Lung Cancer Flashcards
What are the two histological types of lung cancer?
1) small cell lung cancer (20%)
2) non-small cell lung cancer (80%
Which has a worse prognosis, small cell lung cancer or non-small cell lung cancer?
small cell lung cancer
Give 3 subtypes of non-small cell lung cancer?
1) adenocarcinoma (40%)
2) squamous cell carcinoma (20%)
3) large cell carcinoma (10%)
What type of lung cancer are responsible for numerous neuroendocrine related paraneoplastic syndromes?
Small cell lung cancers
What is the name of the lung cancer that affects the pleura cells?
mesothelioma
What is the main cause of mesothelioma?
asbestos exposure
True or false: the prognosis for mesothelioma is very poor
true (treatment is essentially all palliative)
Describe the natural history of mesothelioma:
following asbestos exposure, there is a long latent period before the development of mesothelioma (this can take up to 45 years)
What is the most significant and preventable cause of lung cancer?
smoking
Give 7 presenting features of lung cancer:
1) SOB
2) cough
3) weight loss
4) recurrent pneumonia
5) haemoptysis
6) finger clubbing
7) lymphadenopathy (esp. supraclavicular nodes)
Other than smoking, what are 4 other risk factors for lung cancer?
- Air pollution
- Family history
- Male sex
- Radon gas
Name 9 extrapulmonary manifestations of lung cancer?
- Recurrent laryngeal nerve palsy
- Phrenic nerve palsy
- Superior vena cava obstruction
- Horner’s syndrome
- Syndrome of inappropriate ADH (SIADH)
- Cushings syndrome
- Hypercalcaemia
- Limbic encephalitis
- Lambert-Eaton myasthenic syndrome
What causes recurrent laryngeal nerve palsy in lung cancer?
the tumour can compress the recurrent laryngeal nerve as it passes through the mediastinum
How does recurrent laryngeal nerve palsy present?
Hoarse voice
How does phrenic nerve palsy present?
diaphragm weakness and shortness of breath
What causes phrenic nerve palsy in lung cancer?
the tumour can compress the phrenic nerve
What causes superior vena cava obstruction in lung cancer?
direct tumour compression of the superior vena cava
Give 4 presentations associated with superior vena cava obstruction:
- Facial swelling
- Difficulty breathing
- Distended neck and chest veins
- Pemberton’s sign
What is Pemberton’s sign?
raising hands over the head causes facial congestion and cyanosis
What is Permberton’s sign indicative of?
Superior vena cava obstruction
What is Horner’s syndrome?
An interruption of nerve supply from the brain to the face and eye, on one side of the body. Usually caused due to injury to the spinal cord, stroke, tumor or underlying conditions.
What are the three features of Horner’s syndrome?
- ptosis (eyelids drooping)
- myosis (constriction of the pupil)
- anhidrosis (A condition in which the person does not sweat or prespire. This results in the increase in body heat and cause dizzines and in severe cases heatstroke.)
What causes Horner’s syndrome in lung cancer?
tumour compression on the sympathetic ganglion
What specific type of lung cancer is most likely to cause Horner’s syndrome?
Pancoast tumours (tumours in the pulmonary apex)
What is SIADH?
A condition where the body produces excess antidiuretic hormone leading to water retention and low sodium levels in the body. This causes hallucinations, disorientation, nausea and in severe cases coma.
What causes syndrome of inappropriate ADH (SIADH) in lung cancer?
small cell lung cancer secreting ectopic ADH
What electrolyte imbalance is seen in SIADH?
hyponatraemia
What is Cushing’s syndrome?
A disorder resulting from abnormally high levels of the hormone cortisol. This causes obesity, fatty deposits in the midsection, face, between the shoulders, and upper back.
What causes Cushing’s syndrome in lung cancer?
small cell lung cancer secreting ectopic ADH
What causes hypercalcaemia in lung cancer?
squamous cell carcinomas secreting ectopic parathyroid hormone
Give 4 presentations associated with limbic encephalitis:
1) short term memory impairment
2) hallucinations
3) confusion
4) seizures
What specific antibodies are associated with lung cancer-associated limbic encephalitis?
anti-Hu antibodies
What causes limbic encephalitis in lung cancer?
small cell lung cancers can cause immune cells to make antibodies that target the limbic structures of the brain and cause inflammation
What is Lambert-Eaton Myasthenic Syndrome in lung cancer?
Lambert-Eaton myasthenic syndrome (LEMS) is a very rare condition that affects the signals sent from the nerves to the muscles.
What causes Lambert-Eaton Myasthenic Syndrome in lung cancer?
antibodies against small cell carcinomas can also target motor neurones resulting in weakness in the proximal, intraocular and pharyngeal muscles
Give 4 symptoms of Lambert-Eaton myasthenic syndrome:
1) double vision
2) slurred speech
3) dysphagia
4) ptosis
NICE recommends a CXR within 2 weeks for patients over 40 presenting with any of… with suspected lung cancer: (5)
1) clubbing
2) lymphadenopathy
3) recurrent or persistent chest infections
4) thrombocytosis
5) chest signs of lung cancer
Name the 6 unexplained symptoms used in the NICE CXR guidance:
1) cough
2) shortness of breath
3) chest pain
4) fatigue
5) weight loss
6) loss of appetite
What is the first line investigation for suspected lung cancer?
chest x-ray
Give 4 CXR signs associated with lung cancer:
- Hilar enlargement
- Opacities
- Pleural effusion
- Lung collapse
What imaging method is used to stage lung cancer?
contrast-enhanced CT TAP
What is a PET-CT?
where a radioactive tracer that attaches to glucose molecules is injected and detected to check the metabolic activity of various tissues
What method is used to obtain a biopsy of a lung cancer?
bronchoscopy with endobronchial ultrasound (endoscopy with ultrasound equipment attached to the end of the scope)
What treatment can be curative to non-small cell lung cancers if diagnosed early?
Radiotherapy
What is the typical treatment plan for small cell lung cancers?
radiotherapy and chemotherapy
State a common way used to differentiate between primary and secondary lung cancer:
secondary lung cancer is characterised by multiple diffuse tumours whereas primary lung cancer typically shows a single tumour
What are the three types of surgery used to treat lung cancer?
1) segmentectomy (removal of a wedge of lung)
2) lobectomy
3) pneumectomy
(key hole/ robotic surgery is favoured for this)
Where are adenocarcinomas typically found?
Located peripherally (in the smaller airways
What are the histology findings of an adenocarcinoma?
Glandular differentiation
Who are adenocarcinomas most common in?
- Non-smokers
- Asian females
What are the 2 clinical features of adenocarcinomas?
- Metastasise early
- Responds well to immunotherapy
Where are SCCs typically found?
Located centrally (in the bronchi)
What are the typical histology findings in SCCs?
squamous differentiation (keratinisation)
Who is SCCs most common in?
Smokers
What are 2 clinical features of SCCc?
- Secretes PTHrP causing hypercalcaemia
- Metastasises late via the lymph nodes
Where are large cell carcinomas typically found?
located peripherally and centrally
What are the histology findings in large cell carcinomas?
Large and poorly-differentiated
What are 2 clinical features of LCCs?
- More common in smokers
- Metastasises early
Where are small cell carcinomas typically found?
Located centrally
What are the histological findings of small cell carcinomas?
- Poorly differentiated
Name 4 clinical features of small cell carcinomas?
- More common in older smokers
- Metastasise early
- Secrete ACTH and ADH
- Associated with Lambert-Easton syndrome
What is stage 1 lung cancer?
One small tumour (<4cm) – localised to one lung
What is Stage 2 lung cancer?
Larger tumour (>4cm) – may have spread to nearby lymph nodes
What is Stage 3 lung cancer?
Tumour that has spread to contralateral lymph nodes, or grown into nearby structures (e.g. trachea)
What is stage 4 lung cancer?
Tumour that has spread to lymph nodes outside the chest, or other organs (e.g. liver)
