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Respiratory > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

Lung cancer statistics

A

-25% cancer related deaths Scotland
-5000 new diagnoses a year
-25% adults smoke
-5-year survival 8.7%
-Mortality rates declined

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2
Q

Differentials for lung cancer

A

-Pneumonia/ organising pneumonia (inflammatory)
-Sarcoidosis
-Vasculitis
-TB-acute or old
-Pulmonary metastases
-Alternative malignancy (lymphoma)
-Benign nodules

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3
Q

Common causes of pulmonary metastases

A

-Renal cell
-Breast
-Colorectal
-Bladder

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4
Q

Risk factors for lung cancer

A

-Cigarette smoking
-Smoking cannabis
-Asbestos exposure
-Pulmonary fibrosis

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5
Q

How do lung cancers present?

A

-Incidental
=Asymptomatic
=Ix performed for alternative reason

-Local symptoms
=Cough
=Haemoptysis
=Wheeze/ stridor
=SOB

-Invasive symptoms
=Chest wall pain
=Hoarse voice
=Vascular invasion

-Systemic symptoms
=Weight loss, anorexia
=Fever/ sweats
=Metastatic symptoms

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6
Q

Invasive presentations

A

-Chest wall- chest wall pain
-Superior vena cava
-Hoarse voice (left recurrent laryngeal nerve)
-Dysphagia (oesophagus)
-Horner’s syndrome (from Pancoast tumour)
=meiosis, ptosis, enophthalmos, anhidrosis
=Sympathetic trunk involvement (apex)
-Shoulder pain, arm weakness/ wasting

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7
Q

Symptoms of superior vena cava obstruction

A

-Facial and upper limb oedema
-Venous distension of upper body
-Pemberton’s sign (stridor when lifting arms above head)
-Headache

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8
Q

Management of SVCO

A

-Dexamethasone (reduce oedema)
-Anticoagulation (thrombosis)
-Urgent radiotherapy
-Urgent chemotherapy
-SVC stenting (immediate relief)

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9
Q

Common sites of lung cancer spread

A

-Supraclavicular/ mediastinal/ hilar lymph node
-Adrenal glands
-Pleura
-Liver
-Skin
-Bone
-Brain

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10
Q

Paraneoplastic syndromes

A

-Squamous cell carcinoma
-Small cell lung cancer

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11
Q

Symptoms and signs of squamous cell carcinoma

A

-Hypercalcaemia- ectopic PTH
-Finger clubbing
-HPOA (hypertrophic osteoarthritis)

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12
Q

Symptoms and signs of small cell lung cancer

A

-SIADH
-Ectopic ACTH
-Cerebellar syndrome
-Eaton Lambert syndrome
-Limbic encephalitis

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13
Q

Common symptoms of hypercalcaemia

A

-Confusion
-Constipation
-Thirst
-Fatigue

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14
Q

First management step in hypercalcaemia

A

-IV fluid hydration
=Diuretic helps excrete renal calcium
-IV bisphosphonate

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15
Q

Assessing patient fitness

A

-ECOG performance status 0-4 (PS), ET (exercise tolerance), ADL’s
-Pulmonary function tests
-Cardiac status (ECG, ECHO)
-Renal or hepatic dysfunction
-Comorbidities- diabetes, vascular disease
-Other lung disease- ILD
-Cognitive impairment, frailty

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16
Q

Fitness for lung cancer surgery

A

-FEV1, transfer factor (TCO)
-Incremental walk test
-ABG
-ECHO
-Cardiopulmonary exercise test (CPEX)
-Q scan

17
Q

Staging investigations

A

-1. CT chest/ abdomen (contrast)- early indication
-3. CT head
-2. CT PET (metabolic activity, identifies 10-15% metastases)
-Mediastinoscopy
-Pleural aspiration

18
Q

False negatives in CT PET

A

-Adenocarcinoma with lepidic growth
-Carcinoid tumour (neuroendocrine)
-Renal cell carcinoma
-Hepatoma
-Low grade lymphoma
-Hyperglycaemia (therefore fast)

19
Q

False positives in CT PET

A

-Other inflammatory infective aetiologies (Pneumonia, TB, abscess)
-Thyroid
-Bowel

20
Q

Lung cancer pathology

A

-Small cell lung cancer (15%)

-Adenosquamous
-Adenocarcinoma (40%)
-Squamous (30%)
-Large cell (10%

21
Q

Lung cancer pathology

A

-Small cell lung cancer (15%)

-Adenosquamous
-Adenocarcinoma (40%)
-Squamous (30%)
-Large cell (10%

22
Q

Describe cytology

A

-Cells
-Fine needle aspirates
-Pleural fluid
-LN sampling
=Peripheral FNA
=EBUS-FNA
-Bronchoscopy= washings, brushings
-Skin FNA

23
Q

Describe histology

A

-TISSUES
-Bronchial biopsy
-CT guided biopsy (peripheral lesions, larger lesions as otherwise risk pneumothorax)
-Liver biopsy
-VATS/ thoracoscopy
-Mediastinoscopy
-EUS biopsy
-Resection

24
Q

When is EBUS used?

A

-Sampling of mediastinal and hilar lymphadenopathy external to bronchial tree
-Same contraindications as bronchoscopy
-EUS-FNA for poorer respiratory reserve
-EUS- biopsy (lymphoma)

25
Q

Treatment options for lung cancer

A

-Nodal involvement= radio and chemotherapy
-Early signs of lung cancer= surgical resection if fit for surgery and lobectomy
-SABR radiation

Respiratory (41 decks)

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