Lung Cancer Flashcards
HISTOLOGICAL SUBTYPES
i) which type accounts for 20% and which type accounts for 80%?
ii) nam three types of NSLC
iii) what do small cell lung cancers contain? what does this make them responsible for?
i) small cell = 20%
non small cell = 80%
ii) NSC = adeno, SCC, large cell carcinoma
iii) SC can contain neurosecretory granules that release neurendocrine hormones therefore can be responsible for paraneoplastic syndromes
MESOTHELIOMA
i) which area of the lung does it affect? what is it strongly linked to?
ii) what can the latent period be to deveopment?
iii) what tx is usually given
i) affects mesothelial cells in the pleura
strongly linked to asbestos inhalation
ii) latent period can be 45 years
iii) prognosis is poor - palliative chemo may be given
PRESENTATION
i) which two signs strongly point towards lung cancer?
ii) name three other symptoms that may be seen? which LN is usually enlarged?
i) haemoptysis and finger clubbing
ii) SOB, cough, recurernt pneumonia, weight loss
lymphadenopathy - supraclavic nodes often enlarged
EXTRA PULMONARY MANIFESTATIONS
i) what may present with a hoarse voice? what causes this?
ii) which nerve palsy may px with SOB? why does this happen?
iii) name three ways SVCO may present? what is pembertons sign? what must be done in this case?
iv) what is horners syndrome a triad of? what type of tumour causes this? why?
v) which hormone may SCLC secrete? what does this cause? what electrolyte may be distrubed
i) hoarse voice - recurrent laryngeal nerve palsy due to tumour pressing on RL nerve
ii) phrenic nerve palsy px with SOB > diaphargm weakness
iii) SVCO can px due to direct compression of tumour on SVC - facial swelling, difficulty breathing, distended veins in upper neck and chest
pembertons sign - raising hands ofver head causes facial congestion and cyanosis (medical emergency)
iv) horners syndrome - ptosis, anhidrosis and miosis - can be caused by a pancoast tumour in pulmonary apex pressing on sympathetic ganglion
v) SCLC can produce ADH > SIADH - px with hyponatremia
EXTRA PULMONARY MANIFESTATIONS 2
i) which type of lung cancer can secrete ACTH? what syndrome does this present with?
ii) what type of tumour can cause hypercalcaemia? why?
iii) what is limbic encephalitis? what type of LC causes it? name three symptoms? which antibodies are implicated?
iv) what is lambert eaton myasthenic syndrome? which LC is this implicated in? which ion channels are implicated?
v) name four symptoms of LE syndrome?
i) SCLC > cushings syndrome
ii) SCC (NSCLC) can cause hypercalc by excreting ectopic parathyroid hormone
iii) LE is a paraneoplastic syndrome that occ with SCLC > imm sys makes antibodies to brain tissue (limbic system)
causes short term memory impairment, hallucinations, confusion, seizures - assoc with anti Hu antibodies
iv) LE is caused by antibodies prod against SCLC cells > also target VG calcium channels on motor neurons
v) symptoms = weakness in proximal muscles, diplopia (ABs to intraocular muscles), ptosis, slurred speech (pharyngeal muscles), dysphagia
dry mouth, impotence, dizziness
REFERRAL
i) what investigation should be done within two weeks? name three findings that may indicate LC
ii) patients over 40 with which symptoms should be referred? (5) which two automatically indicate urgent referral?
iii) which two occassions should patients over 40 be referred?
i) chest x-ray
may see hilar enlargement, peripheral opacity (lesion), pleural effusion (usually unilateral), lobar collapse
ii) pts over 40 with clubbing and supraclavic lymphado (most important), recurrent chest infections, raised plats
iii) also refer if 2+ unexplained symp and never smoked
if one or more unexplained symp and ever smoked
unexplained symp = coigh, SOB, fatigue, chest pain, WL, loss of appetite
INVESTIGATIONS
i) what is CT scan used for? should contrast be used?
ii) which imaging is useful to look for cancer spread?
iii) what is EBUS and what does it allow for?
iv) name two methods to make a histological dx
i) staging - contrast enhanced
ii) PET > inject a RA tracer to see metabolically active tissues aorund the body
iii) endobronchial ultrasound - endoscopy with US at the end of the scope - allows detailed assss of tumour and US guided biopsy
iv) bronchoscopy or perc biopsy (thrugh skin)
MANAGEMENT
i) what is first line for NSCLC that is isolated to a single area? what else may be curative for NSCLC dx early?
ii) which two tx are usually given for SCLC? is prognosis better or worse compared to NSC?
iii) what can be used as part of palliative tx to relieve bronchial obstruction?
iv) what three types of surgery may be done? name three techniques that may be used?
v) what will be left in situ after thoracic surgery? what does this allow for?
i) surgery and may also do RT
ii) chemo and RT - worse prognosis
iii) endobronchial tx with stents or debulking
iv) segmentectomy/wedge resection (a portion of a lobe), lobectomy (entire lobe), pneumonectomy (entire lung)
thoracotomy (open sc), video assisted thorascopic surgery (VATS) keyhole, robotic sx
v) chest drain in situ - to drain air and fluid from the thoracic cavity and allow lungs to expand
PERFORMANCE STATUS
what is PS 0,1,2,3,4,5?
PS 0 - asymptomatic
PS 1 - symptomatic but ambulatory (cant do light work)
PS 2 - in bed/sitting for <50% day (unable to work but lives at home with assistance)
PS 3 - in bed >50% day and unable to care for self
PS 4 - bedridden
PS 5 - dead
CASE HX
i) name two things that can cause white out on CXR?
ii) what medication is given in acute cord compression? (2) who should be referred to? what other tx can be given? within what time frame?
iii) what needs to be investigated for with a patient px with swelling of face and neck and engorged veins across the chest? what is the treatment?
iv) what is given prophylactically in SCLC? why?
v) what type of tx can be given in extensive SCLC? (2)
i) large effusion or lung collapse
ii) 16mg OD dex and analgesia
refer to spinal surgeons
if dont do surgery - urgent palliative RT within 24 hours
iii) SVCO - give steroids and oxygen
then stent to relieve the obstruvtion
iv) give prophylactic brain RT as SCLC has a high propensity to travel to the brain
v) triple therapy - 2x chemo drugs eg carbo etop and immunotherapy eg atezolizumab
