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ANKI Respiratory > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

What is the most common cancer in males?

A

Lung

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2
Q

What is the lung cancer mortality rate for males?

A

Around 100 per 100,000

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3
Q

What is happening to the incidence of lung cancer in males?

A

It is slowly falling

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4
Q

Why is the incidence rate of lung cancer in males falling?

A

Due to reduction in smoking

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5
Q

What causes more deaths in women, lung or breast cancer?

A

Lung

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6
Q

What is the lung cancer mortality rate in females?

A

Around 40 per 100,000

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7
Q

What is happening to the incidence of lung cancer in females?

A

It is steadily rising

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8
Q

How much does lung cancer incidence vary between socio-economic groups?

A

Wide variation- rate three times higher in lowest compared with highest

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9
Q

What is lung cancer overwhelmingly related to?

A

Smoking

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10
Q

What is the risk of lung cancer proportional to?

Regarding smoking

A
  • The duration of the habit
  • The number of cigarettes smoked
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11
Q

What % of lung cancers are caused by smoking?

A
  • 90% in men
  • 80% in women
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12
Q

Apart from smoking, what are the aetiological factors for lung cancer?

A
  • Asbestos exposure
  • Radon exposure
  • Genetic factors
  • Dietary factors
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13
Q

What is the problem with the signs and symptoms of lung cancer?

A

They are relatively non-specific, and overlap with those of many respiratory diseases

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14
Q

When do many lung cancer patients first come to medical attention?

A

When they have advanced disease

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15
Q

What are the signs and symptoms of a primary lung tumour?

A
  • Cough
  • Dyspnoea
  • Wheezing
  • Haemoptysis
  • Chest pain
  • Post-obstructive pneumonia
  • Weight loss
  • Lethargy / malaise
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16
Q

What are the signs and symptoms of regional metastases of lung cancer?

A
  • Superior vena cava obstruction
  • Hoarseness
  • Dyspnoea
  • Dysphagia
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17
Q

What courses hoarseness in regional metastases of lung cancer?

A

Left recurrent laryngeal nerve palsy

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18
Q

What causes dyspnoea in regional metastases of lung cancer?

A

Phrenic nerve palsy

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19
Q

What are the signs and symptoms of distant metastases of lung cancer?

A
  • Bone pain / fractures
  • CNS symptoms
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20
Q

What are the CNS symptoms of distant metastases of lung cancer?

A
  • Headache
  • Double vision
  • Confusion
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21
Q

What is paraneoplastic syndrome?

A

The presence of symptoms or disease due to the presence of cancer in the body, but not due to the local presence of cancer cells

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22
Q

What are paraneoplastic syndromes mediated by?

A

Humoral factors secreted by tumour cells, or the immune response against tumour cells

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23
Q

What humoral factors can cause paraneoplastic syndrome?

A
  • Cytokines
  • Hormones
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24
Q

What are the types of paraneoplastic syndrome?

A
  • Endocrine
  • Neurological
  • Skeletal
  • Haematological
  • Other
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25
Q

Give two examples of endocrine paraneoplastic syndromes

A
  • Hypercalcaemia
  • Cushing’s syndrome
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26
Q

Give two examples of neurological paraneoplastic syndromes

A
  • Encephalopathy
  • Peripheral neuropathy
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27
Q

Give an example of a skeletal paraneoplastic syndrome

A

Finger clubbing

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28
Q

Give 3 examples of haematological paraneoplastic syndromes

A
  • Anaemia
  • Thrombocytopenia
  • Disseminated intravascular coagulation (DIC)
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29
Q

Give 3 examples of other paraneoplastic syndromes

A
  • Nephrotic syndrome
  • Anorexia
  • Cachexia
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30
Q

What is the importance of imaging investigations of various types in lung cancer?

A

They are central to both diagnosis and assessment of the disease

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31
Q

What is the purpose of staging?

A

It is one of the most important determinants of treatment and prognosis

32
Q

What imaging techniques are imployed at the first clinical suspicion of lung cancer?

A

Plain chest x-ray

33
Q

What imaging techniques are employed for diagnosis and staging of lung cancer?

A
  • CT scan
  • PET scan
  • Isotope bone scan
34
Q

What are the staging systems for lung cancer?

A
  • Number
  • TMN
35
Q

What is the number staging system for lung cancer?

A
  • Stage 1 - Small cancer, localised to one area of the lung
  • Stage 2 & 3 - Larger cancer, may have grown into surrounding tissue (lymph nodes)
  • Stage 4 - Cancer has metastasised
36
Q

What does the T represent in the TNM staging system?

A

Size and position of tumour

37
Q

What does the N represent in the TNM staging system?

A

Lymph node involvement

38
Q

What does the M represent in the TNM staging system for cancer?

A

Metastases

39
Q

What are the potential T stages?

A

T1-4

40
Q

What does T1 mean with lung cancer?

A

Cancer contained within the lung, and is <3cm diameter

41
Q

What does T2 mean with lung cancer?

A

Cancer has grown to 3-7cm diameter, either;

  • Into the main bronchus, <2cm from the carina
  • Into the visceral pleura
  • Made part of the lung collapse
42
Q

What does T3 mean with lung cancer?

A

Cancer has grown to >7 cm in diameter, and;

  • Cancer invading chest wal, mediastinal pleura, diaphragm, pericardium
  • Complete lung collapse
  • > 1 cancer nodule in same lobe of lung
43
Q

What does T4 mean with lung cancer?

A
  • Cancer invading mediastinum, heart, major blood vessel, trachea, carina, oesophagus, spine, recurrent laryngeal nerve
  • Cancer nodules in more than one lobe of same lung
44
Q

What are the potential N stages?

A

N0-3

45
Q

What does N0 mean in lung cancer?

A

No cancer in lymph nodes

46
Q

What does N1 mean in lung cancer?

A

Cancer in lymph nodes nearest the affected lung

47
Q

What does N2 mean in lung cancer?

A

Cancer in lymph nodes in mediastium, on same side

48
Q

What does N3 mean in lung cancer?

A

Cancer in lymph nodes on the opposite sides of the mediastinum / supraclavicular lymph nodes

49
Q

What are the potential M stages?

A

M0 or M1

50
Q

What does M0 mean in lung cancer?

A

No evidence of distal cancer spread

51
Q

What does M1 mean in lung cancer?

A

Lung cancer cells in distant parts of body, such as pleura, opposite lung, liver, bones etc

52
Q

How is lung tissue for diagnostic purposes usually obtained?

A
  • Bronchoscopy
  • Needly biopsy
  • Surgical biopsy
53
Q

Why is making a histological diagnosis important?

A
  • To confirm the patient has lung cancer
  • Decide the cell type
54
Q

Why is it important to decide the cell type in lung cancer?

A

Important in terms of both prognosis and treatment

55
Q

What is the division of lung cancer into groups based on?

A

The presence or absence of cells

56
Q

What are the groups of lung cancers?

A
  • Non-Small Cell Lung Cancer
  • Small Cell Lung Cancer
57
Q

What proportion of non-small cell lung cancer patients have inoperable disease at presentation?

A

More than 2/3

58
Q

What proportion of small cell lung cancer patients have metastatic disease on presentation?

A

3/4

59
Q

What does lung cancer prognosis depend on?

A
  • Cell type
  • Stage of disease
  • Performance status
  • Biochemical markers
  • Co-morbidities
60
Q

What type of lung cancer has the worse prognosis?

A

Small cell

61
Q

Give two examples of co-morbidities that could worsen the prognosis of lung cancer

A
  • Cardiac disease
  • Chronic respiratory disease
62
Q

What treatments are available for lung cancer?

A
  • Surgery
  • Radiotherpay
  • Chemotherapy
  • Combination therpay
  • Biological targeted therapies
  • Palliative care
63
Q

When is surgery mostly used in lung cancer?

A

Non-small cell

64
Q

What % of non-small cell lung cancers are operable?

A

<20%

65
Q

What are the categories of radiotherapy in lung cancer?

A
  • Radical
  • Palliative
66
Q

What is the purpose of radical chemotherapy in lung cancer?

A

Curative

67
Q

What is the purpose of palliative chemotherapy in lung cancer?

A

Symptom control

68
Q

What is the purpose of chemotherapy in small cell lung cancer?

A

Potentially curative (although this is in a minority of cases)

69
Q

What is the purpose of chemotherapy in non-small cell lung cancer?

A

Symptom control, as only conveys a modest survival increase

70
Q

What is combination therapy?

A

A combination of chemotherapy and radiotherapy

71
Q

Give two examples of biological targeted therapies used against lung cancer?

A
  • EGFR
  • VEGF
72
Q

What does management of non-small cell lung cancer usually involve?

A

Multiple modality therapy;

  • Palliative radiotherapy
  • Chemotherapy
  • Combination therapy
  • Targeted agents
73
Q

What is the response rate to chemotherapy in non-small cell lung cancer?

A

50-60%

74
Q

When is combination therapy important in non-small cell lung cancer?

A

In locally advanced disease

75
Q

What is the problem with small cell cancer?

A

It is rarely operable

76
Q

What does management of small cell cancer involve?

A
  • Combination therapy
  • Palliative chemotherapy
77
Q

How effective is combination therapy against small cell cancer?

A

Responds well, adding ~1 year

ANKI Respiratory (17 decks)

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