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Respiratory > Lung cancer > Flashcards

Lung cancer Flashcards

1
Q

Main risk factor for lung cancer

A

Smoking - proportional to duration and number of cigarettes smokes

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2
Q

How is lung cancer diagnosed?

A

Bronchoscopy and needle biopsy of the lung or pleura
Histological diagnosis is ESSENTIAL to see cell type which changes prognosis and treatment

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3
Q

What is imaging used for in lung cancer?

A

Diagnosis and assessment of extent of disease - staging

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4
Q

Treatments of lung cancer

A

Surgery
Chemotherapy
Radiotherapy
Pallative care

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5
Q

Types of lung cancer

A

Non-small cell - adenocarcinoma, squamous cell carcinoma
Small cell lung cancer

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6
Q

Most common symptom of lung cancer

A

Cough - longer than 3 weeks should go to GP

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7
Q

Other symptoms of lung cancer

A

Haemoptysis - erosion of tumour into airway
Dyspnoea
Recurrent lung infections - airway obstruction
Wheeze - airway obstruction
Hoarseness of voice
Brachial plexus nerve/sympathetic nerve chain compression

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8
Q

Why do we get hoarsness of voice with lung tumours?

A

Can have compression of recurrent laryngeal nerve
Left occurs more often than right as it comes into mediastinal contact of left lung, along lymph nodes and then looping around aortic arch
This nerves supplies intrinsic laryngeal muscles responsible for moving true vocal cords

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9
Q

Why and where can brachial plexus/sympathetic nerve compression occur with lung cancer?

A

Pancoast tumours occuring in the lung apex can cause C8/T1 palsy with small muscle wasting in the hand and weakness, pain radiating down the arm

If sympathetic compressed = Horners syndrome (miosis, partial ptosis, anhidrosis on one side of the face)

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10
Q

What else can lung cancers/enlarged lymph nodes from cancer compress?

A

Superior vena cava

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11
Q

What can result due to SVC compression?

A

Dyspnoea
Difficulty swallowing
Stridor
Swollen oedematous face
Venous distension in neck and dilated veins in upper arms/chest

emergency

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12
Q

What are paraneoplastic syndromes?

A

Clinical disorders associated with malignant diseases not directly related to physical effects of primary or metastatic tumours

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13
Q

Why do paraneoplastic syndromes occur?

A

Secretion of functional peptides/hormones from the tumor or inappropriate cross reaction between normal host cells and tumour cells

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14
Q

Two most common paraneoplastic syndromes associated with lung cancer and which cancer causes them

A

Humoural hypercalcaemia - squamous cell carcinoma

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) - small cell lung cancer

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15
Q

What can humoural hypercalcaemia be caused by in squamous cell carcinoma?

A
  • Parathyroid related protein (secreted from tumour) - most common
  • Ectopic parathyroid hormone production

Osteolytic activity due to bone metastases - but this is not considered as paraneoplastic syndrome

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16
Q

Another rarer paraneoplastic syndrome

A

Cushing syndrome - small cell lung cancer

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17
Q

Why do paraneoplastic neurological syndromes occur?

A

Body makes antibodies to tumour but these antibodies then attack other organs

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18
Q

Example of paraneoplastic neurological syndromes

A

Paraneoplastic associated myasthenia gravis - lung cancer associated myasthenic syndrome

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19
Q

Prevalence of lung cancer

A

Most common cancer killer

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20
Q

System of someone being diagnosed with lung cancer

A

Present to GP with symptoms/signs
Referred by GP to clinic
Staging occurs using tissue diagnosis and radiological diagnosis
Assess pt’s performance status and co-morbidity (can have extra tests eg echo, spirometry)
Patients wishes
Treatment

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21
Q

What is perfomance status?

A

How fit and well they are - assess the benefit they will get from treatment and how well they are likely to respond/cope with treatment
Usually involves assessing co-morbidities eg HF, previous stroke

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22
Q

Usual age for lung cancer diagnosis

A

Older - 60+ mostly

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23
Q

Lung cancer and smoking stats

A

70-80% lung cancer deaths caused by smoking in men and women
20% lung cancer cases are non smokers - probably caused by passive exposure to smoke, reducing now with indoor smoking ban

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24
Q

Risk factors for lung cancer other than smoking

A

Asbestos
Radon - mining or exposure eg cornwall
Other occupational carcinogens - chromium, nickel, arsenic
Genetic/familial factors

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25
Q

Screening for lung cancer info, how are they doing it?

A

New - 55-74 year olds
Who are smokers or ex smokers
CT chest

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26
Q

Criteria to fill for screening program

A

Disease with serious consequences
High prevalence
Detects little pseudodisease
Detects disease before critical point
Causes little morbidity
Affordable and available
Treatment exists
Treatment more effective when applied before symptomatic intervention
Treatment not risky/toxic
Decrease in disease mortality

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27
Q

What else has been implemented to try and increase detection of lung cancer?

A

NHS Campaign - 3 week cough
If pt has had cough for 3 weeks they are recommended to go to GP and get it checked, most common symptom of lung cancer

28
Q

Reasons for staging

A

Prognosis and treatment

29
Q

What is used to predict prognosis from staging of lung cancer?

A

Kaplan-Meier survival estimate

30
Q

Survival percent 1 year following diagnosis with lung cancer for all pt’s

A

40%

31
Q

How is lung cancer staged

A

TNM - tumour, node involvement, metastasis

32
Q

What is T based on in TNM?

A

Size of primary tumour
Multiple nodules?
Location - if invades major airway is automatically stage 4

33
Q

What is N based on in TNM?

A

Near or far lymph node spread - if hilar lymph nodes/ peribronchial thats N1
N2 is mediastinal lymph nodes on same side
N3 is contralateral side or supraclavicular nodes

34
Q

Why is N stage particularly important?

A

Can cure if N1
If N2 or 3 cannot cure with surgery
N3 is pallative care

35
Q

M stage in TNM

A

M0 or M1 - metastasis or not
M1a contralateral lobe, pericardial/pleural nodules
M1b - single extrathoracic met
M1c - multiple extrathoracic met

36
Q

What does lung cancer often spread to locally?

A

Draining lymph nodes
Pericardium
Pleura

37
Q

What does lung cancer often spread to distally?

A

Brain
Liver
Adrenals
Bone

38
Q

Do you get symotoms with mets?

A

No - often 0 symptoms

39
Q

What is radical treatment? Who can have it?

A

Curative - surgery is available for N0-N1 tumours as long as there is no metastasis.
BUT NOT stage T4 with N0 or T3 with N1 - cannot operate on these

40
Q

Imaging for lung cancer options

A

CXR
CT scan - for liver, adrenal glands see if involved
MRI - see if brain involved
PET scan - can see bones and activity of lymph nodes
USS
Bone scan
Echo

41
Q

Why is PET scan used and how?

A

Radioactive glucose into body, metabolically active tissues absorb more and light up more on scan

Can see if enlarged lymph nodes are actually active or if a growth is just benign/scar tissue,

CXR sign could also be caused by infection - this rules it out

42
Q

Tissue sampling options for suspected lung cancer

A

Bronchoscopy with endobronchial biopsy
USS - neck node, lung/chest wall mass, pleural fluid, liver
CT biopsy - lung and pleura
Thoracoscopy
Surgical - pleural biopsy, axillary node excision, adrenal biopsy, brain, bone biopsy

43
Q

4 reasons to do tissue sampling

A

See if it is cancer or benign
Primary or metastasis
Type - small cell or large cell
Molecular markers - see what treatment it would respond well to

44
Q

Primary tumour lung cancer symptoms most common

A

No symptoms - or prolonged cough

45
Q

Symptoms of regional metastasis

A

Bloated face - SVC obstruction
Hoarseness - left RLN palsy
Dyspnoea - anaemia, pleural/pericardial effusions
Dysphagia - oesophageal compression

46
Q

Symptoms of distant metastasis

A

Bone pain/fractures
CNS - headache, double vision, confusion

47
Q

Metabolic symptoms for lung cancer

A

Thirst - hypercalcaemia
Constipation - hypercalcaemia
Seizures - hyponatraemia from SIADH in small cell

48
Q

Signs of lung cancer

A

Finger clubbing
Cachexia - muscle wasting
Pale conjunctiva
Cervical lymphadenopathy
Horners syndrome - sympathetic compression
Consolidation on CXR
Pleural effusion - dull, CXR sign
Muffled heart sounds
Liver enlargement
Skin mets
Neurological signs

49
Q

Neurological paraneoplastic syndromes

A

Encephalopathy - brain diseased

Peripheral neuropathy

Eaton-Lambert syndrome - immune system attacks the connections between nerves and muscles

Pancoast syndrome - ipsilateral shoulder and arm pain, paresthesia, atrophy of the thenar muscles of the hand and Horners syndrome (ptosis, miosis, and anhidrosis).

50
Q

Haematological paraneoplastic syndromes

A

Anaemia
Thrombocytosis - lots platelets

51
Q

Cutaneous paraneoplastic syndrome

A

Dermatomyositis - muscle weakness and a distinctive skin rash

52
Q

Skeletal paraneoplastic syndrome

A

Finger clubbing

53
Q

What imaging do all lung cancer patients get?

A

CXR and Staging CT chest

54
Q

When do patients not get a biopsy?

A

When it does not change management - if they have poor performance or no treatment wanted

55
Q

Examples of biopsy

A

Bronchoscopy with biopsy usually USS guided
Cervical lymph node fine needle aspiration
Pleural fluid aspiration

56
Q

What is a carcinoma?

A

Invasive malignant epithelial tumour

57
Q

Main types of lung cancer

A

Non small cell lung cancer:
Squamous cell carcinoma - 40%
Adenocarcinoma - 35%
Large cell carcinoma - 5%

Small cell carcinoma - 12%

58
Q

Molecular markers of lung cancer

A

EGFR mutations
ALK mutations
KRAS mutations
PD1 mutations
PDL-1 mutations

59
Q

Performance status 0-5

A

0 - no symptoms, normal activity
1 - symptomatic but can carry out daily activities
2 - symptomatic, in chair/bed less than 1/2 day, needs help
3 - symptomatic, in chair for more than 1/2 day
4 - bedridden
5 - dead

(no treatment for 3 onwards)

60
Q

Lung cancer treatment

A

Surgery - best chance of cure
Radiotherapy - radical wit curative intent or pallative for symptom control
Combination chemotherapy
Chemo-radiotherapy
Biological targeted therapy - based on mutational analysis (EGFR, KRAS etc)
Pallative care

61
Q

Combination chemotherapy - nonsmall cell vs small cell

A

Small cell - potentially cure in minority

Non-small cell - modest survival increase, symptom control

62
Q

When can chemotherapy be used?

A

Neoadjuvant - before surgery
Adjuvant - after (no benefit if stage is less than 2 though)

63
Q

What treatment has been called a gamechanger?

A

Biological targeted therapies

64
Q

What is involved in pallative care?

A

Active symptom control - analgesia, radiotherapy, airway stents, nutritional support, patient support groups, tobacco addiction treatment coronary heart disease and other conditions

65
Q

How does someones lung cance get managed team wise?

A

Need multidisciplinary team

66
Q

What is the risk of dying from lung cancer if smoking >25 cigarettes a day?

A

1 in 7 before age 75
1/10 risk of coronary heart disease
1 in 2 risk of dying prematurely

Respiratory (21 decks)

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