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Respiratory > Lung cancer > Flashcards

Lung cancer Flashcards

1
Q

What are the risk factors for lung cancer?

A
  • Smoking
  • Asbestos
  • Radon (from mining or indoor exposure)
  • Other occupational carcinogens (chromium, nickel, arsenic)
  • Genetic/familial factors
    -Around 5000 cases per year in never smokers
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2
Q

Outline the epidemiology of lung cancer

A
  • One of the most frequently diagnosed cancers
  • Leading cause of cancer-related deaths worldwide
  • Commonest male cancer
  • Affects lowest socio-economic group the worst
  • Overwhelmingly related to smoking
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3
Q

How is tissue obtained for diagnosing lung cancer?

A
  • Bronchoscopy
  • Needle biopsy of lung or pleura
  • Histological diagnosis is essential to determine lung cancer and decide cell type
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4
Q

Why do we need to image lung cancers?

A
  • For staging
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5
Q

Why is screening done for lung cancer?

A
  • Diagnose patients at an earlier stage
  • In an attempt to decrease lung cancer-related deaths and improve survival
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6
Q

What are the different types of lung cancer?

A
  • Non-small cell lung cancer (approx 85% of diagnoses)
  • Of NSCLC, adenocarcinomas are the most common, followed by squamous cell carcinomas
  • Small cell lung cancer (approx 15% of total diagnoses)
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7
Q

What is the prognosis for NSCLC?

A
  • 5-year survival for stage 1 NSCLC is roughly for 80%
  • 5 year survival for stages 2 and 3 is 13-60%
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8
Q

What is the standard care for patients with stage 1, stage 2 and some stage 3A NSCLC?

A
  • Surgical resection
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9
Q

What characterises SCLC?

A
  • Rapid growth
  • Tendency to metastasise
  • Poor survival rates
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10
Q

What are the symptoms of lung cancers?

A
  • Cough (most common symptom)
  • Dyspnoea
  • Haemoptysis
  • Recurrent lung infections
  • Wheeze
  • Hoarse voice
  • Brachial plexus nerve and/or sympathetic nerve chain compression
  • Weight loss
  • Chest/shoulder pain
  • Lethargy/malaise
  • Most common finding is no symptoms at all
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11
Q

What are the commonest sites for lung cancer metastases?

A
  • Brain
  • Draining lymph nodes
  • Pericardium
  • Lung
  • Pleura
  • Liver adrenals
  • Bone
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12
Q

What are the symptoms of regional metastases from lung cancer?

A
  • Bloated face (SVC obstruction)
  • Hoarseness (left recurrent laryngeal nerve palsy)
  • Dyspnoea (anaemia, pleural or pericardial effusions)
  • Dysphagia (oesophageal compression)
  • Chest pain (parietal pleural involvement)
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13
Q

What are the symptoms of distant metastases from lung cancer?

A
  • Bone pain/fractures
  • CNS symptoms (headache, double vision, confusion etc)
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14
Q

What are the metabolic symptoms of lung cancer?

A
  • Thirst (hypercalcaemia)
  • Constipation (hypercalcaemia)
  • Seizures (hyponatraemia - small cell causes SIADH)
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15
Q

Why does lung cancer cause dyspnoea?

A
  • Central tumours may occlude airways
  • Results in lung collapse and dyspnoea on exertion or at rest
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16
Q

Why does lung cancer cause haemoptysis?

A
  • Occurs due to tumour erosion into an airway
17
Q

Why does lung cancer cause recurrent lung infections?

A
  • Related to partial airway obstruction
  • Resultant post-obstructive pneumonias
  • Always obtain a post-pneumonia CXR in high risk patients
18
Q

Why does lung cancer cause wheeze?

A
  • May occur secondary to partial airway obstruction caused by a lung tumour
19
Q

Why does lung cancer cause hoarse voice?

A
  • Mediastinal nodal or tumour compression/invasion resulting in compression of RLN
  • Affects left RLN more often than right RLN because left RLN takes a longer course
20
Q

Why does lung cancer cause brachial plexus and/or sympathetic nerve chain compression?

A
  • Pancoast tumours occur in lung apex
  • May invade brachial plexus causing C8/T1 palsy
  • Small muscle wasting in hand and weakness, as well as pain radiating down arm
  • Horner’s syndrome may also occur if sympathetic chain is compressed
21
Q

Why does lung cancer cause SVC obstruction?

A
  • Tumour or enlarged lymph nodes compress or invade SVC
  • A medical emergency
  • Patient will present with dyspnoea, difficulty swallowing, stridor, swollen and oedematous face etc.
22
Q

What are the signs of lung cancer?

A
  • Cachexia
  • Pale conjunctiva
  • Cervical lymphadenopathy
  • Horner’s syndrome
  • Consolidation
  • Signs of pleural effusion
  • Muffled heart sounds
  • Liver enlargement
  • Skin metastases
  • No signs
23
Q

What are paraneoplastic syndromes?

A
  • Group of clinical disorders that are associated with malignant diseases and are not directly related to physical effects of primary or metastatic tumours
  • Arise from secretion of functional peptides or hormones from tumour
  • Or due to inappropriate immune cross-reaction between normal host cells and initially targeted tumour cells
24
Q

Which endocrine paraneoplastic syndromes are caused by lung cancer?

A
  • Hypercalcaemia
  • Cushing’s syndrome
  • SIADH
25
Q

Which neurocrine paraneoplastic syndromes are caused by lung cancer?

A
  • Encephalopathy
  • Peripheral neuropathy
  • Eaton-Lambert syndrome
  • Pancoast syndrome
26
Q

Which haematological paraneoplastic syndromes are caused by lung cancer?

A
  • Anaemia
  • Thrombocytosis
27
Q

Which cutaneous paraneoplastic syndromes are caused by lung cancer?

A
  • Dermatomyositis
28
Q

Which skeletal paraneoplastic syndromes are caused by lung cancer?

A
  • Finger clubbing
29
Q

Which paraneoplastic syndromes are most commonly caused by lung cancers?

A
  • Humoral hypercalcaemia of malignancy - typically caused by squamous cell carcinoma
  • SIADH associated with small cell cancer
30
Q

What might cause humoral hypercalcaemia?

A
  • Parathyroid hormone-related protein (secreted from tumour) - most common
  • Ectopic parathyroid hormone production
  • Can also be seen from osteolytic activity at site of skeletal metastases
31
Q

Where can biopsies for lung cancer be taken?

A
  • Bronchoscopy
  • Cervical lymph node fine need aspiration
  • Pleural fluid aspiration
  • CT guided lung biopsy
  • CT guided pleural biopsy
32
Q

Which treatments can be used to manage lung cancer?

A
  • Surgery
  • Radiotherapy
  • Combination chemotherapy
  • Combination therapy
  • Biological therapies
  • Palliative care and other treatment
33
Q

When is surgery used to treat lung cancer?

A
  • Mostly for non-small cell (20-25% operable)
  • Best chance of cure
34
Q

How does radiotherapy treat lung cancer?

A
  • Radical - with curative intent (includes stereotactic RT)
  • Palliative - symptom control
35
Q

Which cancers are treated with combination chemotherapy?

A
  • Small cell -potentially curative in a minority
  • Non-small cell - modest survival increase, symptom control
  • Neoadjuvant therapy - chemo before surgery (downstages tumour to allow subsequent surgery)
  • Adjuvant chemo after surgery (no benefit if < stage 2)
36
Q

Which mutations are targeted by biological therapies?

A
  • EGFR
  • ALK
  • RAS
  • PD1
  • PDL1

Respiratory (21 decks)

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