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Cardiovascular & Respiratory Medicine > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

What are the 4 main types of lung cancer?

A

-Squamous cell carcinoma (30% of cases)
-Adenocarcinoma (40%)
-Large cell lung cancer (15%)
-Small cell lung cancer (15%)

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2
Q

Where does squamous cell carcinoma originate from in the lungs?

A

Bronchial epithelium, centrally located

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3
Q

Where does adenocarcinoma originate from in the lungs?

A

Mucus-producing glandular tissue- more peripherally located

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4
Q

Where does small cell lung cancer originate from?

A

From pulmonary neuroendocrine cells

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5
Q

What is a neuroendocrine cell?

A

Cell that receives nerve input to release hormones.

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6
Q

Describe the malignancy of small cell cancers

A

Highly mallignant

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7
Q

Which 3 types of lung cancer are described as non small cell lung cancer?

A

-Squamous cell carcinoma
-Adenocarcinoma
-Large cell lung cancer

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8
Q

Define metaplasia

A

Reversible change in which one adult cell type replaced by another adult cell type- adaptive

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9
Q

Define dysplasia

A

Abnormal pattern of growth in which some features of malignancy are present;
-pre-invasive stage with intact basement membrane

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10
Q

What is an oncogene?

A

A gene which in certain circumstances can transform a cell into a tumour cell.

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11
Q

What are clinical signs of lung cancer? (4)

A

-Clubbing
-Horner’s syndrome
-Superior vena cava obstruction (Pemberton’s sign)
-Cachexia

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12
Q

What is horners syndrome

A

Lung tumour at the top of lung compresses thoracic outlet, reducing sympathetic supply to face.

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13
Q

What is cachexia?

A

Unintentional weight loss

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14
Q

What is shown in this x-ray

A

Pleural effusion, counts as metastatic lung cancer.

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15
Q

What is pleural effusion?

A

An excessive collection of fluid in the pleural cavity, the fluid-filled space that surrounds the lungs.

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16
Q

What are the black dots in the top left image patient’s lung?

A

Emphysema

17
Q

What is emphysema?

A

Damaged alveoli weaken and rupture creating larger air spaces.

18
Q

What are the blobs on the liver of the middle patient?

A

Metastases

19
Q

Why are PET scans used for lung cancer?

A

Most useful to exclude occult metastases (metastases that are initially undetected)

20
Q

What kind of lung biopsy would you do for tumours of the central airway where tissue staging is not important?

A

Bronchoscopy

21
Q

What is the central airways?

A

The central airways refer to the trachea and the main-stem bronchi.

22
Q

What other methods for lung biopsies are there?

A

Endobronchial ultrasound and transbronchial-needle aspiration of mediastinal lymph nodes (EBUS [TBNA])

23
Q

What is the TNM system of staging done?

A
  • T, 1-4 → tumour size and location
  • N, 0-3 → regional lymph node involvement- (within mediastinum)
  • M, 0-1c → number of extrathoracic metastases
24
Q

How else can we stage lung cancer?

A

Early vs locally-advanced vs metastatic

25
Q

When would you use surgery to treat lung cancer?

A

-For early stage disease

26
Q

Name this surgery.

A

Wedge resection.

27
Q

Name this kind of surgery.

A

Segmental resection.

28
Q

Name this kind of surgery.

A

Lobectomy

29
Q

Name this kind of surgery.

A

Pneumonectomy.

30
Q

What is the alternative treatment for early stage disease than surgery and what is it particularly useful for?

A

Stereotactic ablative body radiotherapy (SABR)

31
Q

What does NSCLC stand for?

A

Non small cell lung carcinoma

32
Q

What is the first line for metastatic NSCLC with mutation?

A

Oncogene-directed treatment

33
Q

What is the first line for metastatic NSCLC with no mutation (and PDL1>50%)?

A

Immunotherapy to block PD-L1 receptor or PD-1 allowing T cell to kill tumour cell.

34
Q

What is the first line for metastatic NSCLC with no mutation and PDL1 ≤50% ?

A

Cytotoxic chemotherapy

35
Q

What treatment is given in early stage lung cancer?

A

Surgery or radiotherapy with curative intent

36
Q

What’s given in locally advanced disease (involving thoracic lymph nodes)?

A
  • Surgery + adjuvant chemotherapy
  • Radiotherapy + chemotherapy +/- immunotherapy
37
Q

What’s given in metastatic lung cancer? (3)

A
  • With targetable mutation (e.g. EGFR, ALK, ROS-1) a tyrosine kinase inhibitor is given
  • No mutation, PDL-1 positive- immunotherapy alone
  • No mutation, PDL-1 negative- standard chemo + immunotherapy
38
Q

Who do we usually reserve radical treatment for according to the WHO peformance status?

A

PS 0-2
0- Asymptomatic fully active
1- Symptomatic but fully ambulatory
2- Symptomatic and bedbound less than 50% of the day

Cardiovascular & Respiratory Medicine (12 decks)

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