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#passmed 2022 > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

What is Lung cancer epidemiology? (2 things)

A
  1. 3rd most common cancer in da UK
  2. 1st in cancer related deaths in da UK
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2
Q

What are the causes of Lung Cancer? (2 things)

A
  1. Smoking (80-90% of cases)
  2. Asbestos
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3
Q

What are the divisions of Lung cancer? (2 things)

A

Non-Small Cell Lung Cancer (80%)

  • Adenocarcinoma (40%)
  • Squamous Cell Carcinoma (20%)
  • Large Cell Carcinoma (10%)

Small Cell Lung Cancer (20%) (most dangerous)

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4
Q

Where in the lungs does Adenocarcinoma occur?

A

Mucus secreting cells of Lung peripheries

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5
Q

Which type of Lung cancer is a non-smoker most likely to have?

A

Adenocarcinoma

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6
Q

What is the most common type of Lung cancer?

A

Adenocarcinoma (Non-Small Cell)

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7
Q

Where in the lung does Squamous cell carcinoma occur?

A

Central part of lungs

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8
Q

How does Squamous cell carcinoma present? (apart from normal lung cancer CF)?

A

Pneumonia (2ndary to obstructed bronchus)

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9
Q

Does metastases occur EARLY or LATE in Squamous cell carcinoma?

A

Late

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10
Q

What is the epidemiology of Large cell carcinoma?

A

5% of lung cancers

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11
Q

Does metastases occur EARLY or LATE in Large cell carcinoma?

A

EARLY

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12
Q

What is the pathophysiology of Small Cell Lung Cancer? (2 things)

A
  1. Uncontrolled prolif of APUD cells (small immature Neuroendocrine cells in lungs)
  2. Cells contrain Neurosecretory granules –> release Neuroendocrine hormones –> cause Paraneoplastic Syndromes
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13
Q

Where does Small Cell Lung Cancer usually arise?

A

Centrally: in larger airways

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14
Q

What is special about Small Cell Lung Cancer?

A

Exclusive to smokers

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15
Q

What are the CF of Lung Cancer? (12 things)

A
  1. Cough (80%)
  2. Haemoptysis (70%)
  3. SOB (60%)
  4. Chest pain (40%)
  5. Fever n Malaise
  6. Hoarseness (bc recurrent laryngeal nerve clarted)
  7. Stridor
  8. Wheeze
  9. Lymphadenopathy (supraclavicular nodes 1st)
  10. Clubbing
  11. Weight loss
  12. Paraneoplastic Features (mainly in Small Cell)
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16
Q

What are the Extra-Pulmonary manifestations of Lung Cancer? (4 things)

A
  1. Recurrent Laryngeal Nerve Palsy
  2. Phrenic Nerve Palsy
  3. Superior Vena Cava obst
  4. Horner’s Syndrome
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17
Q

What is Recurrent Laryngeal Nerve Palsy?

What does it cause?

A

Cancer presses on Recurrent Laryngeal Nerve (as it passes thru mediastinum)

Causes –> Hoarse voice

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18
Q

What is Phrenic Nerve Palsy?

What does it cause? (2 things)

A

Cancer presses on Phrenic Nerve

Causes:

  1. Diaphrahm weakness
  2. SOB
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19
Q

What is Superior Vena Cava Obstruction?

What does it cause? (4 things)

A

Cancer presses on SVC

Causes:

  1. Facial + Arm swelling
  2. SOB
  3. Distended veins in Neck + Upper chest
  4. Pemberton’s Sign
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20
Q

What is Pemberton’s Sign? (3 things)

A
  1. Sign of Superior Vena Cava Obst
  2. When you raise hands over head –> Facial congestion + Cyanosis
  3. MEDICAL EMERGENCY
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21
Q

What is Horner’s Syndrome?

What are it’s CF? (3 things)

A

Pancoast tumour (Pulmonary apex tumour, usually a Squamous Cell Carcinoma) pressing on Sympathetic ganglion

Triad of

  1. Anhidrosis (loss of sweating on face)
  2. Partial Ptosis (upper eyelid dropping)
  3. Miosis (small pupil)
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22
Q

What type of Lung Cancer are Paraneoplastic Syndromes mainly caused by?

A

Small Cell Lung Cancer

23
Q

What are the Paraneoplastic Syndromes? (5 things)

A
  1. Hypercalcaemia
  2. SIADH
  3. Cushing’s syndrome
  4. Lambert-Eaton syndrome
  5. Hypertrophic osteoarthropathy
24
Q

What causes the Paraenoplastic Syndrome of Hypercalcaemia? (2 things)

A
  1. Bony metastasis
  2. Ectopic Parathyroid Hormone secretion (Squamous Cell Carcinoma)
25
Q

What are the CF of the Paraenoplastic Syndrome of Hypercalcaemia? (5 things)

A
  1. Stones = Renal calculi
  2. Bones = Bone pain
  3. Groans = Abd pain
  4. Bol = Polyuria
  5. Psychiatric Moans = Alt mental status
26
Q

How common is Hypercalcaemia in each type of Lung Cancer?

A

Squamous cell carcinoma = 50%

Adenocarcinoma = 20%

Small Cell Lung Cancer = 15%

27
Q

What causes the Paraenoplastic Syndrome of SIADH?

A

Ectopic ADH secretion by Small Cell Lung Cancer

28
Q

What are the CF of the Paraenoplastic Syndrome of SIADH? (2 things)

A
  1. Hyponatraemia
  2. Cerebral oedema (extreme cases)
29
Q

What causes the Paraenoplastic Syndrome of Cushing’s Syndrome?

A

Ectopic ACTH –> Increase in Glucocorticoids –> Cushing’s

30
Q

What are the CF of the Paraenoplastic Syndrome of Cushing’s Syndrome? (5 things)

A
  1. Moon face
  2. Buffalo Hump (fat pad on upper back) (buffalo shouldaaa)
  3. Proximal limb muscle wasting
  4. Central Obesity
  5. Abdominal striae
31
Q

What causes the CF of the Paraenoplastic Syndrome of Lambert-Eaton syndrome? (2 things)

A
  1. Antibodies prod against Small Cell Lung Cancere
  2. These iGs damage Voltage Gated Calcium Channels (on pre-synaptic terminals in motor neurones)
32
Q

What are the CF of the Paraenoplastic Syndrome of Lambert-Eaton syndrome? (4 things)

A
  1. Proximal muscle weakness
  2. Ocular muscle weakness (–> diplopia)
  3. Levator muscle weakness (–> ptosis)
  4. Pharyngeal muscle weakness (–> slurred speech + dysphagia)

POLP

33
Q

What are the CF of the Paraenoplastic Syndrome of Hypertrophic Pulmonary Osteoarthropathy (HPOA)? (3 things)

A
  1. Clubbing
  2. Periostitis (inflamm periosteum aka layer around bone)
  3. Symmetrical Painful arthropathy (in distal joints)
34
Q

What investigations should you do for sus Lung Cancer? (5 things)

A
  1. CXR (first line)
  2. Staging CT
  3. PET
  4. Bronchoscopy w EndoBronchial Ultrasound (EBUS)
  5. Biopsy (via Bronchoscopy / Percutaneously (thru skin)
35
Q

What is the FIRST LINE investigation for sus Lung Cancer?

36
Q

What may you see in a CXR of Lung Cancer? (4 things)

A
  1. Visible lesion (peripheral opacity)
  2. Hilar enlargement
  3. Pleural effusion (usually unilater in lung cancer)
  4. Collapse
37
Q

What does Hilar Enlargement on sus Lung Cancer CXR show?

A

Lymphadenopathy

38
Q

What does Unilateral Pleural Effusion on sus Lung Cancer CXR show?

A

Stage 4 cancer

39
Q

Who should get a CT scan for sus Lung Cancer? (2 things)

A
  1. Significant suspicion
  2. Sus CXR
40
Q

What should the CT scan you do for sus Lung Cancer be? (2 things)

A
  1. CT: Chest Abd Pelvis
  2. Contrast enhanced
41
Q

What will the CT scan for sus Lung Cancer tell you? (3 things)

A
  1. Stage
  2. Lymph node involvment
  3. Metastasis
42
Q

What will you typically see in a CT scan of Lung Cancer? (3 things)

A
  1. Solitary pulmonary nodule (with spikes maybe)
  2. Lymph node involvment (maybe)
  3. Metastasis (maybe)
43
Q

What is the staging system used for Non-Small Cell Lung Cancer?

44
Q

What is the staging system used for Small Cell Lung Cancer?

Why is it better than TNM for Small?

A

VALSG Staging

Simple 2 stage system, reflects limited treatment opportunities

45
Q

What are the 2 stages of VALSG staging for Small Cell Lung Cancer?

A
  1. Limited Disease
  2. Extensive Disease
46
Q

What are the features of a LIMITED Small Cell Lung Cancer in the VALSG staging system? (2 things)

A
  1. No spread beyond Hemithorax (aka to other side of lung)
  2. Regional nodes (can be treated w single Radiotherapy field)
47
Q

What are the features of an EXTENSIVE Small Cell Lung Cancer in the VALSG staging system? (4 things)

A
  1. Spread beyond Hemithorax (aka to other side of lung)
  2. Distant metastasis
  3. Malignant pleural effusions OR
  4. Contralateral hilar / supraclavicular involvment
48
Q

What are the management options for Lung Cancer? (4 things)

A
  1. Surgery
  2. Radiotherapy
  3. Chemo
  4. Endobronchial treatment (stents / debulking)
49
Q

Who is offered Surgery as first line treatment?

A

Non-small cell lung cancer w cancer isolated to 1 area

50
Q

What is the Surgery types for lung cancer? (3 things)

A
  1. Lobectomy (FIRST LINE)
  2. Segmentectomy
  3. Wedge Resection
51
Q

Can Radiotherapy be curative for Non-Small Cell Lung Cancer?

A

Yes, if early

52
Q

Who is Chemotherapy offered to? (3 things)

A
  1. Adjuvant chemo (w Surgery / Radio) to improve outcome
  2. Palliative Treatmement (to improve survival + Quality of life) (late stage Non-Small)
  3. Palliative for Small Cell (w Radio)
53
Q

What is the management for Small Cell Lung Cancer?

A

Chemo + Radio

(bad prognosis)

54
Q

What is Endobronchial treatment? (2 things)

A
  1. Stents / Debulking to relieve bronchial obst (caused by cancer)
  2. Palliative

#passmed 2022 (27 decks)

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