Lung Cancer Flashcards
What is primary and secondary lung cancer
Primary - lungs (bronchi/alveoli/bronchioles/lung tissue)
secondary - spread to liver and breast
Cancer epidemiology
3rd most common cancer in the UK
Most common cause of death in the UK
What are the risk factors for Lung Cancer
-age (peak 50-60)
-family history
-occupational exposure
-ionising radiation (0.5% radon)
-air pollution
-smoking (86%)
How does smoking increase the risk of lung cancer
chemicals in tobacco have the potential to cause DNA damage in lung cells
Failure to repair DNA damage can lead to the formation of cancer
inhaling tobacco smoke can cause alveoli damage
2 types of lung cancer
small cell lung cancer (20%)
non small cell lung cancer (80%) - adenocarcinoma (40%), squamous cell carcinoma (20%), large cell carcinoma (10%) other types (10%)
features of small cell carcinoma
Oat cell cancer
Smoking linked
Most aggressive - high recurrence rate
Granules release ACTH/ADH/PTH
Features of squamous cell carcinoma
keratinised
mitotic figures
Adenocarcinoma
begins in the cells that line the alveoli e.g. make mucus
most comon type of lung cancer in non-smokers
squamous cell carcinoma
epidermoid carcinoma
start in squamous cells (thin/fat) which line airways
linked to smoking
large cell carcinoma
spreads quickest and found in lungs
What is a pancoast tumour
tumour in the apical region of the lung (non small cell carcinomas)
compresses:
-cervical sympathetic nerves (vagus)
-brachial plexus
-superior vena cava
-laryngeal nerves
-subclavian arteries and veins
Where is asymptomatic lung cancer detected
only in x-rays
non specific symptoms of lung cancer
weight loss
fever
weakness
lethargy
symptoms of metastatic disease
fracture (bone)
jaundice
CNS symptoms (blue)
pulmonary symptoms of cancer
-coughing (not improved by medication)
-shortness of breath
-chest pain
-hemoptysis (blood / in sputum)
What are the extrapulmonary symptoms of lung cancer
-recurrent laryngeal nerve palsy (hoarse voice)
-phrenic nerve palsy (diaphragm weakness/SOB)
-superior vena cava obstruction - facial swelling (Pemberton’s sign where raising hands over head causes congestion and cyanosis)
What is horner’s syndrome
partial ptosis (lid droop)
anhidrosis (eye dryness)
miosis (pupil constriction)
via pancoast tumour pressing on sympathetic ganglion
What is paraneoplastic syndrome
cancer cells become neuroendocrine cells
-syndrome of inappropriate ADH - hyponatraemia
-cushing’s syndrome (high cortisol)
-hypercalcaemia (ectopic parathyroid hormone secreted by a squamous cell carcinoma)
What does a chest x ray show
solitary pulmonary nodule/mass
80% of solitary pulmonary nodules (<4cm diameter) in over 50s are cancer
tumour
thickened lung
How is lung cancer diagnosed
chest x-ray
CT scan
biopsy - determines type of cancer and grade
How is a biopsy obtained
fibreoptic bronchoscopy (via mouth through trachea/bronchus/bronchioles)
-transthoracic fine needle aspiration (if tumour in lung periphery)
What are the stages of small cell lung cancer
limited stage SCLC - present in one lung (may spread to surrounding lymph nodes) chemo & radiotherapy
extensive stage SCLC - cancer spread to both lungs and lymph nodes, not curable
stages of non small cell lung cancer
I-IV
How can cancer spread
bloodstream and lymph system
Common sites for lung cancer metastasis
brain
bones
liver
adrenal glands
lung cancer prevention
-quit smoking
-avoid second hand smoke
-eating healthy
-getting screening
Screening types
CT scan - 20% risk in mortality with low dose CT vs chest radiography
Blood - early CDT lung (blood test only in USA)
Prognosis
most metastasised to distant sites (70%)
25% have regional lymph node involvement
most inoperable (75% NSCLC)
1 year survival - (30%)
5 year survival (9%)
5yr survival for localised lung lesion 45%
