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Year 4 Oncology > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

Risk factors for lung cancer

A
  • Smoking
  • Increased age
  • Exposure to carcinogens such as asbestos
  • FHx
  • Airflow obstruction
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2
Q

Presentation of lung cancer

A
  • haemoptysis
  • chronic cough - more than 3 weeks
  • FLAWS
  • SOB
  • chest pain
  • wheeze
  • dysphagia
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3
Q

Signs of lung cancer

A
  • clubbing
  • Horner’s syndrome
  • asymmetrical chest expansion
  • dull to percussion
  • reduced breath sounds
  • unexplained DVT - swelling in legs
  • SVOC - swelling of face, neck and arms
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4
Q

Horners syndrome triad

A

Partial ptosis
Anhydrosis
Miosis

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5
Q

Pathophysiology of Horner’s syndrome

A

Pancoast tumour often in the right apex of the lung compresses the sympathetic chain.

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6
Q

When should a CXR be done for chronic cough?

A

Unexplained, unresolved cough for 3 + weeks

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7
Q

Complications of lung cancer

A 
SIADH - from small cell lung cancer 
Hypercalcaemia- bone mets or PTHrP 
SVCO 
Metastasise 
VTE 
Pleural effusion 
Pneumonitis 
Pneumothorax 
Cushing’s syndrome 
Lambert Eaton myasthenic syndrome 
Spinal cord compression
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8
Q

Which lung cancer commonly causes SIADH

A

Small cell lung cancer

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9
Q

Types of lung cancer

A

Small cell lung cancer

Non small cell lung cancer:

  • adenocarcinoma
  • squamous cell carcinoma
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10
Q

Features of small cell carcinoma

A

Often rapid progression
High likelihood to metastasise
Treated with chemotherapy

Causes a paraneoplastic syndrome - SIADH

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11
Q

Features of squamous cell lung cancer

A

Can release PTHrP

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12
Q

Features of adenocarcinoma

A

Histology - duct formation

Less associated with smoking

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13
Q

Investigations for lung cancer

A

Bloods - FBC, U+E, LFTs, Ca2+

FEV1 - lung function

Biopsy - bronchoscopy

Imaging

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14
Q

Causes of pulmonary nodules

A

FANGS:

Foreign body

Abscess

Neoplasia - Metastasise, Hamartoma, Bronchial carcinoid, primary bronchial carcinoma

Granuloma - Wegener’s granulocytoma - granulomatosis with polyangiitis, TB or fungal infection
Rheumatoid nodule, sarcoidosis

Structural - Arteriovenous malformation

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15
Q

Management of lung nodules

A

CT surveillance over 24 hours

Lobectomy if good performance status

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16
Q

What causes pneumonitis

A

Reaction to radiotherapy or targeted immunotherapy

17
Q

Causes of pneumothorax in lung cancer

A

Lung biopsy

18
Q

Malignant pleural effusion

A

Pleural effusion positive for cytology - showing presence of cancer cells

Indicative of metastasise

19
Q

Presentation of brain mets

A

Headache

Confusion

20
Q

When to do a 2 ww referral

A

CXR suggestive of lung cancer
40+ with unexplained haemoptysis

40+ with 2+ of:

  • fatigue
  • breathlessness
  • cough
  • weight loss
  • appetite loss
  • persistent or recurrent chest infections
  • finger clubbing
  • supraclavicular lymphadenopathy
  • thrombocytosis
21
Q

Treatment for squamous cell carcinoma

A

Surgery
Chemotherapy
Radiotherapy
Targetted therapy - PD L1 inhibitor - pembrolizumab

22
Q

Radiotherapy in lung cancer

A

Curative - high dose CHART

Palliative - low dose

23
Q

CHART

A

Continuous hyperfractionated accelerated radiotherapy

Given to stage I or II that are unfit or do not want surgery

24
Q

Treatment of small cell carcinoma

A

Mainstay of tx - chemotherapy as rapid growth rate and almost always extensive

Palliative radiotherapy

25
Q

Palliative treatment options

A

YAG lazer - high risk

Cryotherapy

Diathermy

Bronchial stents for airway obstruction

Endobronchial radiotherapy

26
Q

What substance is injected for a PET scan

A

Fluorodeoxyglucose

27
Q

Imaging for lung cancer

A 
Imaging:
1. CXR 
2. CT CAP 
3. FNA of lymph nodes in neck 
\+/- PET scan 
\+/- CTPA 
\+/- EBUS -endobronchial USS
\+/- Bronchoscopy 
\+/- CT guided biopsy
28
Q

Advantages and disadvantages of EBUS

A

Advantages:

  • no radiation
  • can locate lymph nodes

Disadvantages:

  • cant go deep
  • invasive
29
Q

Advantages and disadvantages of bronchoscopy

A

Advantages:

  • camera guided so can locate tumour and take biopsy
  • can go deeper and access central tumours

Disadvantages:

  • can’t biopsy lymph nodes
  • invasive
30
Q

Advantages and disadvantages of CT guided biopsy

A

Advantages:
- good access to peripheral tumours

Disadvantages:

  • can cause pneumothorax
  • May not be able to have CT
  • Radiation
  • Invasive
31
Q

How to assess breathlessness

A

MRC dyspnoea score

Year 4 Oncology (21 decks)

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