Lung Cancer Flashcards
What are the 4 main types of lung cancer?
-Squamous cell carcinoma (30% of cases)
-Adenocarcinoma (40%)
-Large cell lung cancer (15%)
-Small cell lung cancer (15%)
Where does squamous cell carcinoma originate from in the lungs?
Bronchial epithelium, centrally located
Where does adenocarcinoma originate from in the lungs?
Mucus-producing glandular tissue- more peripherally located
Where does small cell lung cancer originate from?
From pulmonary neuroendocrine cells
What is a neuroendocrine cell?
Cell that receives nerve input to release hormones.
Describe the malignancy of small cell cancers
Highly mallignant
Which 3 types of lung cancer are described as non small cell lung cancer?
-Squamous cell carcinoma
-Adenocarcinoma
-Large cell lung cancer
Define metaplasia
Reversible change in which one adult cell type replaced by another adult cell type- adaptive
Define dysplasia
Abnormal pattern of growth in which some features of malignancy are present;
-pre-invasive stage with intact basement membrane
What is an oncogene?
A gene which in certain circumstances can transform a cell into a tumour cell.
What are clinical signs of lung cancer? (4)
-Clubbing
-Horner’s syndrome
-Superior vena cava obstruction (Pemberton’s sign)
-Cachexia
What is horners syndrome
Lung tumour at the top of lung compresses thoracic outlet, reducing sympathetic supply to face.
What is cachexia?
Unintentional weight loss
What is shown in this x-ray
Pleural effusion, counts as metastatic lung cancer.
What is pleural effusion?
An excessive collection of fluid in the pleural cavity, the fluid-filled space that surrounds the lungs.
What are the black dots in the top left image patient’s lung?
Emphysema
What is emphysema?
Damaged alveoli weaken and rupture creating larger air spaces.
What are the blobs on the liver of the middle patient?
Metastases
Why are PET scans used for lung cancer?
Most useful to exclude occult metastases (metastases that are initially undetected)
What kind of lung biopsy would you do for tumours of the central airway where tissue staging is not important?
Bronchoscopy
What is the central airways?
The central airways refer to the trachea and the main-stem bronchi.
What other methods for lung biopsies are there?
Endobronchial ultrasound and transbronchial-needle aspiration of mediastinal lymph nodes (EBUS [TBNA])
What is the TNM system of staging done?
- T, 1-4 → tumour size and location
- N, 0-3 → regional lymph node involvement- (within mediastinum)
- M, 0-1c → number of extrathoracic metastases
How else can we stage lung cancer?
Early vs locally-advanced vs metastatic
When would you use surgery to treat lung cancer?
-For early stage disease
Name this surgery.
Wedge resection.
Name this kind of surgery.
Segmental resection.
Name this kind of surgery.
Lobectomy
Name this kind of surgery.
Pneumonectomy.
What is the alternative treatment for early stage disease than surgery and what is it particularly useful for?
Stereotactic ablative body radiotherapy (SABR)
What does NSCLC stand for?
Non small cell lung carcinoma
What is the first line for metastatic NSCLC with mutation?
Oncogene-directed treatment
What is the first line for metastatic NSCLC with no mutation (and PDL1>50%)?
Immunotherapy to block PD-L1 receptor or PD-1 allowing T cell to kill tumour cell.
What is the first line for metastatic NSCLC with no mutation and PDL1 ≤50% ?
Cytotoxic chemotherapy
What treatment is given in early stage lung cancer?
Surgery or radiotherapy with curative intent
What’s given in locally advanced disease (involving thoracic lymph nodes)?
- Surgery + adjuvant chemotherapy
- Radiotherapy + chemotherapy +/- immunotherapy
What’s given in metastatic lung cancer? (3)
- 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
Who do we usually reserve radical treatment for according to the WHO peformance status?
PS 0-2
0- Asymptomatic fully active
1- Symptomatic but fully ambulatory
2- Symptomatic and bedbound less than 50% of the day
