Lung Cancer Flashcards
what are the three most common cancers in the UK?
breast cancer
prostate cancer
lung cancer
what is the most common cause of lung cancer?
smoking
what percentage of lung cancer is thought to be preventable?
80%
what are the two types of lung cancer and what percentage is each?
small cell lung cancer - around 20%
non-small cell lung cancer - around 80%
what are the types of non-small cell lung cancer and what percentage is each (of total lung cancers) ?
adenocarcinoma - 40%
squamous cell carcinoma - 20%
large cell carcinoma - 10%
other type - 10%
what do squamous cell carcinomas contain?
neurosecretory granules that secret neuroendocrine hormones
what can neuroendocrine hormones cause?
can cause various paraneoplastic syndromes
what is a mesothelioma?
a malignancy that affects the mesothelial cells of the pleura
what is strongly linked to mesotheliomas?
asbestos exposure
can have a latent period between exposure and development of mesothelioma
up to 45yrs
what is the prognosis of mesothelioma?
poor
chemo can help survival
essentially palliative
what are presenting features of lung cancer?
shortness of breath
cough
haemoptosis
weight loss
finger clubbing
lymphadenopathy - supracavicular often first
recurrent pneumonia
what is sometimes the first evidence of lung cancer in otherwise asymptomatic patients?
extra pulmonary manifestations and paraneoplastic syndromes
what are examples of extra pulmonary manifestations of lung cancer?
recurrent laryngeal nerve palsy
pharyngeal nerve palsy
superior vena cava obstruction
Horner’s syndrome
syndrome of inappropriate ADH
Cushing’s syndrome
hypercalcaemia
limbic encephalitis
Lamert-Eaton myasthenic syndrome
what does recurrent laryngeal nerve palsy present as?
hoarse voice
what causes recurrent laryngeal nerve palsy?
tumour pressing on the recurrent laryngeal nerve as it passes through the mediastinum
what does pharyngeal nerve palsy present as?
shortness of breath
what causes pharyngeal nerve palsy?
tumour compressing the pharyngeal never which causes diaphragm weakness
what does a superior vena cava obstruction present as?
facial swelling
difficulty breathing
distended chest and neck veins
what causes a superior vena cava obstruction in lung cancer?
a tumour pressing directly on the superior vena cava
what is Pemberton’s sign and what does it indicate?
when hands are lifted above the head there is facial congestion and cyanosis
indiction of superior vena cava obstruction
what does Horner’s syndrome present like?
triad of:
- partial ptosis - dropping eyelid
- annidrosis - absence of sweating
- miosis - smaller pupil
what causes Horner’s syndrome?
a pan coast tumour pressing on the sympathetic ganglion which interrupts the sympathetic nerve supply to the face
what is a Pancoast tumour?
a tumour in the pulmonary apex at the top of the lung
what does syndrome of inappropriate ADH - antidiuretic hormone (SIADH) present as?
hyponatreamia - low sodium
what causes SIADH ( syndrome of inappropriate antidiuretic hormone ) ?
ectopic antidiuretic hormone (ADH) secreted by small-cell lung cancer
what caused Cushing’s syndrome in lung cancer?
ectopic adrenocroticotropic hormone secreted by small cell lung cancer
what causes hypercalcaemia in lung cancer ?
ectopic parathyroid hormone secreted by squamous cell carcinoma
what is limbic encephalitis?
a paraneoplasic syndrome that makes the immune system produce antibodies to brain tissues causing inflammation in these areas
what does limbic encephalitis cause/present as?
short-term memory impairment
seizures
hallucinations
confusion
what is Lambert-Eaton myasthenic syndrome?
when antibodies against small cell lung cancer are produces but also target and damage voltage gated io channels on presynaptic terminals in motor neurones
what does Lambert-Eaton syndrome cause/present as?
weakness ;
- proximal muscles
- intraocular muscles =diplopia (double vision)
- levator muscles in eyelid = ptosis (dropping eyelid)
- pharyngeal muscles = slurred speach and dysphagia
what can Lambert-Eaton syndrome other cause, besides muscle weakness?
autonomic dysfunction =
- dry mouth
- blurred vision
- impotence
- dizziness
what is the referral criteria for an urgent ( within 2 weeks ) chest X-ray in suspected lung cancer?
over 40 and;
- lymphadenopathy - supravclavicular or persistent abnormal cervical nodes
- clubbing
- recurrent or persistent chest infections
- raised platelet count -thrombocytosis
- chest signs of lung cancer
what else indicates an urgent chest X-ray for suspected lung cancer?
2+ unexplained and never smoked
1+ unexplained if ever smoked or asbestos exposure;
- cough
- shortness of breathe
- chest pain
- fatigue
- weight loss
- loss of appetite
what would indicate lung cancer when looking at a chest xray ?
hilar enlargement
peripheral opacity - visible lesions in lung field
pleural effusion - usually unilateral in lung cancer
collapse of lung tissues
what body of the body would a staging CT scan be done in lung cancer and why?
chest, abdomen, pelvis
asses the stage, lymph node involvement and presence of metastases
what is a staging CT usually contrast enhanced?
inject contrast to give more detail of the tissues
what is a PET-CT scan?
positron emission tomography CT
scans with injecting a radioactive tracer, usually attached to glucose molecules, tot ak eimages using a CT scanner and gamma ray detector
what does a PET-CT scan do?
visualise how metabolically active tissues are
helps to identify metastases - they will have increased metabolic acitivity
what is a bronchoscopy with endobronchial ultrasound (EBUS) ?
an endoscopy with and ultrasound on the end
what does an EBUS do?
allows for a detailed assessment of the tumour and ultrasound guided biopsy
why are biopsies needed?
for histological diagnosis
to check the cell type of the tumour
what two types of biopsy can be used for lung cancer?
bronchoscopy
percutaneous (through skin)
how is treatment of lung cancer decided?
in an MDT meeting
what is first line treatment for min-small cell lung cancer?
surgery if in an isolated area
aim to remove entire tumour = cure
what is the benefits of radiotherapy in small cell lung cancer?
can be curative if diagnosed early
in small cell lung cancer when is chemotherapy used?
can be used in combination with surgery/radiotherapy in certain patents to improve outcomes - adjuvant chemotherapy
can be used in late-stage non-small cell cancer to improve survival and quality of life - palliative chemotherapy
what is the treatment of small cell lung cancer?
usually a combination of chemotherapy and radiotherapy
prognosis is sully poorer than non-small cell lung cancer
what does endobronchial treatment do?
puts in stents or debunking of tumour in bronchial obstrucion
what is end-bronchial treatment used for?
palliative treatment
helps relieve bronchial obstruction
what are the options for removing a lung tumour?
segmentectomy/wedge resection = remove segment or wedge (portion of a lobe)
lobectomy = remove whole lobe
pneumonectomy = remove entire lung
what is the most common way to remove a lung tumour?
lobectomy
what types of surgery can be done to remove a lung tumour?
thoracotomy
video-assisted thorascopic surgery (VATS)
robotic surgery
what is a thoracotomy?
open surgey with an incision and separation of ribs to access the thoracic cavity
what incisions can be used in a thoracotomy?
anterolateral - incision around the front and side
axillary - incision in the axilla
posterolaterla - around the back and side
what is the most common incision for a thoracotomy to remove lung cancer?
porsterolateral -around back and side
what is video-assisted thorascopic surgery?
minimally invasive, ‘keyhole’ surgery
generally prefers as it has a faster recovery and less complications
what does a thoracotomy scar indicate?
lobectomy, pneumonectomy or lung volume reduction surfer for COPD
what does a right-sided mini-thoracotomy scar indicate?
in cardio station - minimally invasive mitral valve urgent?
what breath sounds indicate a lobectomy?
focal asset breath sounds
what breath sounds indicate a pneumonectomy?
absent breath sounds on an entire side
what are lobectomies and pneumonectomies used to treat?
lung cancer
used to be used to treat tuberculosis - be mindful in older patients
