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Medicine 1 - Clinical > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

How common is lung cancer?

A

Third most common cancer in the UK behind breast and prostate

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2
Q

What is the biggest cause of lung cancer?

A

Cigarette smoking is the biggest cause and around 80% of lung cancers are thought to be preventable.

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3
Q

What are the two types of lung cancers?

A

Non-small cell lung cancer
(80%)
Small cell lung cancer (20%)

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4
Q

What are the four types of non-small cell lung cancers?

A

Adenocarcinoma (around 40%)
Squamous cell carcinoma (around 20%)
Large-cell carcinoma (around 10%)
Other types (around 10%)

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5
Q

What do small cell lung cancer (SCLC) cells contain?

A

Neurosecretory granules that can release neuroendocrine hormones.

This makes SCLC responsible for multiple paraneoplastic syndromes.

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6
Q

Signs

A

Cachexia

Finger Clubbing

Hypertrophic pulmonary osteoarthropathy

Anaemia

Horner’s syndrome (if the tumour is apical)

Enlargement of supraclavicular and axillary lymph nodes

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7
Q

Signs on examination

A

Consolidation (pneumonia)

Collapse (absent breath sounds, ipsilateral tracheal deviation)

Pleural effusion (Stony dull percussion, decreased vocal resonance and breath sounds)

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8
Q

Paraneoplasmic syndromes

A

Cushing’s syndrome, SIADH, and Lambert-Eaton syndrome (suggest small-cell), hyperparathyroidism (suggests squamous cell)

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9
Q

What are the features of adenocarcinoma?

A

Located peripherally (in the smaller airways)

Histology: glandular differentiation

More common in non-smokers and Asian females

Metastasise early

Responds well to immunotherapy

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10
Q

What are the features of squamous cell carcinoma?

A

Located centrally (in the bronchi)

Histology: squamous differentiation (keratinisation)

More common in smokers

Secrete PTHrP, causing hypercalcaemia

Metastasise late (via lymph nodes)

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11
Q

What are the features of large carcinoma?

A

Located peripherally and centrally

Histology: large and poorly-differentiated

More common in smokers

Metastasise early

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12
Q

What are the features of small cell?

A

Located centrally

Histology: poorly-differentiated

More common in older smokers

Metastasise early

Secrete ACTH (Cushing’s syndrome) and ADH (SIADH)

Associated with Lambert-Eaton syndrome

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13
Q

What are the risk factors for lung cancer?

A

Main: smoking

Air pollution (indoor and outdoor)

Family history of cancer, especially lung cancer

Male sex

Radon gas (typically affects miners)

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14
Q

Clinical features of lung cancer

A

Unexplained cough for at least 3 weeks (with or without haemoptysis)

Unintended weight loss (>5% in 6 months)

New-onset dyspnoea

Pleuritic chest pain (due to the tumour invading the pleura or the chest wall)

Bone pain (due to metastases – commonly the spine, pelvis and long bones)

Fatigue (due to anaemia of chronic disease)

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15
Q

What is the first line investigation for suspected lung cancer?

A

CXR

Findings suggesting cancer:

Hilar enlargement
“Peripheral opacity” – a visible lesion in the lung field
Pleural effusion – usually unilateral in cancer
Collapse

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16
Q

After a CXR, what investigations are used?

A

Staging CT scan
PET-CT
Bronchoscopy with endobronchial ultrasound
Histological diagnosis

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17
Q

Why would a staging CT scan be used for lung cancer?

A

To establish the stage and check for lymph node involvement and metastasis.

Should be contrast enduced.

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18
Q

Why would a PET-CT scan be used?

A

To identify areas that the cancer has spread to by showing areas of increased metabolic activity suggestive of cancer

19
Q

What do PET-CT scans include?

A

Injecting a radioactive tracer (usually attached to glucose molecules) and taking images using a combination of a CT scanner and a gamma ray detector to visualise how metabolically active various tissues are.

20
Q

What does a bronchoscopy involve?

A

Endoscopy of the airways (bronchi) with ultrasound on the end of the scope.

This allows for detailed assessment of the tumour and ultrasound guided biopsy.

21
Q

What is a histological diagnosis used for and how can it be carried out?

A

Check the type of cells in the cancer requires a biopsy.

This can be either by bronchoscopy or percutaneously (through the skin).

22
Q

How is lung cancer staged?

A

I - One small tumour (<4cm) – localised to one lung

II - Larger tumour (>4cm) – may have spread to nearby lymph nodes

III - Tumour that has spread to contralateral lymph nodes, or grown into nearby structures (e.g. trachea)

IV - Tumour that has spread to lymph nodes outside the chest, or other organs (e.g. liver)

23
Q

Management:

Non-small cell lung cancer

Stage I-III

A

Surgery: options include lobectomy/pneumonectomy in patients with intact lung function, or wedge resection in patients with reduced lung function (e.g. elderly, underlying respiratory conditions).

Pre-operative chemotherapy

Post-operative chemotherapy and radiotherapy: may not be needed in some cases of stage I lung cancer.

24
Q

What can be given to patients with non-small cell lung cancer who cannot have surgery?

Stages I-III

A

Stereotactic ablative radiotherapy (SABR).

Directing a more intense and focused beam of radiation at the tumour

Reduces the number of radiotherapy sessions needed and minimises damage to surrounding tissue.

25
Q

Management:

Non-small cell lung cancer

Stage IV

A

Targeted therapy
Immunotherapy
Chemotherapy
Palliative care

26
Q

What is targeted therapy?

A

These drugs target mutations which drive the pathogenesis of lung cancer

27
Q

What is immunotherapy?

A

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

28
Q

What is the treatment in small cell lung cancer?

A

Chemotherapy & radiotherapy

Surgery: rare in small cell lung cancer, as most patients present with advanced disease.

Prophylactic cranial irradiation: since small cell lung cancer is associated with a high risk of brain metastases, radiotherapy is directed at the brain to prevent brain metastases.

29
Q

How does cancer lead to a hoarse voice?

A

Recurrent laryngeal nerve palsy
-
cancer pressing on or affecting the recurrent laryngeal nerve as it passes through the mediastinum

30
Q

How can cancer lead to phrenic nerve palsy?

A

Due to nerve compression causes diaphragm weakness and presents as shortness of breath

31
Q

What is superior vena cava obstruction?

A

Direct compression of the tumour on the superior vena cava.

It presents with facial swelling, difficulty breathing and distended veins in the neck and upper chest.

“Pemberton’s sign” is where raising the hands over the head causes facial congestion and cyanosis.

This is a medical emergency.

32
Q

What is Horner’s syndrome?

A

A triad of partial ptosis, anhidrosis and miosis.

It is caused by a Pancoast’s tumour (tumour in the pulmonary apex) pressing on the sympathetic ganglion.

Ptosis is when the upper eyelid droops over the eye

Anhidrosis is a condition in which you can’t sweat (perspire) normally in one or more areas of your body

Miosis means excessive constriction (shrinking) of your pupil

33
Q

What happens in Horner’s syndrome?

A

Affects the face and eye on one side of the body.

It is caused by the disruption of a nerve pathway from the brain to the head and neck.

Typically, signs and symptoms of Horner syndrome include decreased pupil size, a drooping eyelid and decreased sweating on the affected side of the face.

34
Q

What causes syndrome of inappropriate ADH (SIADH)?

A

Ectopic ADH secretion by a small cell lung cancer and presents with hyponatraemia

35
Q

How can cushing’s syndrome be caused?

A

Ectopic ACTH secretion by a small cell lung cancer.

36
Q

What is cushing’s syndrome?

A

Condition caused by having too much of a hormone called cortisol in your body.

37
Q

What are the symptoms of cushing’s syndrome?

A

Increased fat on your chest and tummy, but slim arms and legs
a build-up of fat on the back of your neck and shoulders, known as a “buffalo hump”

A red, puffy, rounded face

Skin that bruises easily

Large purple stretch marks

Weakness in your upper arms and thighs

Reduced sex drive (low libido) and fertility problems

Depression and mood swings

38
Q

What is the most common type of lung cancer?

A

Squamous cell cancer followed by adenocarcinoma

39
Q

Where does lung cancer commonly spread to?

A

Brain
Breast
Adrenals
Bone

40
Q

How does lung cancer spread?

A

Via lymph nodes

41
Q

What should be given for superior vena cava obstruction?

A

Intravenous dexamethasone
Dexamethasone can be administered to reduce swelling and therefore the pressure on the SVC

42
Q

What does SIADH cause?

A

Hyponatraemia

43
Q

What lung cancer is most likely to show cavitating lesions in a CXR?

A

Squamous cell carcinoma

44
Q

Hypercalcaemia treatment

A

Intravenous 0.9% sodium chloride infusion

Medicine 1 - Clinical (41 decks)

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