LUNG CANCER Flashcards
How prevalent is lung cancer?
3rd most common cancer in UK
Leading cause of cancer death
What demographic is most likely to get lung cancer?
Male of age 75-90 who has lower social economic status and has been smoking for a long time intensely
What percentage of patients who have lung cancer have smoked?
85-90%
What are the causes of lung cancer other than smoking?
Passive smoking Asbestos (now banned) Radon (from mining) Indoor cooking fumes - wood smoke/frying fats... Chronic lung diseases (COPD, fibrosis) Immunodeficiency e.g from HIV Genetic (several loci)
Name the different stages of lung cancer development
Normal epithelium Hyperplasia Squamous metaplasia Dysplasia Carcinoma in situ Invasive carcinoma
What is metaplasia?
Reversible change in which one adult cell type replaced by anther adult cell type as an adaptive mechanism
What is dysplasia?
Abnormal growth where some of the cellular and architectural features of malignancy are present
Pre-invasive stage with intact basement membrane
What are oncogenes?
Mutated genes which contribute to the development of cancer
What are the key symptoms of lung cancer?
Cough Weight loss Breathlessness Fatigue Chest pain Haemoptysis (coughing of blood)
Frequently asymptomatic
Why does lung cancer have such a high mortality?
Symptoms often present late and non-specific which delays patients from seeing a doctor
There is a lot of space in the lungs for the tumour to grow before impacting any vital structures unlike other cancers
What are the common sites of lung cancer metastases?
Liver Brain Lymph nodes Adrenal glands Bones
What are the features of advanced/metastatic disease?
Neurological features:
- Focal weakness
- Seizures
- Spinal cord compression
Paraneoplastic syndromes:
- Clubbing
- Hypercalcaemia
- Hyponatraemia
- Cushing’s
Bone pain
What is Horner’s syndrome and why might lung cancer cause this?
Ptosis and meiosis of an eye
Apical lung tumour on top of lungs compressing the thoracic outlet and thus sympathetic chain. Reduced SNS supply to face
What is Pemberton’s sign and why might lung cancer cause this?
Facial swelling and redness which gets worse when arms are lifted.
Superior vena cava is obstructed by tumour which reduces venous return.
What are the stages for diagnosis of lung cancer?
Establish most likely diagnosis
Establish fitness for investigation and treatment
Confirm diagnosis e.g. biopsy
Confirm staging
What imaging can you carry out on a patient with lung cancer?
Chest X-ray
Staging CT of chest and abdomen
PET scan for staging too
What does opacification of the lungs suggest in a patient with lung cancer?
Pleural effusion meaning the cancer has metastasised to the pleural membrane
What are the black boles seen in a lung CT suggestive of?
Emphysema which is caused by smoking
Many lung cancer patients will have this
What does a PET scan show and why do it?
Parts of the body using a lot of glucose. Can be used to exclude potential metastases that you aren’t too sure of
What 3 types of biopsy can you carry out on lung cancer patients?
Bronchoscopy
Endobronchial ultrasound and transbronchial needle aspiration of mediastinal lymph nodes (EBUS[TBNA])
CT guided lung biopsy
When is a bronchoscopy done?
For tumours of central airway
When tissue staging not important
When is EBUS[TBNA] done?
To stage mediastinum and/or achieve tissue diagnosis
Mediastinum contains lymph nodes in chest
When is CT-guided lung biopsy done?
To access peripheral lung tumours not close to the airways
How are cancers staged?
T1-4: tumour size and location
N0-3: lymph node involvement - mediastinum + beyond
M0-1c: metastases and number
