Lung Cancer Flashcards
What are the two histological types of lung cancer, and their prevalence percentage?
- Small cell lung cancer (SCLC)- 20%
- Non-small cell lung cancer- 80%
What carcinoma can non-small cell lung cancer be further divided into?
- adenocarcinoma
- squamous cell carcinoma
- large-cell carcinoma
- other types
What is Mesothelioma, and what is its cause? What is its prognosis like?
lung malignancy that affects the mesothelial cells of the pleura. It is strongly linked to asbestos inhalation. It has a huge latent period of up to 45 years and is essentially palliative.
List the clinical presentations of Mesothelioma.
- Shortness of breath
- cough
- hemoptysis
- finger clubbing
- recurrent pneumonia
- weight loss
- lymphadenopathy (supraclavicular nodes are the first to be found on examination)
What are some extrapulmonary manifestations of lung cancer?
Which clinical presentations would indicate an urgent chest x-ray referral in patients over 40 years old?
Top 2:
- finger clubbing
- supraclavicular lymphadenopathy
- recurrent/persistent chest infections
- raised platelet count
- chest signs of lung cancer
What would you do if a 60 year old ex-smoker presents feeling tired all the time, with no other symptoms?
Urgent chest x-ray to exclude lung cancer
What are the chest x-ray findings that would indicate cancer?
- hilar enlargement
- peripheral opacity- a visible lesion in the lung field
- pleural effusion- usually unilateral in lung cancer
- collapse
What other investigations would you do to confirm/diagnose lung cancer, and how do they work?
- Staging CT scan of chest, abdomen and pelvis is used to assess the stage, lymph node involvement and presence of metastases.
- PET-CT (positron emission tomography) scans involve injecting a radioactive tracer to visualise how metabolically active various tissues are. They are useful in identifying areas that cancer has spread to by showing areas of increased metabolic activity.
- Bronchoscopy with endobronchial ultrasound (EBUS) involves endoscopy with ultrasound equipment on the end of the scope. This allows detailed assessment of the tumour and ultrasound-guided biopsy.
- Histological diagnosis requires a biopsy to check the type of cells in the tumour.
What are the treatment options for non-small cell lung cancer?
- surgery- removal of the tumor
- radiotherapy
- chemotherapy
- endobronchial treatment with stents or debulking to relieve bronchial obstruction (as part of palliative treatment)
What are the treatment options for small-cell lung cancers? And how is its prognosis compared to non-small cell cancers?
- chemo and radio
- prognosis worse than non-small cell carcinoma
What are the different types of lung surgeries?
- segmentectomy/wedge resection- taking a segment or wedge of a lung
- lobectomy- removing the entire lung lobe containing the tumor
- pneumonectomy- removing an entire lung
What are the three ways in which the lungs can be operated through?
- thoracotomy- open surgery
- video-assisted thoracoscopic surgery (VATS)- minimally invasive keyhole surgery
- Robotic surgery
What are the three main sites for thoracotomy incisions?
- anterolateral- incision around the front and side
- axillary- in the axilla
- posterolateral- incision around the back and side
Important Information
If you see a patient with a thoracotomy scar in your OSCEs, they are likely to have had a lobectomy, pneumonectomy or lung volume reduction surgery for COPD. If they have no breath sound on that side, this indicates a pneumonectomy rather than lobectomy. If they have absent breath sound in a specific area on the affected side (e.g., the upper zone), but breath sounds are present in other areas, this indicates a lobectomy. Lobectomies and pneumonectomies are usually used to treat lung cancer. In the past, they were often used to treat tuberculosis, so keep this in mind in older patients. If it is a cardiology examination and they have a right-sided mini-thoracotomy incision, this is more likely to indicate previous minimally invasive mitral valve surgery.
