Lung Cancer Flashcards
What is the most common cancer in males?
Lung
What is the lung cancer mortality rate for males?
Around 100 per 100,000
What is happening to the incidence of lung cancer in males?
It is slowly falling
Why is the incidence rate of lung cancer in males falling?
Due to reduction in smoking
What causes more deaths in women, lung or breast cancer?
Lung
What is the lung cancer mortality rate in females?
Around 40 per 100,000
What is happening to the incidence of lung cancer in females?
It is steadily rising
How much does lung cancer incidence vary between socio-economic groups?
Wide variation- rate three times higher in lowest compared with highest
What is lung cancer overwhelmingly related to?
Smoking
What is the risk of lung cancer proportional to?
Regarding smoking
- The duration of the habit
- The number of cigarettes smoked
What % of lung cancers are caused by smoking?
- 90% in men
- 80% in women
Apart from smoking, what are the aetiological factors for lung cancer?
- Asbestos exposure
- Radon exposure
- Genetic factors
- Dietary factors
What is the problem with the signs and symptoms of lung cancer?
They are relatively non-specific, and overlap with those of many respiratory diseases
When do many lung cancer patients first come to medical attention?
When they have advanced disease
What are the signs and symptoms of a primary lung tumour?
- Cough
- Dyspnoea
- Wheezing
- Haemoptysis
- Chest pain
- Post-obstructive pneumonia
- Weight loss
- Lethargy / malaise
What are the signs and symptoms of regional metastases of lung cancer?
- Superior vena cava obstruction
- Hoarseness
- Dyspnoea
- Dysphagia
What courses hoarseness in regional metastases of lung cancer?
Left recurrent laryngeal nerve palsy
What causes dyspnoea in regional metastases of lung cancer?
Phrenic nerve palsy
What are the signs and symptoms of distant metastases of lung cancer?
- Bone pain / fractures
- CNS symptoms
What are the CNS symptoms of distant metastases of lung cancer?
- Headache
- Double vision
- Confusion
What is paraneoplastic syndrome?
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
What are paraneoplastic syndromes mediated by?
Humoral factors secreted by tumour cells, or the immune response against tumour cells
What humoral factors can cause paraneoplastic syndrome?
- Cytokines
- Hormones
What are the types of paraneoplastic syndrome?
- Endocrine
- Neurological
- Skeletal
- Haematological
- Other
Give two examples of endocrine paraneoplastic syndromes
- Hypercalcaemia
- Cushing’s syndrome
Give two examples of neurological paraneoplastic syndromes
- Encephalopathy
- Peripheral neuropathy
Give an example of a skeletal paraneoplastic syndrome
Finger clubbing
Give 3 examples of haematological paraneoplastic syndromes
- Anaemia
- Thrombocytopenia
- Disseminated intravascular coagulation (DIC)
Give 3 examples of other paraneoplastic syndromes
- Nephrotic syndrome
- Anorexia
- Cachexia
What is the importance of imaging investigations of various types in lung cancer?
They are central to both diagnosis and assessment of the disease
What is the purpose of staging?
It is one of the most important determinants of treatment and prognosis
What imaging techniques are imployed at the first clinical suspicion of lung cancer?
Plain chest x-ray
What imaging techniques are employed for diagnosis and staging of lung cancer?
- CT scan
- PET scan
- Isotope bone scan
What are the staging systems for lung cancer?
- Number
- TMN
What is the number staging system for lung cancer?
- 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
What does the T represent in the TNM staging system?
Size and position of tumour
What does the N represent in the TNM staging system?
Lymph node involvement
What does the M represent in the TNM staging system for cancer?
Metastases
What are the potential T stages?
T1-4
What does T1 mean with lung cancer?
Cancer contained within the lung, and is <3cm diameter
What does T2 mean with lung cancer?
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
What does T3 mean with lung cancer?
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
What does T4 mean with lung cancer?
- Cancer invading mediastinum, heart, major blood vessel, trachea, carina, oesophagus, spine, recurrent laryngeal nerve
- Cancer nodules in more than one lobe of same lung
What are the potential N stages?
N0-3
What does N0 mean in lung cancer?
No cancer in lymph nodes
What does N1 mean in lung cancer?
Cancer in lymph nodes nearest the affected lung
What does N2 mean in lung cancer?
Cancer in lymph nodes in mediastium, on same side
What does N3 mean in lung cancer?
Cancer in lymph nodes on the opposite sides of the mediastinum / supraclavicular lymph nodes
What are the potential M stages?
M0 or M1
What does M0 mean in lung cancer?
No evidence of distal cancer spread
What does M1 mean in lung cancer?
Lung cancer cells in distant parts of body, such as pleura, opposite lung, liver, bones etc
How is lung tissue for diagnostic purposes usually obtained?
- Bronchoscopy
- Needly biopsy
- Surgical biopsy
Why is making a histological diagnosis important?
- To confirm the patient has lung cancer
- Decide the cell type
Why is it important to decide the cell type in lung cancer?
Important in terms of both prognosis and treatment
What is the division of lung cancer into groups based on?
The presence or absence of cells
What are the groups of lung cancers?
- Non-Small Cell Lung Cancer
- Small Cell Lung Cancer
What proportion of non-small cell lung cancer patients have inoperable disease at presentation?
More than 2/3
What proportion of small cell lung cancer patients have metastatic disease on presentation?
3/4
What does lung cancer prognosis depend on?
- Cell type
- Stage of disease
- Performance status
- Biochemical markers
- Co-morbidities
What type of lung cancer has the worse prognosis?
Small cell
Give two examples of co-morbidities that could worsen the prognosis of lung cancer
- Cardiac disease
- Chronic respiratory disease
What treatments are available for lung cancer?
- Surgery
- Radiotherpay
- Chemotherapy
- Combination therpay
- Biological targeted therapies
- Palliative care
When is surgery mostly used in lung cancer?
Non-small cell
What % of non-small cell lung cancers are operable?
<20%
What are the categories of radiotherapy in lung cancer?
- Radical
- Palliative
What is the purpose of radical chemotherapy in lung cancer?
Curative
What is the purpose of palliative chemotherapy in lung cancer?
Symptom control
What is the purpose of chemotherapy in small cell lung cancer?
Potentially curative (although this is in a minority of cases)
What is the purpose of chemotherapy in non-small cell lung cancer?
Symptom control, as only conveys a modest survival increase
What is combination therapy?
A combination of chemotherapy and radiotherapy
Give two examples of biological targeted therapies used against lung cancer?
- EGFR
- VEGF
What does management of non-small cell lung cancer usually involve?
Multiple modality therapy;
- Palliative radiotherapy
- Chemotherapy
- Combination therapy
- Targeted agents
What is the response rate to chemotherapy in non-small cell lung cancer?
50-60%
When is combination therapy important in non-small cell lung cancer?
In locally advanced disease
What is the problem with small cell cancer?
It is rarely operable
What does management of small cell cancer involve?
- Combination therapy
- Palliative chemotherapy
How effective is combination therapy against small cell cancer?
Responds well, adding ~1 year
