Lung Cancer Flashcards
How is lung cancer classified?
Small cell lung cancer (SCLC- 20%)
Non-small cell lung cancer (NSCLC- 80%)
What are the subtypes of NSCLC?
Adenocarcinoma
Squamous
Large cell
Alveolar cell carcinoma
Bronchial adenoma
What is the most common type of lung cancer?
Adenocarcinoma
List 3 risk factors for lung cancer
Tobacco smoking
Exposure to carcinogens: passive smoking, RADON, asbestos
FH
List 5 general symptoms of lung cancer
Cough
Dyspnoea
Haemoptysis
Chest pain
Weight loss
List 3 general signs of lung cancer
Fixed monophonic wheeze
Supraclavicular lymphadenopathy or persistent cervical lymphadenopathy
Clubbing
Give 3 pathological features of SCLC
Usually CENTRAL
Arise from APUD cells
a/w ectopic ADH + ACTH secretion
What are the 3 paraneoplastic manifestations of SCLC?
ADH: hyponatraemia
ACTH: Cushing’s syndrome
Lambert-Eaton syndrome
How does the ectopic ACTH in SCLC present?
HTN
Hyperglycaemia
Hypokalaemia (high cortisol can lead to hypokalaemic alkalosis)
Bilateral adrenal hyperplasia
What is Lambert-Eaton syndrome?
AI disorder, development of Abs to VGCC causing myasthenic like syndrome
Where are adenocarcinomas commonly located?
Peripherally
Which lung cancer is most commonly seen in non-smokers?
Adenocarcinoma
Which form of lung cancer is almost always seen in smokers?
Small cell carcinoma
Give 2 paraneoplastic manifestations of adenocarcinoma
Gynaecomastia
Hypertrophic pulmonary osteoarthropathy (HPOA)
Which type of lung cancer most commonly causes caveatting lesions?
Squamous
Give 2 features of alveolar cell carcinoma
Not related to smoking
++ sputum
What is the most common type of bronchial adenoma?
Carcinoid
List 4 paraneoplastic manifestations of squamous cell lung cancer
PTHrP secretion causing hypercalcaemia
Clubbing
Hypertrophic pulmonary osteoarthropathy
Hyperthyroidism due to ectopic TSH
Give 2 indications for referral using the suspected cancer pathway for an appointment within 2w
CXR findings suggestive of lung cancer
>,40 with unexplained haemoptysis
To which patients should an urgent (<2w) CXR be offered?
> ,40 + 2 unexplained Sx or if they’ve ever smoked + 1 unexplained Sx:
* cough
* fatigue
* SOB
* chest pain
* weight loss
* appetite loss
In which patients should an urgent (<2w) CXR be considered?
> 40s with any of:
* persistent/ recurrent chest infection
* finger clubbing
* supraclavicular lymphadenopathy or persistent cervical lymphadenopathy
* chest signs consistent with lung cancer
* thrombocytosis
What imaging is performed for suspected lung cancer?
CXR
Contrast CT of lower neck, thorax + upper abdomen
Once confirmed diagnosis from imaging, what does bronchoscopy allow?
Biopsy to obtain histological dx
Sometimes aided by endobronchial US
What investigation is typically performed in NSCLC? How?
PET scanning
Uses 18-fluorodeoxygenase which is preferentially taken up by neoplastic tissue
Why is PET scanning performed in NSCLC?
Establishes eligibility for curative Tx
Has been shown to improve diagnostic sensitivity of local + distant metastatic spread
What bloods should be performed in suspected lung cancer?
FBC: may show anaemia/ raised platelets
LFTs: raised if liver mets
U+Es: baseline. Hyponatraemia in SCLC
serum Calcium: high in squamous
In what percentage of patients with lung cancer is CXR normal?
10%
What procedure is performed prior to surgery for NSCLC? Why?
Mediastinoscopy as CT does not always show mediastinal LN involvement
Describe management for stage I and II NSCLC in patients suitable for surgery
Lobectomy or pneumonectomy with curative intent
+/- neoadjuvant + post-op chemo/ chemoradiotherapy
What surgeries can be performed for elderly/ co-morbid patients instead of pneumonectomy?
Wedge resection or
Segmentectomy
Describe management for stage I and II NSCLC in patients NOT suitable for surgery
Radiotherapy with curative intent
+/- neoadjuvant chemo
List 6 contraindications to surgery in NSCLC
Stage IIIb or IV (metastatic)
FEV1 <1.5L
Malignant pleural effusion
Tumour near hilum
Vocal cord paralysis
SVC obstruction
Describe management for stage III NSCLC
Chemoradiotherapy +/- immunotherapy
Possibly surgery
Describe management of extensive stage III or stage IV NSCLC
Palliative radiotherapy
What is the difference between limited and extensive SCLC?
Limited: No distant mets (T1-4, N0-3, M0)
Extensive: Distant mets
Describe management of SCLC if limited disease
Chemo
+
Radiotherapy if good response to chemo
+
Prophylactic cranial irradiation
Why is Prophylactic cranial irradiation performed in SCLC?
High risk of developing brain mets
Describe management of SCLC with extensive disease
Chemo + immunotherapy
+
Prophylactic cranial irradiation
+/-
palliative radiotherapy
Describe management for relapse for SCLC after initial treatment
Further chemo (max. 6 cycles)
Palliative radiotherapy to control local Sx
List 3 complications of lung cancer due to local disease spread
Nerve palsy
SVC obstruction
Pericarditis
List 5 common sites of metastasis of lung cancer
Brain
Spinal cord
Bone
Liver
Adrenal glands
What is the investigation of choice for suspected lung cancer?
CT
What is the most common cause of superior vena cava obstruction?
Lung cancer
What can PTHrP secretion in SCC present with?
Raised serum calcium
Bone + abdo pain
Kidney stones
Low mood
How does ectopic ACTH in small cell lung cancer usually present?
HTN
Hyperglycaemia
Hypokalaemia
Alkalosis
Muscle weakness
Give 2 complications of lung cancer
Hoarseness
Stridor
