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RESPIRATORY > LUNG CANCER > Flashcards

LUNG CANCER Flashcards

1
Q

Whats the epidemiology of lung cancer?

A

Over 48,000 new lung cancers are diagnosed each year in the UK
It’s the third most common malignancy in the UK and the leading cause of cancer-released death

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2
Q

How often is smoking implicated in lung cancer?

A

In 80% of cases

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3
Q

How is lung cancer categorised?

A

Small-cell lung cancer
Non-small cell lung cancer - adenocarcinoma, squamous cell carcinoma and large cell

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4
Q

What are the aetiological factors for lung cancer?

A

Tobacco smoking 80-90% of cases
Asbestos and radon gas exposure

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5
Q

Whats the most common type of lung cancer?

A

Non-small cell lung cancers account for 80-85% of lung cancers
Adenocarcinoma is the most common form (40%) and squamous cell accounts for 35%

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6
Q

What is adenocarcinoma of the lungs?

A

A cancer of the glandular cells

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7
Q

Which type of lung cancer is most common in non-smokers?

A

Adenocarcinoma (although smoking and asbestos exposure are still risk factors)

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8
Q

Which lung cancers tend to occur in the central parts of the lungs?

A

Squamous cell lung cancer
Small cell lung cancer

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9
Q

Which lung cancers tend to occur in the peripheries of the lungs?

A

Adenocarcinoma
Large cell lung carcinoma

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10
Q

Whats the most aggressive lung cancer type?

A

Small cell lung cancer - aggressive nature and early metastasis

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11
Q

What cell type does large cell lung cancer affect?

A

Epithelial cells lining the lungs
Characterised by the presence of large abnormal cells

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12
Q

What cell type does small cell lung cancer affect?

A

Kulchitsky cells which are endocrine cells - APUD cells

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13
Q

What are APUD cells?

A

An acronym for…
Amine - high amine content
Precursor Uptake - high uptake of amine precursors
Decarboxylase - high content of decarboxylase enzyme

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14
Q

which lung cancer is most associated with paraneoplastic syndromes?

A

Small cell lung cancer

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15
Q

Which paraneoplastic syndromes is small cell lung cancer most associated with?

A

Ectopic ADH secretion - hypertension, oedema, concentrated urine
Ectopic ACTH secretion - Cushing syndrome
Lambert-Eaton myasthenic syndrome

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16
Q

Which type of lung cancer is most likely to have cavitation lesions?

A

Squamous cell carcinoma

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17
Q

What is a bronchial adenoma?

A

A rare tumour that starts in the glandular tissue of bronchi
They are usually benign but they can be malignant in rare cases. Malignant bronchial adenomas are also known as carcinoid tumors and are a type of neuroendocrine tumor.

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18
Q

What age pt do bronchial adenomas typically affect?

A

Adults under 45

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19
Q

Which type of lung cancer is most likely to secrete beta-HCG?

A

Large cell lung cancer

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20
Q

Which type of lung cancer tends to cause tumours associated with occupation factors?

A

adenocarcinoma

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21
Q

Which lung cancer type causes excessive mucous secretion?

A

Adenocarcinoma

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22
Q

What is radon?

A

A colourless, odourless gas which is a natural breakdown product of uranium found in the soil

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23
Q

Which gene mutations are associated with lung cancer?

A

Epidermal growth factor receptor gene - EGFR
TP53
KRAS
Anaplastic lymphoma kinase gene - ALK
ROS1 gene
BRAF gene
Neurotrophic tyrosine receptor kinase gene - NTRK
Mesenchymal-epithelial transition gene - MET
RET gene

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24
Q

Where does lung cancer typically metastasise to?

A

Mediastinum
Hilar lymph nodes
Lung pleura
Heart
Breasts
Liver
Adrenal glands
Brain
Bones

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25
Q

Why does small cell carcinoma have a poor prognosis?

A

Rapid growth
High propensity + rapid ability to metastasise
Often resistant to conventional cancer treatments
Late diagnosis which limits treatment options

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26
Q

How do we stage small cell carcinomas?

A

Limited - if cancer is confined to one lung and may have spread to lymph nodes on the same side
Extensive - if spread beyond 1 lung

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27
Q

How do we stage non-small cell carcinoma?

A

TNM staging

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28
Q

Which lung tumours can form Pancoast tumours?

A

Non-small cell lung cancers - squamous cell is most common. Adenocarcinomas and large cell carcinomas can cause them but it’s less common
(Small cell lung cancer rarely causes them as it tends to grow centrally in the lung)

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29
Q

What are Pancoast tumours?

A

Aka a superior sulcus tumour
A tumour arising in the very apex of the lungs and invading the surrounding tissue and chest wall - must cause characteristic symptoms to be considered a Pancoast tumour e.g. shoulder pain, arm weakness, arm numbness, and Horner’s syndrome

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30
Q

What can Pancoast tumours compress and damage?

A

Thoracic inlet and thoracic outlet obstructions
Brachial plexus
Cervical sympathetic nerve

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31
Q

What causes Horner syndrome?t

A

Compression of cervical sympathetic nerves typically by a Pancoast tumour

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32
Q

What are the symptoms of Horner syndrome?

A

Ptosis
Myosis
Anhydrosis
Enopthalmosis (sunken eye)

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33
Q

Which paraneoplastic syndromes are most associated with squamous cell lung cancer?

A

Hypercalcaemia (parathyroid hormone-related protein produced from tumour cells). In 50% of pt

Others - clubbing, hypertrophic pulmonary osteoarthropathy and hyperthyroidism (due to ectopic TSH)

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34
Q

Which paraneoplastic syndromes are most associated with large cell lung cancer?

A

Really rare
Hypertrophic pulmonary osteoarthropathy
Neuromyopathy
Lambert-Eaton syndrome
May secrete beta hCG

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35
Q

Which paraneoplastic syndromes are most associated with adenocarcinoma?

A

Gynaecomastia (related to secretion of HCG or alpha-fetoprotein or estrogen-like substances by tumour)
Hypertrophic pulmonary osteoarthropathy

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36
Q

What is SIADH?

A

Syndrome of inappropriate anti diuretic hormone
Hyponatraemia secondary to the dilution all effects of excessive water retention by the kidneys due to ezxcess ADH

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37
Q

How does small cell lung cancer cause Cushing syndrome?

A

10-15% of SCLC patients have tumours which produced ACTH or CRH which stimulates the adrenal glands to produce more cortisol than the body needs = Cushings

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38
Q

How do small cell lung cancers cause lambert-Eaton syndrome?

A

Autoimmune disorder
Tumour cells produce a protein called voltage-gated calcium channel which is similar in structure to presynaptic voltage gated calcium channels found in nerve cells in PNS. The immune system produces antibodies against it which can cross-react with calcium channels on nerve cells leading to impaired nerve conduction and muscle weakness

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39
Q

What causes hypertrophic pulmonary osteoarthropathy?

A

Tumour cells release certain hormones and cytokines such as vascular endothelial growth factor which lead to inflammation and abnormal bone growth
Associated with lung cancer but may also be caused by COPD, cystic fibrosis and other lung disorders

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40
Q

What are symptoms of SIADH?

A

Nausea and vomiting
Headaches
Confusion and disorientation particularly in elderly
Seizures
Muscle weakness or cramps
Fatigue

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41
Q

What are symptoms of hypercalcaemia?

A

Stones - renal calculi
Bones - bone pain
Groans - abdominal pain
Thrones - polyuria
Psychiatric moans - altered mental status

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42
Q

What are the 2 mechanisms by which lung cancers may cause hypercalcaemia?

A

Bony metastasis
Tumour secretion of parathyroid hormone-related protein

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43
Q

What are symptoms of Cushing’s syndrome?

A

Fatigue
Depression
Weight gain
Easy bruising
Amenorrhoea and reduced libido
Striae
Acne
Moon facies
Buffalo hump
Hypertension
Proximal muscle weakness
Hyperpigmentation

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44
Q

What are symptoms of lambert-Eaton syndrome?

A

Repeated muscle contractions lead to increased muscle strength
Limb-girdle weakness
Hyporeflexia
Autonomic symptoms - dry mouth, impotence, difficulty micturition

Opthalmoplegia and ptosis less common

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45
Q

What are symptoms of hypertrophic pulmonary osteoarthropathy?

A

Joint stiffness
Severe pain in wrists and ankle
Sometimes gynaecomastia
Digital clubbing

On x-ray - proliferative periostitis at the ends of the long bones which have an ‘onion skin’ appearance

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46
Q

What can Pancoast tumours cause?

A

Horners syndrome
Pain in shoulder that radiates into arm and hand
Atrophy of muscles of upper limb
Oedema of upper limb

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47
Q

Whats the most common lung cancer to cause superior vena cava obstruction?

A

Small cell lung cancer

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48
Q

What are the features of SVC obstruction?

A

Dyspnoea
Swelling of face, neck and arms (conjunctival and periorbital oedema may be seen)
Headaches that are worse in the morning
Visual disturbance
Pulseless jugular venous distension

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49
Q

What is Pemberton’s sign?

A

Where raising hands over the head causes facial congestion and cyanosis

50
Q

What is limbic encephalitis?

A

a paraneoplastic syndrome where the small cell lung cancer causes the immune system to make antibodies to tissues in the brain, specifically the limbic system, causing inflammation in these areas.
Associated with anti-hu antibodies

51
Q

What symptms are associated with limbic encephalitis?

A

short term memory impairment, hallucinations, confusion and seizures

52
Q

What happens if a lung cancer invades the recurrent laryngeal nerve?

A

Recurrent laryngeal nerve palsy which presents with a hoarse voice

53
Q

What happens if a tumour invades the phrenic nerve?

A

Phrenic nerve palsy - diaphragm weakness and presents was SOB

54
Q

What are bronchial carcinoid tumours?

A

Rare neuroendocrine tumours that account for 1-2% of all lung tumours
Very aggressive
rarely causes carcinoid syndrome - particularly causes release of serotonin which causes increased peristalsis and diarrhoea, and bronchoconstriction

55
Q

What are symptoms suggestive of lung cancer?

A

Shortness of breath
Cough
Haemoptysis
Chest pain
Fatigue
Recurrent chest infections
Weight loss and loss of appetite
Lymphadenopathy
Hoarseness
SVC syndrome
Horners syndrome
First presentation may be due to mets, particularly bone or brain

56
Q

What are symptoms of pleural mesothelioma?

A

Cough
SOB
Chest pain
Weight loss

57
Q

Whats the 5 year survival rate for lung cancer?

A

16.2%

58
Q

What signs might you find in lung cancer?

A

Lymphadenopathy (supraclaviuclar and axillary)
Stridor
Wheeze
Clubbing
Hypertrophic pulmonary osteoarthropathy
Signs of pleural effusion - dull percussion, reduced vocal fremitus, reduced breath sounds
Horner’s syndrome signs
Signs of paraneoplastic syndromes

59
Q

When should you refer people for 2WW when considering lung cancer?

A

Chest X-ray findings that suggest lung cancer
40 or over with unexplained haemoptysis

Offer an urgent chest X-ray within 2 weeks if 40 or over and have smoked with cough, fatigue, SOB, chest pain, weight loss or appetite loss (if they haven’t smoked they need 2 of these symptoms)

Consider if over 40 and have either persistent chest infections, finger clubbing, supraclavicular lymphadenopathy or persistent cervical lymphadenopathy, chest signs consistent with lung cancer or thrombocytosis

60
Q

When should I refer a person with suspected mesothelioma?

A

2WW for suspected cancer pathway referral - if CXR findings suggesting mesothelioma

Urgent CXR for people 40 or over and if they have ever smoked/been exposed to asbestos and have either cough, fatigue, SOB, chest pain, weight loss, appetite loss (if no smoking history or asbestos exposure then they need 2 symptoms)

Consider urgent CXR if 40 and over with clubbing or chest signs compatible with pleural disease

61
Q

What investigations should you do for lung cancer?

A

Bloods - FBC (thrombocytosis and anaemia), LFTs, hypercalcaemia, hyponatraemia, bone profile. U&Es
Sputum cytology
Lung function tests
Chest X-ray (note in 10% it will be normal as you can’t see masses <1cm diameter)
CT thorax
staging CT abdomen and CT head which looks at liver, adrenals and brain
(MRI if necessary to assess extent of disease e.g. for superior sulcus tumours)
Endobronchial ultrasoundguided transbronchial needle aspiration to take a biopsy
PET scanning is typically done in NSCLC to establish eligibility for curative treatment

62
Q

What might you see on chest X-ray in lung cancer?

A

Hilar enlargement
Peripheral opacity
Pleural effusion (usually unilateral)
Lung collapse
Nodules
Consolidation
Bony metastasis

63
Q

Why is a CT chest done for lung cncer?

A

Picks up smaller tu,ours
May show mets so should include neck and upper abdomen to look for liver and adrenal mets
(May also do CT brain to exclude cerebral metastasis)

64
Q

How does a PET-CT work?

A

positron emission tomography (combined with CT) involves the injection of a radioactive tracer, for example, fluorodeoxyglucose-18 (FGD-18). FGD-18 is a radiolabelled glucose taken up preferentially into more metabolically active cells - this includes cancers

65
Q

How is a bronchoscopy done?

A

involves a thin long camera that enters the trachea and bronchial tree via the mouth. It allows for visualisation of the airways and any lesions that may be impinging or invading them. It also allows for washings/brushings to be taken for cytological analysis. In EBUS-TBNA an ultrasound probe is passed into the trachea and bronchial tree via the mouth. It allows for ultrasound-guided biopsy of paratracheal and peri-bronchial intra-parenchymal lung lesions.

66
Q

Why may lung function tests be done before lung resection for cancer?

A

It allows clinicians to estimate if the patient will have sufficient residual lung capacity following a wedge resection, a lobectomy or pneumonectomy. This is of particular importance in patients with pre-existing lung disease (e.g. emphysema) as they will already have reduced lung function.
Offer surgery if FEV1 is within normal limits the pt has good exercise tolerance

67
Q

What are the stages of non-small cell lung cancer?

A

1A - T1N0M0
1B - T2aN0M0

2A - T2bN0M0
2B - T1N1M0, T2N1M0, T3N0M0

3A - T1N2M0, T2N2M0, T3N1M0, T4N0M0, T4N1M0
3B - T1N3M0, T2N3M0, T3N2M0
3c - T3N3M0, T4N3M0

4 - any T any N M1

68
Q

Outline the tumour part of TNM staging for NSCLC?

A

To - primary tumour can’t be assessed
T0 - no evidence of primary tumour
Tis- carcinoma in situ
T1 - tumour 3cm or less without bronchoscopes evidence of invasion more proximal than the lobar bronchus
T2 - tumour 3-5cm or a tumour smaller that involves the main bronchus or invades visceral pleur or is associated with atelectasis or obstructive pneumonia is that extensds to the Hilar region
T3 - tumour 5-7cm or associated with separate tumour nodules in the same lode as primary tumour or directly invades chets wall, phrenic nerve or parietal pericardium
T4 - tumours >7cm or associated with separate tumour nodules in i psi lateral lobe or invades diaphragm/mediastinum/heart/great vessels/trachea/recurrent laryngeal nerve/oesophagus/vertebral body/carina

69
Q

Outline the node part of TNM staging for NSCLC?

A

Nx: Regional lymph nodes cannot be assessed
N0: No regional lymph node metastasis
N1: Metastasis in ipsilateral peribronchial and/or ipsilateral hilar lymph nodes and intrapulmonary nodes, including involvement by direct extension
N2: Metastasis in ipsilateral mediastinal and/or subcarinal lymph node(s)
N3: Metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s)

70
Q

How is non-small cell lung cancer managed?

A

smoking cessation
Surgical resection is the treatment of choice in stage 1 and 2 if under 65
Perform Hilar and mediastinal lymph node sampling for all who have surgery with curative intent
Radical radiotherapy can be used where surgery is not suitable or declined
Adjuvant chemotherapy is used in combination with surgery or given as palliative therapy to improve survival in more advanced diseases

71
Q

How is small cell lung cancer managed?

A

Smoking cessation
Surgical resection is only an option in early disease, appropriate in < 5% of cases. In T1/2a N0 M0 disease surgery with curative intent may be utilised.

Generally, treatment consists of chemotherapy (often cisplatin-based) and/or radiotherapy with the goal of extending survival and reducing troublesome symptoms. Never really curative as nearly always metastasised by time of presentation

72
Q

What is endobronchial ultrasound-guided transbronchial needle aspiration?

A

Uses a bronchoscope and ultrasound probe to creat pictures of the lungs and other structures

73
Q

Why is it important to obtain a histological diagnosis of lung cancer?

A

To distinguish non-cancer from cancer
To distinguish primary cancers from secondary cancers
To determine treatment decisions - i.e. cell type and molecular testing to ascertain suitability for targeted treatments

74
Q

What is atelectasis?

A

Complete or partial collapse of a ;lung or lobe of lung

75
Q

What is ECOG performance status?

A

Eastern Cooperative Oncology Group performance scale
It determines the ability of pt to tolerate therapies in serious illness, specifically for chemotherapy - simpler than Karnofsky scale

Asymptomatic
Symptomatic but completely ambulatory
Symptomatic <50% in bed during day
Symptomatic with >50% in bed but not bedbound
Bedbound
Death

76
Q

What is SABR?

A

Stereotactic ablative radiotherapy

77
Q

When is SABR used?

A

For medically inoperable pt
Early stage non-small cell lung cancer

78
Q

What type of chemotherapy is offered for non-small cell lung cancer?

A

Cisplatin or carboplatin based with at least 1 other chemotherapy drug e.g. Paclitaxel, pemetrexed, vinorelbine, gemcitabine

79
Q

What type of chemotherapy is offered for metastatic non-small cell lung cancer?

A

carboplatin or cisplatin with pemetrexed and pembrolizumab
carboplatin and paclitaxel and bevacizumab and atezolizumab
carboplatin and paclitaxel and atezolizumab
carboplatin and paclitaxel and pembrolizumab

80
Q

What type of chemotherapy is offered for limited small cell lung cancer?

A

Cisplatin and etoposide
Or
Carboplatin and etoposide

81
Q

What type of chemotherapy is offered for extensive small cell lung cancer?

A

carboplatin and etoposide with atezolizumab or durvalumab
cisplatin and etoposide with durvalumab

82
Q

What drugs can be given if they have non small cell lung cancer with EGFR-TK mutation?

A

EGFR tyrosine kinase inhibitors e.g. geftinib, erlotibin, afatinib and Osimertinib

83
Q

What drugs can be given if they have non-small cell lung cancer with ALK gene rearrangement?

A

Oral tyrosine kinase inhibitors that inhibit the normal ALK protein e.g. Crizotinib, ceritinib, alectinib

84
Q

What drugs can be given if they have non-small cell lung cancer with PD-L1 expression level >50%?

A

Immunotherapy with a checkpoint inhibitor e.g. Pembrolizumab or atezolizumab (blocks PD-L1 protein)

85
Q

What drugs can be given if they have non-small cell lung cancer with tumours that are ROS1 positive?

A

Oral tyrosine kinase inhibitors that specifically target and inhibit abnormal ROS1 protein e.g. crizotinib, entrectinib, or lorlatinib.

86
Q

What proportion of lung cancer cases are preventable?

A

79%

87
Q

How much does smoking increase your risk of lung cancer?

A

If you smoke more than 25 cigarettes a day, you are 25 times more likely to get lung cancer than someone who does not smoke.

88
Q

Outline the prognosis rates of non-small cell lung cancer according to TNM staging?

A

Stage 1 - 90% 5 year survival
Stage 2 - 70%
Stage 3 M0 - 60%
Stage 3C -25%
Stage 4 - 7%

89
Q

What stage of cancer can non-small cell lung cancer be curable via surgery?

A

T1, N0, M0

90
Q

What are operable stages of lung cancer?

A

T1N0 - T3N2 (stage 1 - 3A)

91
Q

Why is poor lung function a contraindication for radiotherapy?

A

As it can cause radiation pneumonia is and radiation fibrosis and their lung tissue may be less able to cope with radiation so more likely to get these SE and more likely to be unable to tolerate them = poorer outcome

92
Q

Why should a pt with NSCLC have a mediastinoscopy performed prior to surgery?

A

CT does not always show mediastinal lymph node involvement

93
Q

What are surgery contraindications for NSCLC?

A

Poor general health e.g. >65
Stage 3b or 4 (i.e. metastasis present)
FEV1<1.5L
Malignant pleural effusion
Tumour near Hilar
Vocal cord paralysis
SVC obstruction

94
Q

What is mesothelioma?

A

Lung malignancy affecting mesothelioma cells of the pleural cavity. In a small percentage of cases other mesothelial layers may be affected such as abdominal layers
Strongly linked to asbestos inhalation with huge latent period of 10-50 years
Very poor prognosis.

95
Q

What are the 3 types of mesothelioma?

A

Pleural mesothelioma
Peritoneal mesothelioma
Pericardial mesothelioma

96
Q

Is mesothelioma associated with smoking?

A

NO!

97
Q

Whats the pathogenesis of mesothelioma?

A

Asbestos fibres are inhaled/ingested and become lodged in mesothelial cells. These fibres can cause chronic inflammation which can cause mutations and cancer

98
Q

Who does mesothelioma typically affect?

A

Men (5:1 m:f)
Occupations of shipbuilding, railway engineering, abstesos product manufacture
Older age 60-79

99
Q

What cancers can asbestos cause?

A

Mesothelioma
Lung cancer
Ovarian cancer
Laryngeal cancer

?Pharyngeal cancer
?Gastrointestinal cancers maybe

100
Q

How should you investigate mesothelioma?

A

CXR - shows pleural effusion or pleural thickening
Pleural CT
Pleural fluid MC&S, biochemistry and cytology
Local anaesthetic thoracoscopy may be used
Image-guided pleural biopsy may be used if an area of pleural modularity is seen

101
Q

Outline the staging for mesothelioma?

A

International Mesothelioma Interest Group system (IMIG)

Stage 1 - mesothelioma cells on one side of chest (a if within parietal and b if in visceral pleura)
Stage 2 - both layers of pleura on 1 side of body and spread to diaphragm or lung tissue
Stage 3 - spread t chest wall or pericardium or lymph nodes same side of chest
Stage 4 - grown through diaphragm, pleura on other side, chest organs, inner layers of pericardium or spread to contra lateral lymph nodes or other parts of the body

102
Q

How is mesothelioma managed?

A

Curative surgical treatment may be possible with stage 1 disease
Chemotherapy - main treatment (usually pemetrexed)
Radiotherapy
Immunotherapy
Palliative pain relief and relief from pleural effusions by pleurectomy and decortication

103
Q

What proportion of lung cancers occur in the bronchus?

A

95%
(2% are alveolar and 3% are benign)

104
Q

What are examples of benign lung cancer tumours?

A

Hamartomas
Bronchial adenomas
Rarer - fibromas, lipomas, chondromas, clear cell tumours

105
Q

Outline how stopping smoking reduces risk of cancer?

A

Risk of lung cancer in a non-smoker is 1%
Risk of lung cancer 10 years after quitting smoking is Half of that who is still smoking (2-10%)
Risk in current smoker is 15-30 times higher (>15%)

106
Q

Which primary tumours tend to metastasise to the lungs?

A

Lung cancer
Colorectal cancer
Renal cell carcinoma
Pancreatic cancer
Breast cancer
Bladder cancer
Testicular cancer
Melanoma
Bone cancer
Soft tissue sarcomas
Head and neck cancers

(Secondary lung cancers are more common than primary!)

107
Q

Outline top tips for smoking cessation counselling?

A

Establish smoking history - duration, form and amount
Explore if pt has previously tried to reduce/quit
Identify factors/triggers that have resulted in previous failed attempts of quitting
Explore why the pt wants to stop smoking now
Ask if pt has previously used smoking cessation products or services
Maybe explore pt background e.g. PMH, drug history, social history, lifestyle

(UNITED)
understanding - how smoking affects their life (behaviour, finances, health)
non-negotiable issues - ‘any options you don’t want to discuss?’
Identify common ground - risks of smoking incorporating into pt’s ICE ‘all things to motivate to stop’
Signpost moving on to discuss potential smoking cessation options
Tensions remaining - ask if they have any questions or concerns before
Explore possible solutions - nicotine replacement therapy vs counselling and support including a follow up within 1-2 weeks
Decide together -

(STAR approach)
Set a quit date
Tell friends and family about stop date?
Anticipate challenges - can you think of any challenges you might come across and how you would overcome them?
Remove all tobacco products (we suggest removing all cigarettes from home/bag to take away the temptation, this makes people much more likely to be successful with stopping)

Provide pt with information leaflets
Any other questions or concerns?

108
Q

What risks of smoking should you tell the pt when advising them on quitting?

A

CVD
Lung cancer and COPD
Stroke
PVD

109
Q

What pharmacological therapies can be tried to help a pt quit smoking?

A

Nicotine replacement therapy - patches, sprays
Bupropion - start 1-2 weeks before quit date and complete 12 week course
Varenicline - commence 1 week before quit date and complete 12 weeks
E.cigarettes

110
Q

What non-pharmacological therapies can be offered to help support a pt quit smoking?

A

Brief intervention - face-to-face behavioural therapy short discussion
Individual counselling
Group counselling
Telephone counselling

111
Q

Is there any screening for lung cancer in the UK?

A

Targeted lung cancer screening - People at high risk are invited to screening (i.e. 55-74 and smoke or used to smoke)
Low dose CT scan of lungs

112
Q

Why did the number of lung cancer diagnoses fall during the COVID-19 pandemic?

A

During pandemic there was a reduction in routine CT scanning for other organs which often picks up incidental earl stage lung cancer
Reluctance in pt seeking medical advice during the pandemic
Misdiagnosis for covid19 due to similar symptoms

113
Q

How should you break bad news?

A

SPIKES
Setting - consider physical setting, consider if other people should be present
Perception - how much does the pt already know?
Invitation - obtain permission from pt to have the discussion ‘are you happy for me to discuss the results?’ ‘How much detail do you like to know?’. Give a warning shot
Knowledge - give info in small chunks, using pt friendly language, give pt time and silence, speak slowly and clearly
Emotions and empathy - recognise and respond to emotions with empathy and concern. Acknowledge the shock. Do not give false hope!
Strategy and summary - check their understanding, explain and agree next steps, offer ongoing assistance, answer any questions

114
Q

What causes the haemoptysis in lung cancer?

A

Tumours invading the nearby blood vessels

115
Q

How does lung cancer cause pleural effusion?

A

Blockage of the lymphatic system, preventing the proper drainage of fluid from the pleural space = fluid to accumulates
Metastasis to the pleura = cause inflammation and the production of excess fluid, leading to pleural effusion.
Lung cancer cells can produce substances that increase the permeability of blood vessels in the pleura, causing fluid to leak out and accumulate in the pleural space.

116
Q

Why can lung cancer cause a pneumothorax?

A

Tumour erosion into the lung tissue or the pleura, creating a hole or tear which can allow air to escape from the lung into the pleural space
Blockage of the airways, preventing air from reaching certain parts of the lung. As the trapped air builds up, it can cause the lung to collapse and lead to a pneumothorax.
Radiation therapy used to treat lung cancer can cause inflammation and scarring of the lung tissue, increasing the risk of a pneumothorax.
Biopsy or other medical procedures performed on the lung can cause a pneumothorax as a possible complication.

117
Q

How does squamous cell carcinoma tend to present?

A

As an obstructive lesion of the bronchus which can cause infections
Occasionally cavitates

118
Q

Which lung cancer type is most likely to cause pleural effusion?

A

Adenocarcinoma

119
Q

Whats the most likely mechanism that lung cancer spreads by?

A

Blood stream

120
Q

Whats the moa of bupropion?

A

a norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist

121
Q

Whats the moa of varenicline?

A

Nicotinic receptor partial agonist

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