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Semester 3 > Lung cancer > Flashcards

Lung cancer Flashcards

1
Q

What % of death by lung cancer are caused by smoking?

A

Men - 90%
women - 80%
1/3 of all cancer deaths

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2
Q

What are the risk factors of lung cancer?

A 
Smoking
COPD
Asbestos 
Radon 
Other occupational carcinogens
Diet
Genetic/familial factors
Social class
Around 5000 cases a year in never smokers
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3
Q

What are the symptoms of a primary lung tumour?

A 
Cough
Dyspnoea
Wheezing
Hemoptysis
Chest pain
Postobstructive pneumonia
Weight loss
Lethargy/malaise
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4
Q

What are the symptoms of lung cancer regional metastases?

A

Superior vena caval obstruction
Hoarseness (left recurrent laryngeal nerve palsy)
Dyspnoea (phrenic nerve palsy)
Dysphagia

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5
Q

What are the symptoms of lung cancer distant metastases?

A 
Bone pain/fractures
CNS symptoms (headache, double vision, confusion etc)
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6
Q

What investigations are carried out to diagnose and stage lung cancer?

A

Plain chest x-ray - does NOT have to appear abnormal
Serum biochemistry (Sodium, LFT, calsium
Imaging (cross sectional)- CT and PET-CT scans. Isotope bone scan etc
Bronchoscopy, CT guided needle biopsy, lymph node biopsy, mediastinoscopy, pleural biopsy/cytology

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7
Q

How many people with non-small cell lung cancer have inoperable disease at presentation?

A

2/3rds

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8
Q

In small cell lung cancer, how many people have metastatic disease at presentation?

A

75%

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9
Q

What is the incidence of the various types of lung cancer?

A

Small/oat cell - 20-25%
Squamous cell - 30-35%
Adenocarcinoma - 30-35%
Large cell undifferentiated - 15-20%

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10
Q

What do the letters of TNM classification mean?

A

T - Primary tumour (<3 cm, surrounded by lung and visceral pleura, no invasion proximal to lobar bronchus at bronchoscopy)
N - Regional lymph node
M - Distant metastasis

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11
Q

What is the role of imaging in lung cancer?

A 
Diagnosis
Staging
Treatment plan
Response to treatment
Complications
Intervention
Recurrence
Screening
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12
Q

What does ultrasonography show?

A

Metastases - liver, adrenal
Pleural effusion
Aspiration-PI fluid
Chest wal invasion

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13
Q

What is the abbreviation for metastases?

A

MO - No known distant metastasis
M1a - lung nodules, pleural effusion
M1b - distant metastases

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14
Q

Explain the abbreviations of nodal staging

A

N1 - peribronchial ipsilateral hilar
N2 - ipsilateral mediastinal and subcranial nodes
N3 - Contralateral mediastinal, contralateral mediastinal hilar, scalene, supraclavicular

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15
Q

What are the cellular histological factors of malignancy?

A

Nuclei of irregular shape (pleomorphic)
Nucleic dark staining (hyper chromatic)
Increased size of nuclei compared to cytoplasm
Frequent/abnormal mitoses (cell division)
Prominent/multiple nucleoli

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16
Q

What architectural histological features suggest malignancy?

A 
Ulceration
Necrosis
Infiltrative margins
Vascular invasion
Poorly circumscribed 
Reaction in the surrounding tissue (stroma)
Little resemblance to normal tissue
17
Q

What is a lung carcinoma?

A

Invasive malignant epithelial tumour

18
Q

How are NSCLC further subclassified?

A

Use additional pathology stains - immunocytochemistry and mucin

19
Q

Describe squamous carcinoma

A 
Often central tumours
Angulate cells
Eosinophilic cytoplasm
Keratinisation
Intercellular bridges - 'prickles'
Keratin pearls

Immunos: CK5/6 and P63 +

20
Q

Describe adenocarcinoma.

A 
Often peripheral tumours
Columnar/cuboidal cells
Form glands (acini)
Papillary structures
May line alveoli
Some produce mucin

Immunos: Most TTF-1+

21
Q

Describe small cell carcinoma.

A 
"Oat cell carcinoma"
Very cellular tumour
Small nuclei - c.f. size of lymphocyte 
Little cytoplasm
Nuclear moulding
Often necrosis and lots of mitoses

Immunos: CD56, Synaptphysin

22
Q

What local complications can result from lung cancer?

A

Necrosis =/- cavitation
Ulceration - haemoptysis
Infection - abscess formation
Bronchial obstruction - lung collapse, consolidation

23
Q

Where might lung cancer metastasise to locally (within the thorax)?

A

Direct spread or metastasis pleural/pericardial effusions
Mediastinal structures - SVCO, dysphagia
Recurrent laryngeal nerve - vocal cord palsy and hoarseness
Phrenic nerve - diaphragm palsy

24
Q

Where does lung cancer commonly metastasise to?

A 
Other lung
Liver
Adrenals
Bone
Brain
25
Q

What is the survival rate for lung cancer?

A

10% live to 5 years
Overall median survival around 6 months
Worse in the UK than most other western countries

26
Q

What is survival of lung cancer dependent on?

A 
Cell type
Stage of disease
Performance status
Biochemical markers
Co-morbidities
27
Q

What is the treatment for lung cancer?

A

Surgery - mostly for non - small cell
Radiotherapy - ‘radical’ with curative intent or ‘pallative’ - symptom control
Chemotherapy - small cell, potential curvature in minority, non-small cell modest survival increase, symptom control
Combination therapy - combination chem-radiotherapy
Biological (targeted) therapies
Palliative care

28
Q

What % of lung cancer is operable?

A

20%

Surgical survival = 50% at 5 years

29
Q

What treatment is used for people with “operable” tumours who aren’t fit for surgery?

A

Radiotherapy

30
Q

What is the management for small cell carcinoma?

A

A systemic disease in >80% of cases
Rarely operable
3 month median survival untreated
85-90% respond to combination chemo (Approx 1 year of added survival)
10-15%s urvive 2 year; less than 8% survive 5 years
Good symptom palliation with chemo
Death from cerebral metastases common

31
Q

Describe the palliative care involved in Lung cancer management.

A

A disease with multiple symptoms and often poor survival - need for prompt treatment of symptoms
Need for early involvement of palliative care services
Specific palliation usually best done by appropriate specialist
Communication betwen and coordination of various treatment agencies is vital. Patient held records may be useful

32
Q

What is the problem with treatment of lung cancer?

A 
Late diagnosis
Overall poor prognosis
Very symptomatic
Professional nihilism
Variable standards of care
Lack of public pressure

Semester 3 (19 decks)

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