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Year One - Respiratory System > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

What is lung cancer?

A

It is defined as the proliferation of malignant epithelial cells in the lungs

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2
Q

How common is lung cancer in the UK?

A

It is the third most common cancer

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3
Q

What is the mortality rate of lung cancer in the UK?

A

It has the highest cancer mortality rate

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4
Q

What are the two main classifications of lung cancer?

A

Small Cell Lung Cancer (SCLC)

Non-Small Cell Lung Cancer (NSCLC)

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5
Q

What is SCLC?

A

It is defined as lung cancer that results in abnormal proliferation of small epithelial cells

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6
Q

Where are SCLC’s located?

A

They are located centrally in the bronchi

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7
Q

Which patient group tends to be affected by SCLC?

A

Older smokers

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8
Q

How quickly does SCLC metastasise?

A

It metastasises early during disease progression

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9
Q

SCLC is associated with what syndromes? How?

A

Paraneoplastic syndromes

Small cells contain neurosecretory granules, which release neuroendocrine hormones – such as ACTH and ADH

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10
Q

What percentage of lung cancer cases are SCLC?

A

15%

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11
Q

What is the prognosis of SCLC in comparison to NSCLC?

A

The prognosis is worse for these patients

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12
Q

What is NSCLC?

A

It is defined as lung cancer that results in abnormal proliferation of epithelial cells – other than small cells

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13
Q

What percentage of lung cancer cases are NSCLC?

A

85%

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14
Q

What is the prognosis of NSCLC in comparison to SCLC?

A

The prognosis is better for these patients

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15
Q

What are the three subclassifications of NSCLC?

A

Adenocarcinoma

Squamous Cell Carcinoma

Large Cell Carcinoma

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16
Q

What is the most common classification of lung cancer?

A

Adenocarcinoma

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17
Q

What is adenocarcinoma?

A

It is defined as the abnormal proliferation of glandular cells within the epithelial tissue of the lung

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18
Q

Where are adenocarcinomas located?

A

They are located peripherally in the bronchioles

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19
Q

Which two patient groups do adenocarcinomas tend to affect?

A

Non-smokers

Asian females

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20
Q

How quickly do adenocarcinomas metastasise?

A

It metastases early during disease progression

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21
Q

What is squamous cell carcinoma?

A

It is defined as the abnormal proliferation of squamous cells within the epithelial tissue of the lung

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22
Q

Where are squamous cell carcinomas located?

A

They are located centrally in the bronchi

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23
Q

Which patient group tend to be affected by squamous cell carcinoma?

A

Smokers

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24
Q

How quickly does squamous cell carcinoma metastasise?

A

It metastases late during disease progression

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25
Q

What is a characteristic feature of squamous cell carcinoma on CXR?

A

Cavitating lesions

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26
Q

What is large cell carcinoma?

A

It is defined as an undifferentiated malignant tumour that lacks the characteristic cytologic features of squamous cell carcinoma, adenocarcinoma and small cell carcinoma

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27
Q

Where are large cell carcinomas located?

A

They are located both peripherally in the bronchioles and centrally in the bronchi

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28
Q

Which patient group tends to be affected by large cell carcinomas?

A

Smokers

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29
Q

How quickly does large cell carcinoma metastasise?

A

It metastasises early in disease progression

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30
Q

What are the five risk factors of lung cancer?

A

Smoker

Male Gender

Family History

Air Pollution

Radon Gas Exposure

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31
Q

What is the main risk factor of lung cancer?

A

Smoking

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32
Q

What genetic mutation is associated with lung cancer? What induces this mutation?

A

KRAS

Smoking

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33
Q

What are the nine clinical features associated with lung cancer?

A

Chronic Cough > 3 Weeks

Haemoptysis

Dyspnoea

Pleuritic Chest Pain

Recurrent Pneumonia

Weight Loss

Fixed Monophonic Wheeze

Supraclavicular Lymphadenopathy

Finger Clubbing

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34
Q

What weight loss is deemed as significant?

A

> 5% in 6 months

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35
Q

Which clinical feature is specifically associated with adenocarcinomas?

A

Gynaecomastia

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36
Q

What are the four investigations used to diagnose lung cancer?

A

Blood Tests

Chest X-Ray (CXR)

Contrast CT Scan

Bronchoscopy

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37
Q

What two blood tests are conducted to diagnose lung cancer? Why?

A

FBC = Increased Plts, Increased Calcium Levels Indicate SSC, Increased ADH Levels Indicate SCLC

LFTs = Increased ALP & GGT Levels Indicate Hepatic/Bone Metastases

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38
Q

What is the first line investigation used to diagnose lung cancer?

A

CXR

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39
Q

What are the four signs of lung cancer on CXR?

A

Hilar Enlargement

Peripheral Opacities

Unilateral Pleural Effusion

Lung Collapse

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40
Q

In what two ways are contrast CT scans used to investigate lung cancer?

A

They are used to confirm the findings established on CXR

They are used to determine the staging of lung cancer

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41
Q

What is bronchoscopy?

A

It involves the insertion of a small camera into the bronchi

This enable direct visualisation of the lung cancer and a biopsy of the tumour to be obtained

42
Q

What can bronchoscopy be conducted with? What is this? Why is it advantageous?

A

Endobronchial ultrasound (EBUS)

It involves the attachment of ultrasound equipment to the bronchoscope

This enables detailed assessment of the cancer and an ultrasound guided biopsy

43
Q

How do we stage lung cancer?

A

It is initially staged with the TMM classification system and then converted to the I-IV staging system

44
Q

What is stage I lung cancer?

A

It is defined as a small tumor (<4cm) localised to one lung

45
Q

What is stage II lung cancer?

A

It is defined as a large tumour (>4cm)

There may be metastasis to nearby lymph nodes within the same lung

46
Q

What is stage III lung cancer?

A

It is defined as lung cancer that has metastasised to contralateral lymph nodes or nearby respiratory structures (eg. trachea)

47
Q

What is stage IV lung cancer?

A

It is defined as lung cancer that has metastasised to extra pulmonary structures

48
Q

What are the five management options for NSCLC?

A

Surgical Management

Stereotactic Ablative Radiotherapy (SABR)

Chemotherapy

Targeted Therapies

Immunotherapy

49
Q

When is surgery recommended to manage NSCLC?

A

It is the first line option in individuals with stage I – III NSCLC

50
Q

What three surgeries can be used to treat NSCLC?

A

Lobectomy

Pneumonectomy

Wedge Resection

51
Q

What is lobectomy?

A

It involves the surgical removal of the lung lobe containing the tumour

52
Q

When is lobectomy recommended?

A

It is the first line surgical management option in individuals with intact lung function

53
Q

What is pneumonectomy?

A

It involves the surgical removal of the whole lung containing the tumour

54
Q

When is pneumonectomy recommended?

A

It is the second line surgical management option in individuals with intact lung function

55
Q

What is wedge resection?

A

It involves the surgical removal of a wedge shaped segment of lung that contains the tumour

56
Q

When is wedge resection recommended?

A

It is the first line surgical management option in individuals with reduced lung function – such as the elderly or those with underlying respiratory conditions

57
Q

What are the six contraindications of the surgical management of non-small cell lung cancer?

A

Stage IIIb/IV Cancer

FEV1 < 1.5L

Malignant Pleural Effusion

Tumour Near Hilum

Vocal Cord Paralysis

Superior Vena Cava Obstruction

58
Q

When is SABR recommended to manage NSCLC?

A

It is the second line option in individuals with stage I – III non-small cell lung cancer, who are unsuitable for surgery

59
Q

What is SABR?

A

In comparison to conventional radiotherapy, SABR involves directing a more concentrated, focused beam of radiation at the tumour

60
Q

What are the two advantages of SABR?

A

It reduces the number of radiotherapy sessions needed

It minimises damage to surrounding tissue

61
Q

How is chemotherapy used to manage lung cancer?

A

It can be administered neoadjuvantly or adjuvantly, in combination with surgical or radiotherapy management techniques to improve the likelihood of success

62
Q

When are targeted therapies recommended to manage NSCLC?

A

It can be used in individuals with stage IV non-small lung cancer

63
Q

What are targeted therapies?

A

These drugs target mutations which drive the pathogenesis of lung cancer

64
Q

What two targeted therapies are used to target EGFR mutations in lung cancer?

A

Gefitinib

Osimertinib

65
Q

What targeted therapy is used to target ALK mutations in lung cancer?

A

Alectinib

66
Q

What targeted therapy is used to target ROS1 mutations in lung cancer?

A

Crizotinib

67
Q

When is immunotherapy recommended to manage NSCLC?

A

It can be used in individuals with stage IV non-small cell lung cancer

68
Q

What is immunotherapy?

A

These drugs target immune checkpoints, which prevent the patient’s immune cells from targeting tumour cells

69
Q

What are the three management options for SCLC?

A

Chemotherapy

Radiotherapy

Prophylactic Cranial Irradiation

70
Q

What is prophylactic cranial irradiation? Why is recommenced in SCLC?

A

It involves the use of radiotherapy to prevent brain metastases

There is a high risk of brain metastases with small cell lung cancer

71
Q

Why is surgery not usually recommended in SCLC?

A

It is usually metastatic by the time of presentation

72
Q

What are the four common locations of lung cancer metastasis?

A

Brain

Bones

Adrenal glands

Liver

73
Q

What are the eleven extrapulmonary complications of lung cancer?

A

Recurrent Laryngeal Nerve Palsy

Phrenic Nerve Palsy

Superior Vena Cava Obstruction

Horner’s Syndrome

Syndrome of Inappropriate ADH Secretion (SIADH)

Cushing’s Syndrome

Limbic Encephalitis

Lambert Eaton Myasthenic Syndrome

Hypercalcaemia

Hyperthyroidism

Hypertrophic Pulmonary Osteoarthropathy (HPOA)

74
Q

How can lung cancer cause recurrent laryngeal nerve palsy?

A

When the tumour compresses the recurrent laryngeal nerve as it passes through the mediastinum

75
Q

What is the additional clinical feature associated with recurrent laryngeal nerve palsy?

A

Hoarseness

76
Q

How can lung cancer cause phrenic nerve palsy?

A

When the tumour compresses the phrenic nerve as it passes anterior to the lung root

77
Q

What are the two additional clinical features associated with phrenic nerve palsy?

A

Diaphragm weakness

Dyspnoea

78
Q

How can lung cancer cause superior vena cava obstruction?

A

When the tumour compresses the superior vena cava, which prevents venous drainage from the head and neck

79
Q

What are the three additional clinical features associated with superior vena cava obstruction?

A

Facial swelling

Breathing difficulties

Vein distention in the neck and chest

80
Q

What sign indicates that superior vena cava obstruction has become a medical emergency?

A

Pemberton’s sign

81
Q

What is Pemberton’s sign?

A

This is when the raising of hands over the head causes facial congestion and cyanosis

82
Q

How can lung cancer cause Horner’s syndrome?

A

When the tumour is present in the pulmonary apex, therefore compressing the sympathetic ganglion

83
Q

What specific tumour is associated with Horner’s syndrome?

A

Pancoast

84
Q

What are the three additional clinical features of Horner’s syndrome?

A

Partial ptosis

Anhidrosis

Miosis

85
Q

Which classification of lung cancer is associated with SIADH? How?

A

SCLC

It stimulates ectopic ADH secretion due to neuroendocrine hormone release

86
Q

What is the additional clinical feature associated with SIADH?

A

Hyponatraemia

87
Q

Which classification of lung cancer is associated with Cushing’s syndrome? How?

A

SCLC

It stimulates ectopic ACTH secretion due to neuroendocrine hormone release

88
Q

What are the additional five clinical features associated with Cushing’s syndrome?

A

Moon face

Central obesity

Abdominal striae

Buffalo hip

Skin changes

89
Q

Which classification of lung cancer is associated with limbic encephalitis? How?

A

SCLC

It causes the immune system to produce anti-Hu antibodies against the limbic tissues of the brain – resulting in inflammation of this area

90
Q

What are the four additional clinical features associated with limbic encephalitis?

A

Short term memory impairment

Hallucinations

Confusion

Seizures

91
Q

What is Lambert Eaton myasthenia syndrome?

A

It is defined as an autoimmune condition, in which the immune system produces antibodies against small cell lung cancer cells

These antibodies specifically target the voltage gated calcium channels of these cells, located on the presynaptic terminals in motor neurones

92
Q

When can Lambert-Eaton syndrome present?

A

It may precede the cancer diagnosis by a number of years

93
Q

What is the characteristic clinical feature of Lambert Eaton myasthenic syndrome?

A

Muscle fatiguability

It results in the characteristic features of myasthenia gravis, in which muscles become progressively weaker during periods of activity and slowly improve after periods of rest

This usually means that clinical features are minimal in the morning and worse at the end of the day

94
Q

What are the six clinical features of Lambert Eaton myasthenic syndrome?

A

Proximal Muscle Weakness

Diplopia

Ptosis

Facial Muscle Weakness

Dysphagia

Slurred Speech

95
Q

Which classification of lung cancer is associated with hypercalcaemia? How?

A

Squamous cell

It stimulates ectopic parathyroid hormone (PTH-rp) secretion due to neuroendocrine hormone release

96
Q

How are PTH levels affected by hypercalcaemia secondary to malignancy?

A

Decreased

97
Q

Which classification of lung cancer is associated with hyperthyroidism? How?

A

Squamous cell

It stimulates ectopic TSH hormone secretion due to neuroendocrine hormone release

98
Q

Which two classifications of lung cancer is associated with HPOA? How?

A

Squamous cell

Adenocarcinoma

They cause fibrovascular proliferation of the organs, lungs, bones and joints

99
Q

What are the three additional clinical features associated with HPOA?

A

Periostitis

Finger clubbing

Large joint arthropathy

100
Q

What is mesothelioma?

A

It is defined as a lung malignancy affecting the mesothelial cells of the pleura

101
Q

What is the most common risk factor of mesothelioma?

A

Asbestos exposure

102
Q

What is the management of mesothelioma?

A

Palliative care

Year One - Respiratory System (14 decks)

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