Lung cancer Flashcards
Lung cancer
What type of lung cancers are 95% of lung cancers?
SCLC or NSCLC
This distinction is important for staging, treatment and prognosis.
Lung cancer
What types of cancers are included in NSCLC?
adenocarcinoma
SCC
large cell carcinoma
Bronchial carcinoid
Lung cancer
The vast majority of patients with lung cancer are diagnosed at a late stage of disease progression.
The clinical manifestations of lung cancer can be due to…
1. -
2. -
3. -
- intrathoracic effects of the tumour
- extrathoracic metastases
- paraneoplastic phenomena
Lung cancer
Intrathoracic effects of lung cancer include…
- Cough
- Haemoptysis
- Chest pain
- Dyspnoea
- Hoarseness
- Pleural disease
- Pancoast syndrome
Lung cancer
Why do some pt develop a hoarse voice as an intrathoracic effect of lung cancer?
due to malignancy involving the recurrent laryngeal nerve along its course under the arch of the aorta and back to the larynx
Lung cancer
What is the most common form of pleural involvement in lung cancer?
malignant pleural effusion
Lung cancer
What is pancoast syndrome?
Lung cancer arising in the superior sulcus causing:
- pain (usually in the shoulder)
- Horner syndrome
- bony destruction
- atrophy of hand muscles
Lung cancer
What organs does lung cancer most often metastasise to?
- liver
- bone
- brain
- adrenal glands
Lung cancer
What is a paraneoplastic phenomena?
remote effects of the tumour that are not related to direct invasion, obstruction or metastasis
Lung cancer
Name 4 associated paraneoplastic phenomena.
- hyperCa2+
- Cushings syndrome
- SIADH secretion
- neurologic syndromes
Lung cancer
Why might a pt get a paraneoplastic phenomena of hypercalcaemia?
Can be due to both bone metastasis or to the tumour secreting parathyroid hormone-related protein (PTHrP)
Lung caner
Why might a pt get a paraneoplastic phenomena of Cushings syndrome?
Due to ectopic production of ACTH
Lung cancer
Which type of lung cancer are associated with paraneoplastic phenomena of SIADH secretion?
Frequently caused by SCLC and results in hyponatraemia
Lung cancer
What are some examples of paraneoplastic phenomenas of neurologic syndromes?
- Lambert-Eaton myasthenic syndrome
- cerebellar ataxia
- autonomic neuropathy
Lung cancer
Smoking is the main risk factor for lung cancer.
What are some other risk factors?
- Radiation therapy
- Environmental toxins e.g. asbestos, radon, polycyclic aromatic hydrocarbons
- Pulmonary fibrosis
- Alcohol
- HIV
- Family history of lung cancer
Lung cancer
What investigations should be carried out alongside imaging?
- Full blood count
- Urea and Electrolytes
- Calcium
- Alkaline phosphatase
- ALT, AST and bilirubin
- Creatinine
Lung cancer
What radiological investigations should be carried out?
- CT scanning of the chest, lower neck and upper abdomen with IV contrast is preferred in lung cancer
This is to evaluate the extent of the primary tumour and potential spread to the mediastinum, liver, and adrenal glands
Lung cancer
How is NSCLC staged?
TNM
Lung cancer
How is SCLC staged?
- Limited stage: disease confined to ipsilateral hemithorax, which can be safely encompassed within a tolerable radiation field
- Extensive stage: all other diseases, including metastatic disease and malignant effusions
Lung cancer
How do we manage NSCLC? (prescribing)
pts stage 3/4
aim: reverse, delay or prevent symptoms
treatment according to histological subtype, molecular genotype and PD-L1 status
agents used: chemotherapy agents, TKI
chemo: cisplatin, gemcitabine
tyrosine kinase inhibitors used particularly where sensitising EGFR mutations are detected
Lung cancer
How do we manage SCLC for limited and extensive stage? (prescribing)
limited
- concurrent chemo and radiotherapy
extensive
- chemo (4-6 cycles)
limited:
An example of a typical chemotherapy regime is cisplatin and etoposide.
extensive:
Commonly used regimens include cisplatin and etoposide, carboplatin and etoposide, and cisplatin and irinotecan.
Lung cancer
How do we manage NSCLC? (non-prescribing)
surgery with curative intent in stage 1-2
lobectomy prefered over wedge resection
access to chest: video-assistaed thoracic surgery (VATS)
Surgery should only be used adequate lung function (FEV1 > 60%).
Lung cancer
How do we manage SCLC? (non-prescribing)
surgery rarely performed
Lung cancer
What is the most common type of cancer in smokers?
SCC
