Lung Cancer Flashcards
What is the most important aetiological factor in lung cancer
Smoking
There are different types of primary lung cancer and they are divided into 2 main groups.
Name these two main groups
small cell lung cancer (SCLC)
non small cell lung cancer (NSCLC)
There are different types of primary lung cancer and they are divided into 2 main groups: non-small cell lung cancer and small cell lung cancer.
Which is most common?
Non small cell lung cancer
Small cell lung cancer (SCLC) are most commonly caused by?
Smoking
Small Cell Lung Cancer – less common but worse prognosis. Why is this?
Tend to spread quite early on.
Small cell lung cancers are also classed as neuroendocrine tumours.
What are Neuroendocrine tumours
Rare tumours that develop in cells of the neuroendocrine system.
In small cell lung cancer, the tumour starts in the neuroendocrine cells of the lung.
Non small cell lung cancer account for 80% of lung cancer cases.
What are the three main types?
Adenocarcinoma
Squamous cell carcinoma
Large cell carcinoma
There are three main types of non small cell lung cancer: adenocarcinoma, squamous cell carcinoma and large cell carcinoma.
Which is the most common type of non small cell lung cancer?
adenocarcinoma
Adenocarcinoma is a type of non small cell lung cancer (NSCLC).
It tends to be located where in the lungs?
Tend to occur in lung peripheries
Adenocarcinoma is a type of non small cell lung cancer (NSCLC).
What cells are affected?
Starts in the mucus-secreting gland cells that line the airways
Squamous cell lung cancer is a type of ___
a) small cell lung cancer
b) non-small cell lung cancer
b) non-small cell lung cancer
Adenocarcinoma lung cancer is a type of ___
a) small cell lung cancer
b) non-small cell lung cancer
b) non-small cell lung cancer
Large cell lung cancer is a type of ___
a) small cell lung cancer
b) non-small cell lung cancer
b) non-small cell lung cancer
Adenocarcinoma is the most common histological type of lung cancer.
What is the second?
Squamous cell lung cancer
Large cell lung cancer tend to metastasis ____
a) early
b) late
a) early
Small cell lung cancer has a ____ prognosis
a) good
b) poor
b) poor
What is the most common type of lung cancer in non-smoker
Adenocarcinoma
Mesothelioma is a lung malignancy affecting the mesothelial cells of the pleura.
What is it strongly linked to
Asbestos inhalation
Small cell lung cancer occurs almost exclusively in which patient group
In smokers
Name some of the risk factors for lung cancer
Smoking
Other environmental agents e.g. asbestos, silica, welding fumes, coal
HIV
Organ transplantation
In the majority of lung cancer cases patients are asymptomatic.
If there are symptoms, what are the classic symptoms?
Chronic cough
Malaise
Haemoptysis
Cancer symptoms e.g. Weight loss, night sweats, fevers, recurrent infections
Hoarseness is a potential symptom of lung cancer.
How does this occur?
Occurs in Pancoast tumours which pressing on the recurrent laryngeal nerve
What are the two key examination findings of lung cancer that automatically indicate an urgent referral
Finger clubbing
Lymphadenopathy – often supraclavicular nodes
Squamous cell NSCLC typically occurring in the ____ parts of the lungs
a) Central
b) Peripheral
a) Central
What are the 3 signs of pleural effusion on respiratory examination
Dull (‘stony dull’) percussion
Reduced vocal fremitus
Reduced breath sounds
What is the cancer that is associated with Horners syndrome
Pancoast tumour
Horner’s syndrome is a triad of symptoms.
Name the symptoms
Partial ptosis
Anhidrosis
Miosis
Define Paraneoplastic syndromes
Refer to remote effects of tumours - usually due to hormones produced by the tumor or antibodies produced by the immune system.
They can affect the function of other bodily tissues and organs and cause symptoms at sites distant from the tumor
Name some of the paraneoplastic syndrome signs that can be caused by small cell lung cancer
Cushing’s syndrome
Lambert-Eaton syndrome
Name some of the paraneoplastic syndrome signs that can be caused by squamous cell lung cancer
Hyperparathyroidism
Hyperthyroidism due to ectopic TSH
Name some of the paraneoplastic syndrome signs that can be caused by Adenocarcinoma lung cancer
Gynaecomastia
Name some of the Extrapulmonary manifestations of lung cancer
Recurrent laryngeal nerve palsy
Phrenic nerve palsy
Superior vena cava obstruction
Horner’s syndrome
Syndrome of inappropriate ADH (SIADH)
Cushing’s syndrome
Hypercalcaemia
Recurrent laryngeal nerve palsy is a potential extrapulmonary manifestation of lung cancer.
Describe how lung cancer causes this?
The cancer pressing on or affecting the recurrent laryngeal nerve as it passes through the mediastinum.
Presents with a hoarse voice
Phrenic nerve palsy is a potential extrapulmonary manifestation of lung cancer.
Describe how lung cancer causes this?
Caused by nerve compression causes diaphragm weakness
Presents as shortness of breath
Superior vena cava obstruction is a potential extrapulmonary manifestation of lung cancer.
Describe how lung cancer causes this?
Caused by direct compression of the tumour on the superior vena cava
Presents with facial swelling, difficulty breathing and distended veins in the neck and upper chest.
“Pemberton’s sign” is where raising the hands over the head causes facial congestion and cyanosis
Superior vena cava obstruction is a potential extrapulmonary manifestation of lung cancer.
What are the symptoms of this?
Presents with facial swelling, difficulty breathing and distended veins in the neck and upper chest.
What are the 4 common sites for lung cancer metastasis
Brain
Breast
Adrenals
Bone
Refer people using a suspected cancer pathway referral for lung cancer.
How long does a patient have to wait for an appointment
Appointment within 2 weeks
What is the gold standard investigation for lung cancer
Chest X-Ray
What are the 4 key findings on chest x-ray for lung cancer
*
Hilar enlargement
“Peripheral opacity” – a visible lesion in the lung field
Pleural effusion – usually unilateral in cancer
Collapse
Biopsy is required for histology of the lung cancer.
What two ways are we able to acquire biopsy samples
Either taken by bronchoscopy or percutaneous biopsy (through the skin)
Imaging is important aspect of investigating lung cancer.
Name the 3 imaging modalities that are important in investigating lung cancer
Chest X-Ray
Staging CT (chest, abdomen and pelvis)
Bronchoscopy (endoscopy)
Consider an urgent chest X-ray (to be performed within 2 weeks) to assess for lung cancer in people aged 40 years and over with any of the following.
Name the 5 following things
- Persistent or recurrent chest infection
- Finger clubbing
- Supraclavicular lymphadenopathy or persistent cervical lymphadenopathy.
- Chest signs consistent with lung cancer
- Thrombocytosis (high platelet count)
What is the staging tool used in lung cancer
TNM staging
The options for managing lung cancer include: chemotherapy, radiotherapy, surgery, palliative
What options are used in managing small cell lung cancer
chemotherapy, radiotherapy, palliative
Surgery is not useful as the cancer has poor prognosis – usually metastatic disease by time of diagnosis
What is the first line management option for non small cell lung cancer
Surgery
What are the management options for non small cell lung cancer
Chemo, radio, palliative and surgery are all options
1st line management is surgery
Consider adjuvant chemotherapy and radiotherapy to improve outcomes in certain patients or as part of palliative treatment to improve quality of life
Radiotherapy may be curative alone if caught early enough
What are the management options for small cell lung cancer
Poor prognosis – usually metastatic disease by time of diagnosis
Receive combination of chemotherapy and radiotherapy
Palliative in a lot of cases
Several options for surgical removal of a lung cancer.
First line surgical option for lung cancer
Lobectomy (removing the lung lobe containing the tumour)
Several options for surgical removal of a lung cancer.
Name the 3 surgical options
Lobectomy (removing the lung lobe containing the tumour)
Segmentectomy or wedge resection (taking a segment or wedge of lung to remove the tumour)
Pneumonectomy (removal of entire lung)
What is Lobectomy
Surgical removal of the lung lobe containing the tumour
What is Segmentectomy or wedge resection
Surgical option taking a segment or wedge of lung to remove the tumour
What is Pneumonectomy
Surgical removal of entire lung
Name three palliative treatment options for lung cancer
Chemotherapy
Radiotherapy
Endobronchial treatment with stents or debulking can be used to relieve bronchial obstruction caused by lung cancer
