

Chemotherapy has best outcome

Surgery is very rare

31
Q

What mutations are common in cancer and can be treated with focussed therapy?

A

KRAS
APK
EGFR

32
Q

How can young, non-smoking patients get lung cancer?

A

Mutation, usuallyy adenocarcinoma

33
Q

What is the most lethal cancer?

A

Pancreatic cancer

34
Q

Which cancer is almost exclusively the result of smoking?

A

Squamous cell carcinoma

35
Q

What percentage of NSCLCs will have spread by the time of diagnosis?

A

40%

36
Q

What is the median survival for small cell lung cancer?

A
  • Median survival untreated 2-4 months

- With treatment 12-24 months

37
Q

When cancer spreads, what is the clinical presentation?

A
  1. Lymphadenopathy
  2. Pain in shoulder
  3. SVCO
  4. Hoarse voice (laryngeal nerve)
  5. Dysphagia (compression of oesophagus)
  6. Elevated hemidiaphragm
  7. Brain metastasis
  8. Cord compression
  9. Live metastasis
  10. Paraneoplastic phenomenon
    1. Hypercalcaemia
    2. HPOA
    3. SIADH - syndrome of inappropriate ADH secretion
38
Q

What tissues is MRI used for?

A

Fluid and fat

39
Q

What endocrine phenomenon can small cell lung cancer cause?

A

Syndrome of inappropriate ADH secretion

40
Q

What treatment is best for stage 1, 2, and 3A NSCLC?

A

Surgery!

Patient must be fit enough

41
Q

How would you diagnose syndrome of inappropriate ADH secretion?

A

Hyponatraemia
Low plasma osmolality
Inappropriately elevated urine osmolality (i.e. greater than plasma osmolality)
Urine [Na+] >40 mmol/L despite normal salt intake
Euvolaemia
Normal thyroid and adrenal function

42
Q

Small cell lung cancer can cause syndrome of inappropriate ADH secretion.

What are other causes of this syndrome?

A

Primary brain injury (e.g. meningitis. subarachnoid haemorrhage)
Drugs (e.g. carbamazepine, SSRIs, amitriptyline)
Infectious (e.g. atypical pneumonia, cerebral abscess)
Hypothyroidism

43
Q

What are the signs of SIADH?

A

Decreased level of consciousness
Cognitive impairment: short-term memory loss, disorientation and confusion.
Focal or generalised seizures
Brain stem herniation (severe acute hyponatraemia) resulting in coma and respiratory arrest.
Hypervolaemia: pulmonary oedema, peripheral oedema, raised jugular venous pressure and ascites.

44
Q

What are the symptoms of SIADH?

A

Mild hyponatraemia: nausea, vomiting, headache, anorexia and lethargy.
Moderate hyponatraemia: muscle cramps, weakness, confusion and ataxia.
Severe hyponatraemia: drowsiness, seizures and coma.

6. Cancer (15 decks)

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