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YR6: RESPIRATORY > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

How is lung cancer classified?

A

Small cell lung cancer (SCLC- 20%)
Non-small cell lung cancer (NSCLC- 80%)

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2
Q

What are the subtypes of NSCLC?

A

Adenocarcinoma
Squamous
Large cell
Alveolar cell carcinoma
Bronchial adenoma

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3
Q

What is the most common type of lung cancer?

A

Adenocarcinoma

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4
Q

List 3 risk factors for lung cancer

A

Tobacco smoking
Exposure to carcinogens: passive smoking, RADON, asbestos
FH

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5
Q

List 5 general symptoms of lung cancer

A

Cough
Dyspnoea
Haemoptysis
Chest pain
Weight loss

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6
Q

List 3 general signs of lung cancer

A

Fixed monophonic wheeze
Supraclavicular lymphadenopathy or persistent cervical lymphadenopathy
Clubbing

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7
Q

Give 3 pathological features of SCLC

A

Usually CENTRAL
Arise from APUD cells
a/w ectopic ADH + ACTH secretion

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8
Q

What are the 3 paraneoplastic manifestations of SCLC?

A

ADH: hyponatraemia

ACTH: Cushing’s syndrome

Lambert-Eaton syndrome

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9
Q

How does the ectopic ACTH in SCLC present?

A

HTN
Hyperglycaemia
Hypokalaemia (high cortisol can lead to hypokalaemic alkalosis)
Bilateral adrenal hyperplasia

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10
Q

What is Lambert-Eaton syndrome?

A

AI disorder, development of Abs to VGCC causing myasthenic like syndrome

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11
Q

Where are adenocarcinomas commonly located?

A

Peripherally

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12
Q

Which lung cancer is most commonly seen in non-smokers?

A

Adenocarcinoma

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13
Q

Which form of lung cancer is almost always seen in smokers?

A

Small cell carcinoma

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14
Q

Give 2 paraneoplastic manifestations of adenocarcinoma

A

Gynaecomastia
Hypertrophic pulmonary osteoarthropathy (HPOA)

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15
Q

Which type of lung cancer most commonly causes caveatting lesions?

A

Squamous

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16
Q

Give 2 features of alveolar cell carcinoma

A

Not related to smoking
++ sputum

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17
Q

What is the most common type of bronchial adenoma?

A

Carcinoid

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18
Q

List 4 paraneoplastic manifestations of squamous cell lung cancer

A

PTHrP secretion causing hypercalcaemia
Clubbing
Hypertrophic pulmonary osteoarthropathy
Hyperthyroidism due to ectopic TSH

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19
Q

Give 2 indications for referral using the suspected cancer pathway for an appointment within 2w

A

CXR findings suggestive of lung cancer
>,40 with unexplained haemoptysis

20
Q

To which patients should an urgent (<2w) CXR be offered?

A

> ,40 + 2 unexplained Sx or if they’ve ever smoked + 1 unexplained Sx:
* cough
* fatigue
* SOB
* chest pain
* weight loss
* appetite loss

21
Q

In which patients should an urgent (<2w) CXR be considered?

A

> 40s with any of:
* persistent/ recurrent chest infection
* finger clubbing
* supraclavicular lymphadenopathy or persistent cervical lymphadenopathy
* chest signs consistent with lung cancer
* thrombocytosis

22
Q

What imaging is performed for suspected lung cancer?

A

CXR
Contrast CT of lower neck, thorax + upper abdomen

23
Q

Once confirmed diagnosis from imaging, what does bronchoscopy allow?

A

Biopsy to obtain histological dx
Sometimes aided by endobronchial US

24
Q

What investigation is typically performed in NSCLC? How?

A

PET scanning
Uses 18-fluorodeoxygenase which is preferentially taken up by neoplastic tissue

25
Q

Why is PET scanning performed in NSCLC?

A

Establishes eligibility for curative Tx
Has been shown to improve diagnostic sensitivity of local + distant metastatic spread

26
Q

What bloods should be performed in suspected lung cancer?

A

FBC: may show anaemia/ raised platelets
LFTs: raised if liver mets
U+Es: baseline. Hyponatraemia in SCLC
serum Calcium: high in squamous

27
Q

In what percentage of patients with lung cancer is CXR normal?

A

10%

28
Q

What procedure is performed prior to surgery for NSCLC? Why?

A

Mediastinoscopy as CT does not always show mediastinal LN involvement

29
Q

Describe management for stage I and II NSCLC in patients suitable for surgery

A

Lobectomy or pneumonectomy with curative intent
+/- neoadjuvant + post-op chemo/ chemoradiotherapy

30
Q

What surgeries can be performed for elderly/ co-morbid patients instead of pneumonectomy?

A

Wedge resection or
Segmentectomy

31
Q

Describe management for stage I and II NSCLC in patients NOT suitable for surgery

A

Radiotherapy with curative intent
+/- neoadjuvant chemo

32
Q

List 6 contraindications to surgery in NSCLC

A

Stage IIIb or IV (metastatic)
FEV1 <1.5L
Malignant pleural effusion
Tumour near hilum
Vocal cord paralysis
SVC obstruction

33
Q

Describe management for stage III NSCLC

A

Chemoradiotherapy +/- immunotherapy
Possibly surgery

34
Q

Describe management of extensive stage III or stage IV NSCLC

A

Palliative radiotherapy

35
Q

What is the difference between limited and extensive SCLC?

A

Limited: No distant mets (T1-4, N0-3, M0)
Extensive: Distant mets

36
Q

Describe management of SCLC if limited disease

A

Chemo
+
Radiotherapy if good response to chemo
+
Prophylactic cranial irradiation

37
Q

Why is Prophylactic cranial irradiation performed in SCLC?

A

High risk of developing brain mets

38
Q

Describe management of SCLC with extensive disease

A

Chemo + immunotherapy
+
Prophylactic cranial irradiation
+/-
palliative radiotherapy

39
Q

Describe management for relapse for SCLC after initial treatment

A

Further chemo (max. 6 cycles)
Palliative radiotherapy to control local Sx

40
Q

List 3 complications of lung cancer due to local disease spread

A

Nerve palsy
SVC obstruction
Pericarditis

41
Q

List 5 common sites of metastasis of lung cancer

A

Brain
Spinal cord
Bone
Liver
Adrenal glands

42
Q

What is the investigation of choice for suspected lung cancer?

A

CT

43
Q

What is the most common cause of superior vena cava obstruction?

A

Lung cancer

44
Q

What can PTHrP secretion in SCC present with?

A

Raised serum calcium
Bone + abdo pain
Kidney stones
Low mood

45
Q

How does ectopic ACTH in small cell lung cancer usually present?

A

HTN
Hyperglycaemia
Hypokalaemia
Alkalosis
Muscle weakness

46
Q

Give 2 complications of lung cancer

A

Hoarseness
Stridor

YR6: RESPIRATORY (38 decks)

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