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Lung cancer Flashcards

1
Q

Risk factors lung cancers

A

Smpking - 10 fold
Asbestos - x 5
synergistic - together = 50 x risk
exposure to arsenic, Radon, Nicke, Chromate , Aromatic hydrocarbon, Cryptogenic fibrosing alveolitis
Radiotheraoy to breast or chest, exposure in workpleace, medical imaging tests ef CT, atomic bomb radiation
Air pollution
FH
HIV
beta carotene supplements

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2
Q

What is more common type of lung cancer

A

Non samll cell - 80%

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3
Q

What types of cancer is included in non small cell lung cancer

A

SCC - 25%
Adenocarcinoma - 40% - most common in smokers
Large cell carcinoma - 10%

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4
Q

What are small lung cell cancers

A

Neuro endocrine differntiation
Large AWs strong smoking ass

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5
Q

Primary lung cancer tumour symptoms

A

Cough - progresisive
Haemoptysis
Dysponiea
Chest pain - dull and persistent, shar if pleuritic involvement
Wheezing or stridor
Recurrent chest infections
Anorexia and weight loss

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6
Q

Symptoms of regional lung cancer spread

A

Hoarseness
Dysphagia
SVC obstruction
Pancoast tumour

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7
Q

What causes hoarseness in lung cancer

A

recurrent laryngeal nerve involvement.

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8
Q

Distance metastatsis related symptoms

A

Bone pain esp spine, pelvis, long bones
Neurological symptoms - brain mets
Abdo pain or jaundice - liver mets
Adrenal insufficiency - adrenal mets

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9
Q

Paraneoplastic symptoms

A

Hypercalcemia
Cushigns syndrome - ACTH production
SIADH -> hyponatremia
Lambert Eaton myasthenic syndrome - LEMS - neuromuscular disorder antibodies against voltage gated calcium channels in presynaptic
Clubbing

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10
Q

when refer for 2 week wait lung cacner

A

CXR suggestive
>40 unexplained haemoptysis

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11
Q

When offer an urgent CXR lung cancer

A

> 40 + 2 or more following or if ever smoked and 1 or more of -
Cough
Fatigue
SOB
Chest pain
Weight loss
Appetite loss

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12
Q

When do you consider an urgent CXR for lung cancer

A

Persistent or recurrent chest infection
Finger clubbing
supraclavicular lymphadenopathy or persistent cervical lymphadenopathy
Chest signs consistent with lung cnacer
Thrombocytosis

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13
Q

Investigation of choice for suspected lung cancer

A

CT chest

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14
Q

Investigations for lung cancer

A

CXR first line
CT chest
Bronchoscopy - biopsy, endo US
PET scan - non small lung cacner - curative or palleative

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15
Q

How does PET scan work

A

18-fluorodeoxygenase taken up preferentially by neoplastic tissue seen on scan

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16
Q

Epidemiology of sage of lung cancer at presentation

A

75% stage III/IV

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17
Q

First line treatment for stage I or II lung cancer

A

Surgical resection - lobectomy with hilar and mediastinal lymph node resection and sampling
Curative intent

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18
Q

First line for lung cancer stage I-III if unfit for surgery

A

Radiotherapy
Curative intent

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19
Q

What is offered for lung cancer stage III or IV

A

Chemotherapy - improve survival and QOL
3rd gem chemo eg docetael, paclitacel, gemcitabine
Platinum agent - carboplatin or cisplatin
Alos consider for chemoradiotherapy

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20
Q

Which lung cancer paitents are offered adjuvant chemotherapy

A

Complete resection

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21
Q

Which lung cancer paitents are offered adjuvant Radidotherapy

A

Incoplete resection of tumour

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22
Q

What is limited stage small cell lung cancer

A

SCLC without distant mets

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23
Q

First line for SCLC limited disease

A

4-6 cycles of cispltin based combination therapy
Radiotherapy adjunct or concurrent only considered if good response

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24
Q

What is extensive stage SCLC

A

Distant mets

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25
First line treatment for extensive SCLC
Platinum based combo therapy - reassess for response after each cycle - up to a maximum of 6 cycles Concurrent or adjunct radio if good response to chemo at primary and metastatic sites
26
Relapsed lung cancer treat
6 cycles max of chemo Palliatuive radiotherapy symptom control
27
Complications of local spread of lung cancer
Nerve plasy SVC Pericarditis
28
Metastatic spread of lung cancer
Brain, spina cord, bone, liver, adrenal glands
29
Palliative therapy in lung cnacer
Radiotherpay - symptom control Endobrachial stenting or debulking for bronchial obstruction Pleural drainage or aspiration for pleural effusion Dexamethasone therapy for symptomatic brain mets Opioid therapy relieve cough and SOB
30
Survival rate small cell LC
5 year surival of 30-40% very early stage - v rare 10-15% IIIA 5-10% IIIB IV - 1-3%
31
NSCLC surivval 5 years
IB - 45-55% IIA - 40-50% IIB - 30-40% IIIA - 20-30% IIIB - 10-15% IV -<5%
32
Factors affecting lung prognosis
Age - older = poorer Overall health - cormorbidites Tumour size and location - near vital strucutres etc Molecular markers - EGFR mutations, ALK rerrangements - impact treatment options
33
What is pancoasts syndrome
Chest wall pain Horners syndrome Pain in T1 dermatome - apical tumour invading chest wall
34
Horners syndrome symptoms
Miosis Anhydrosis Partial ptosis and enophtalmos
35
Gender epidemiology lung cancer
3:1
36
How does lung cancer spread
Spread is circumferential and longitudinal along the bronchus of origin Tumours frequently involve regional lymphatics Spread is to ipsilateral peribronchial and hilar nodes, followed by mediastinal, contralateral hilar and supraclavicular nodes There is a propensity to disseminate widely via the bloodstream and virtually any site may be involved
37
Where are SCLCs more common
Central tumour Larger AWs
38
Mutations in SCLC
RB1 and TP53 Abnormal DNA methylation of cyclin D2 gene
39
Types of lung cancer with higher metatastic spread vs less
Adrenocarcinoma - peripherally occuring from bronchial muscosal glands - high risk metatastic spread often to mediastinal lymph and pleura -> effusion Large cell - can be paraneoplastic features - high risk mets poor differentiate SCC spead locally, less likely mets
40
Investigations for radical treatment in SCLC
pulmonary function tests contrast CT scan of the thorax and upper abdomen V/Q scan MRI scan ultrasound scan mediastinoscopy, laryngoscopy, PET-CT additional investigation if clinical, biochemical or radiological suspicion of metastatic disease.
41
Investigations for lung cncare
Bronchoscopy Fine needle aspirate from lympg node or CT guided transthoracic biopsy Fluid cytology from pleural effusion MRI OR PET/CT to determine operability
42
Adverse prognostic factors lung cancer
Pulmonary symptoms Large tumour size >3cm Nonsquamous histology Mets to multiple lymph nodes Vascular invasion
43
Low risk adverse prognostic factors
Poor performance status Any site metastasis Increased serum LDH
44
Medium adverse prognostic factors
Bone metastasis Liver metastasis Male gender >5% weight loss
45
High risk adverse prohnostic factors
Brain mets >65 years Non squamous tyoe Prev RT
46
Where does squamous cell carcinoma originate
Near a bronchus
47
Mutations of subsets of adrenocarcinoma of lung
MAPK EGFR P13K
48
Core biopsy vs FNA
Core biopsy provides more tissue to pathologise - larger and more resprecsenative smaple
49
Best approach biopsy specimen lung cancer
Biopsy from R supraclavicular fossa mass
50
Most likley cause of confusion in lung cancer
Calcium
51
What can be offered as treatment if EGFR mutations present
EGFR tyrosine kinase inhibitors - gefitinib, erlotinib
52
Curative radiotherapy for lung cacner
f continuous hyperfractionated accelerated radiotherapy (CHART), delivered in 3 fractions per day for 12 days
53
Genetics in NSCLC
EGFR mutations strongly predict the improved response rate and progression-free survival of inhibitors of EGFR. Fusions of ALK with EML4 and other genes form translocation products that occur in ranges from 3% to 7% in unselected NSCLC and are responsive to pharmacological inhibition of ALK by agents such as crizotinib. The MET oncogene encodes hepatocyte growth factor receptor. Amplification of this gene has been associated with secondary resistance to EGFR tyrosine kinase inhibitors. Recurrent fusions involving the ROS1 gene are observed in up to 2% of NSCLCs and are responsive to treatment with crizotinib and entrectinib. NTRK gene fusions can occur in up to 1% of NSCLCs and can be treated with the TRK inhibitors, larotrectinib and entrectinib."1
54
Disease related complications in NSCLC
Local invasion SVC obstruction Pleural effusion Distant metastasis Brain, liver, bone Non-metastatic Hypercalcaemia Cushing syndrome SIAD Neurological syndromes
55
What is caused by SVC obstruction
Compression, invasion, thrombosis in superior mediastinum
56
symptoms of SVC obstruction
Dyspnoea Facial swelling Head fullness Cough Arm swelling Chest pain Venous distention of neck or chest wall Facial oedema Cyanosis Plethora of face Oedema of arms
57
Causes of SVC obstruction
Lung cancer Lymphoma Other malignancies - primary or secondary nonneoplastic Undiagnosed
58
CXR findings on SVC obstruction
15% normal Supreior mediastinal widening Pleural effusion R hilar mass Bilateral diffuse infiltrates, cardiomegaly, calcified paratrahceal nodes, ant mediastinal mass
59
Brain mets presentation
Headache (70-80%) Cognitive dysfunction (40%) Neurological deficit (40%) Seizures (15-20%)
60
How do steroids treat brain mets
Decrease peritumoral oedema Minimal mineralcorticoid actiit Can double surival 10 mg stat iv, followed by 16 mg per 24 hours
61
Treatment for brain mets
Dexamethasone Anticonvulsants eg phenyotin if seizures Surgery - limited ecisend Radiotherapy Chemoterhapy - often doesnt cross BBB

Cancer (22 decks)

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