Lung cancer Flashcards
Main risk factor for lung cancer
Smoking - proportional to duration and number of cigarettes smokes
How is lung cancer diagnosed?
Bronchoscopy and needle biopsy of the lung or pleura
Histological diagnosis is ESSENTIAL to see cell type which changes prognosis and treatment
What is imaging used for in lung cancer?
Diagnosis and assessment of extent of disease - staging
Treatments of lung cancer
Surgery
Chemotherapy
Radiotherapy
Pallative care
Types of lung cancer
Non-small cell - adenocarcinoma, squamous cell carcinoma
Small cell lung cancer
Most common symptom of lung cancer
Cough - longer than 3 weeks should go to GP
Other symptoms of lung cancer
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
Why do we get hoarsness of voice with lung tumours?
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
Why and where can brachial plexus/sympathetic nerve compression occur with lung cancer?
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)
What else can lung cancers/enlarged lymph nodes from cancer compress?
Superior vena cava
What can result due to SVC compression?
Dyspnoea
Difficulty swallowing
Stridor
Swollen oedematous face
Venous distension in neck and dilated veins in upper arms/chest
emergency
What are paraneoplastic syndromes?
Clinical disorders associated with malignant diseases not directly related to physical effects of primary or metastatic tumours
Why do paraneoplastic syndromes occur?
Secretion of functional peptides/hormones from the tumor or inappropriate cross reaction between normal host cells and tumour cells
Two most common paraneoplastic syndromes associated with lung cancer and which cancer causes them
Humoural hypercalcaemia - squamous cell carcinoma
Syndrome of inappropriate antidiuretic hormone secretion (SIADH) - small cell lung cancer
What can humoural hypercalcaemia be caused by in squamous cell carcinoma?
- 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
Another rarer paraneoplastic syndrome
Cushing syndrome - small cell lung cancer
Why do paraneoplastic neurological syndromes occur?
Body makes antibodies to tumour but these antibodies then attack other organs
Example of paraneoplastic neurological syndromes
Paraneoplastic associated myasthenia gravis - lung cancer associated myasthenic syndrome
Prevalence of lung cancer
Most common cancer killer
System of someone being diagnosed with lung cancer
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
What is perfomance status?
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
Usual age for lung cancer diagnosis
Older - 60+ mostly
Lung cancer and smoking stats
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
Risk factors for lung cancer other than smoking
Asbestos
Radon - mining or exposure eg cornwall
Other occupational carcinogens - chromium, nickel, arsenic
Genetic/familial factors
Screening for lung cancer info, how are they doing it?
New - 55-74 year olds
Who are smokers or ex smokers
CT chest
Criteria to fill for screening program
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