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Lung Cancer Flashcards

1
Q

3 examples of benign tumours in the lungs:

A
  • hamartoma
  • arterio-venous malformation (AVMs)
  • granuloma
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2
Q

3 examples of malignant tumours in the lungs:

A
  • primary lung cancer
  • carcinoid tumour
  • Secondary: metastases from breast, colon, kidney, ovaries, prostate, thyroid
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3
Q

Bronchiogenic tumours:

  • malignant or benign?
  • %?
  • arises from?
A
  • malignant
  • accounts for 90% of lung cancers
  • arise from the cells of the bronchial mucosa:
    - NSCLC (non-small cell lung cancer) arises from the epithelial and glandular cells
    - SCLC (small cell lung cancer) arises from neuroendocrine cells
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4
Q

Adenocarcinoma in situ (previously called bronchoalveolar cell carcinoma):

  • malignant or benign?
  • accounts for??
  • arises from?
A
  • malignant
  • accounts for 5% of lung cancers
  • arises from alveolar cells
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5
Q

Mesothelioma:

  • malignant or benign?
  • where?
  • associated with?
A
  • malignant
  • tumour of the pleura
  • associated with asbestos
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6
Q

What is the most common fatal malignancy in men and women in the UK?

A

Lung cancer

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7
Q

Lung cancer is the —— most common cause of death in the UK

A

3rd

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8
Q

Incidence of lung cancer in the UK?

A

40,000 new cases/year in the UK

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9
Q

Mortality from lung cancer in the UK?

A

34,000 deaths/year in the UK

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10
Q

Male: Female ratio of lung cancer (reflecting previous smoking habits)?

A

1.5:1

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11
Q

What is the leading cause of cancer death in the UK?

A

Lung cancer
women started smoking too in the 60s

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12
Q

Lung cancer is the leading cause of cancer deaths in men.

True or False?

A

True

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13
Q

Which age range is majority of lung cancers diagnosed between?

A

40-70 years

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14
Q

Which of the following is the biggest risk factor for developing lung cancer?

1 = age
2 = asbestos exposure
3 = cigarette smoking
4 = smoking marijuana
5 = smoking and asbestos exposure
together

A

5

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15
Q

Aetiology of lung cancer (11) :

A
  • cigarette smoking
  • passive smoking
  • asbestos exposure
  • ionising radiation (radon gas)
  • polycyclic aromatic hydrocarbons
  • vinyl chloride
  • arsenic
  • nickel
  • genetic predisposition (family history): polymorphisms in P450
  • idiopathic pulmonary fibrosis (IPF)
  • scar carcinoma: tumours can arise from areas of chronic fibrosis
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16
Q

Talk about relation of incidence and prevalence of lung cancer

A
  • incidence high
  • prevalence low
  • because many diagnosed, most survived
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17
Q

Cigarette smoking and lung cancer

A
  • smoking cigarettes is the main risk factor
  • cigarette smoke contains carcinogens, which cause genetic mutations
  • passive smoking increases risk of lung cancer by 1.5x
  • smoking cessation decreases the risk of lung cancer withing the first 5 years after cessation, but remains higher than in a never smoker
  • individuals who stop smoking gain 6-10 years of life
  • cigar smoking is associated with an increased risk of lung cancer, with a relative risk of 2.1
  • pipe smoking also increases the risk of lung cancer with a relative risk of 5
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18
Q

Asbestos

A
  • latent period of 30-40 years from exposure to development of bronchogenic lung cancer
  • asbestos and cigarette smoking act synergistically and increase risk of lung cancer 10x
  • asbestos associated with mesothelioma
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19
Q

Pathophysiology of bronchogenic lung cancer (5):

A
  • carcinogens damage DNA in the bronchial mucosa and cause squamous metaplasia
  • Squamous metaplasia: benign, non-cancerous change as a response to irritation and inflammation
  • can progress to dysplasia in several areas
  • dysplasia: development of abnormal cells within the bronchial mucosa (mild, moderate or severe)
  • dysplastic cells then progress to become malignant cells
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20
Q

Why does lung cancer present late

A
  • most common symptom is persistent cough, lung cancer presents late as it presents with cough but assumed to be smokers cough hence
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21
Q

Local invasion of lung cancer:

A
  • parenchyma (ipsilateral or contralateral sides)
  • pleura
  • pericardium
  • ribs
  • muscle
  • nerves (recurrent laryngeal nerve so hoarse voice, phrenic nerve so diaphragmatic ….., sympathetic chain, brachial plexus
  • lymph nodes in thorax (hilar, mediastinal, subcarinal)
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22
Q

Distal invasion of lung cancer:

A

Lung cancer can spread to:

  • lymphatics to lymph nodes outside the thorax mainly subclavicular and cervical
  • haematogenous spread to other sites:
    • liver
    • adrenals
    • bones
    • brain
    • skin
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23
Q

Which of the following symptoms will make you worry about lung cancer in a 60 year old man who has been smoking for 45 years

1 = persistent cough
2 = increased shortness of breath
3 = haemoptysis
4 = weight loss
5 = all of the above

A

5

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24
Q

Local symptoms of lung cancer (4)(6):

A
  • Persistent cough (80%)
  • Breathlessness (60%)
  • Chest pain (50%)
  • Haemoptysis (30%)
  • Monophonic wheeze
  • Shoulder pain (Pancoast’s tumour causes - - invasion of brachial plexus)
  • Hoarse voice (vocal cord palsy secondary
    to left recurrent laryngeal nerve palsy)
  • Superior vena cava (SVC) obstruction (20%)
  • Enlarged lymph nodes
  • Skin nodules
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25
Q

Systemic symptoms of lung cancer:

A
  • weight loss (of muscle)(cachexia leads to
    anorexia)
  • lethargy
  • bone pain
  • neurological symptoms: headache, limb
    weakness,
    peripheral
    neuropathy
  • spinal cord compression
  • paraneoplastic symptoms caused by secretion of hormones or cytokines by SCLC (small cell lung cancer)
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26
Q

Signs of lung cancer:

A
  • cachexia (extreme weight loss)
  • CLUBBING (20% of non small cell lung cancer)
  • hypertrophic pulmonary osteoarthropathy (HPOA) with adenocarcinoma: painful tender swelling of wrists and ankles
  • Hoarse voice
  • HORNER’S SYNDROME: (meiosis, ptosis, enophthalmos, anhidrosis)
  • cervical and supraclavicular lymphadenopathy
  • tracheal deviation (upper lobe collapse, pleural effusion)
  • SVCO?
  • clinical signs of pleural effusion: (↓ chest expansion, ↓breath sounds, dullness on percussion, ↓ TVF and ↓VR)

TVR: tactile vocal resonance
VR: vocal resonance

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27
Q
A

Ptosis

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28
Q

image of clubbing

A

insert

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29
Q

Which of these signs seen when you examine a 70 year old woman will make you concerned about lung cancer?

1 = clubbing of fingernails
2 = CO2 retention flap
3 = crackles on auscultation
4 = tar staining of fingernails
5 = raised JVP

A

1

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30
Q

WHO performance status:

A

0 = able to carry out normal activity
1 = symptomatic but ambulatory and able to
carry out light work
2 = in bed 50% of the day, unable to work
but capable of self-care
3 = in bed >50% of the day, limited self care
4 = bedridden, unable to self-care

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31
Q

A 48 year old woman goes to her GP coughing up blood. She has been a heavy smoker since the age of 14. Which investigation should the GP organise immediately?

1 = blood tests for tumour markers
2 = chest X-ray
3 = MRI scan of thorax
4 = spirometry
5 = sputum analysis

A

2

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32
Q

Imaging for suspected lung cancer:

A
  • Chest x-ray: to confirm
  • Staging CT thorax and abdomen with contrast: to see stage
  • PET scan: to see stage

Maybe:
- Bone scan: to assess bone metastases and pathological fractures
- CT brain: if brain metastases are suspected and prior to radical treatment
- MRI scan of thorax: to assess structural changes prior to surgery

33
Q

Findings of concern on chest x-ray?

A
  • mass]- cavitating lesion
  • unilateral pleural effusion
  • non-resolving consolidation (pneumonia)
  • solitary pulmonary nodule (SPN)
34
Q
A

Lung lancer

35
Q

insert x ray

36
Q

Why do we order a staging CT of thorax and abdomen with contrast when suspected lung cancer?

A
  • essential for the initial staging of lung cancer
37
Q

CT staging thorax and abdomen: modern scanners detect —— of what size?

A
  • nodules
  • 3-4 nm
38
Q

Contraindications for using iodine when ordering a staging CT thorax and or abdomen:

A
  • renal failure
  • allergy to iodine or to previous contrast
39
Q

Insert Ct

40
Q

Insert CT

41
Q

PET scan for lung cancer

A
  • essential for accurate staging of lung cancer
  • 18 FDG is taken up by rapidly metabolising cells, including cancer cells
  • releases positrons which are detected by a gamma camera
  • dual PET/CT scans can correlate the FDG avid areas with the anatomy
42
Q

PET scans are good at detecting distant metastases of lung cancer except and why?

A
  • brain
  • brain is always active and taking up glucose
43
Q

What is the sensitivity of PET for lung cancer?

44
Q

What is the specificity of PET for lung cancer?

45
Q

Insert PET scan

A

FDG avid lesion right upper lobe

46
Q

What blood tests are run for suspected lung cancer?

A
  • full blood count: anaemia, platelet count, clotting
  • Urea & Electrolytes: hyponatraemia (low sodium) secondary to syndrome of inappropriate anti-diuretic hormone (SIADH)
  • Liver Function Test: may be abnormal with liver metastases
  • Hypercalcaemia: (too much calcium) (squamous cell lung cancer) (bone metastases)
47
Q

Why do people with small cell lung cancer present with low sodium?

A
  • hyponatraemia is a common presentation
    of lung cancer
  • might be due to syndrome of
    inappropriate anti-diuretic hormone
  • produced by people with small cell lung
    cancer
48
Q

Why may a full blood count for lung cancer show anaemia?

A

tumour growing in bone marrow

49
Q

squamous cell lung cancers lead to hypercalcaemia as

A

squamous cell lung cancers (non-small cell) secrete pth (parathyroid hormone)

50
Q

Bone metastases of lung cancer can lead to

A

hypercalcaemia

51
Q

What is ectopic secretion of a hormone?

A

when a hormone is secreted out of its normal physiological mechanism

52
Q

Ectopic secretion of hormones in lung cancer Paraneoplastic Syndrome:

A
  • small cell lung cancer arises from Kulchitsky neuroendocrine cells of teh “amine uptake and decarboxylation (APUD) system”
  • syndrome of inappropriate anti-diuretic hormone (ADH) secretion can lead to hyponatraemia
  • parathyroid hormone (PTH) (squamous cell not small cell lung cancer) related peptide can lead to hypercalcaemia
  • adrenocortioctrophic hormone (ACTH) can lead to raised cortisol levels (cushing’s syndrome)
53
Q

Pulmonary function test for suspected lung cancer

A
  • most patients with lung cancer have COPD
  • FEV1, FVC, FEV1/FVC and TLCO required:
    - prior to obtaining a CT guided lung
    biopsy
    - prior to considering surgery or
    radiotherapy
  • because if they have borderline lung function then will not survive even a biopsy
  • ECG
  • echocardiogramm
54
Q

Histological diagnoses of lung cancer (9)

A
  • bronchoscopy and biopsy (if central tumour)
  • endobronchial ultrasound guided biopsy
  • transbronchial needle aspiration of lymph nodes (TBNA)
  • CT guided lung biopsy
  • ultrasound guided lung biopsy
  • fine needle aspiration (FNA) of lymph nodes in the neck
  • pleural aspiration from malignant pleural effusion
  • any other site with metastases: liver, bone, adrenal
  • sputum cytology
55
Q

Risks of invasive procedures for lung cancer diagnosis:

A
  • consider fitness
  • consider lung function
56
Q

Risks of biopsy for diagnosis of lung cancer:

A
  • bleeding
  • pneumothorax if borderline lung function
57
Q

Insert bronchoscopy: where is the tumour?

58
Q

CT guided biopsy

59
Q

What % of bronchogenic cancers are Non-small cell lung cancer?

60
Q

5 examples of non-small cell lung cancer

A
  • squamous cell lung cancer
  • adenocarcinoma
  • large cell lung cancer
  • malignant carcinoid
  • mixed
61
Q

Squamous cell lung cancer arises from

A

squamous epithelial cells

62
Q

Adenocarcinoma arises from

A

mucin producing glandular epithelium

63
Q

Large cell lung cancer arises from

A

undifferentiated cells

64
Q

Does small cell lung cancer have a better prognosis than non-small cells lung cancer?

65
Q

What has improved treatment options (immunotherapy) and improved survival in recent years for lung cancers?

A

molecular mutation testing

66
Q

Small cell lung cancer main facts (5):

A
  • arises from neuroendocrine cells
  • produces hormones (ADH)
  • has usually metastasized on presentation
  • very aggressive
  • poor prognosis
67
Q

Staging of lung cancer uses —– classification?

A

TMN
T = tumour size T0,T1-T4
N = nodal metastases N0-N3
M = distant metastases M0-M1

68
Q

Management of lung cancer:

A
  • histology of lung cancer
  • staging of the cancer TNM
  • WHO performance status
  • Lung function
  • co-morbidities
  • wishes of the patient
  • MDT decision
  • Radical: Surgery, radiotherapy
  • Palliative: chemo, immuno, radiotherapy, symptom control
69
Q

medical oncologists give —– clinical oncologists give

A

medical oncologists give chemotherapy
clinical oncologists give radiotherapy

70
Q

What is radical treatment for lung cancer aimed at?

A

curing the patient

71
Q

What is palliative treatment for lung cancer aimed at?

A

Easing symptoms

72
Q

Management of non-small cell lung cancer

A
  • surgery
  • lobectomy (removal of a lung lobe)
  • pneumonectomy (removal of one lung)
  • wedge resection or segmentectomy (part of lobe)
  • radiotherapy (radical)
  • chemotherapy
  • immunotherapy
  • palliative care
73
Q

Management of small cell lung cancer

A
  • unlikely to offer radical treatment as metastases
  • chemotherapy
  • immunotherapy
  • palliative chemotherapy
  • palliative radiotherapy
74
Q

Immunotherapy for lung cancer:

A
  • cancer cells have an over expression of certain receptors
  • drugs target these proteins
  • EGFR: epithelial growth factor receptor mutation
  • VEGF Vascular Endothelial Growth Factor receptor
  • checkpoint inhibitors
75
Q

What is the most common acquired lung cancer mutation?

A

EGFR
epithelial growth factor receptor

76
Q

1 year survival in lung cancer % in men and women?

A

Men: 30%
Women: 35%

77
Q

% for 5 year survival of lung cancer?

78
Q

5 Preventions of lung cancer:

A
  • smoking cessation
  • reduce exposure to passive smoking exposure
  • reduced exposure to radiation
  • legislation in the workplace: ban asbestos, reduce exposure to coal dust
  • good nutrition
79
Q

Early detection of lung cancer:

A
  • education of patients re symptoms and early review by doctor
  • education of healthcare professionals re early symptoms and signs
  • early chest x ray
  • low does CT screening: groups at risk

HLB (49 decks)

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