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Year 4 - Cancer Care > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

What are the 3 most common cancers in order?

A

Breast
Prostate
Lung

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2
Q

What is the biggest cause of lung cancer?

A

Smoking, 80%

Radon gas exposure also causes a small % of cases

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3
Q

Outline the thoracic anatomy

A

Trachea
Splits into left and right main bronchi

Bronchi then split into lobar bronchi
Segmental bronchi
Bronchioles
Alveoli

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4
Q

How many lobes does each lung have?

A

Right - 3 lobes
Left - 2 lobes

Not enough space on left for 3 lobes due to heart

Both have oblique fissure
Right also has horizontal fissure

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5
Q

What is the membrane called that surrounds the lungs?

A

Visceral pleura

Parietal pleura is the chest wall

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6
Q

Where is the pleural cavity?

A

Potential space between the visceral and parietal pleura

Negative pressure pulls the pleural layers close together

As the chest expands, negative pressure in the pleural cavity pulls the lungs towards the chest wall causing them to expand

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7
Q

What does a pleural effusion do to the pleural pressures?

A

Inward pressure on the lungs, reducing lung volume

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8
Q

How is lung cancer broadly divided?

A

Small cell lung cancer (20%)
Non-small cell lung cancer (80%)

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9
Q

How is non-small cell lung cancer divided?

A

Adenocarcinoma (40%)
Squamous cell carcinoma (20%)
Large cell carcinoma (10%)
Other types (10%)

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10
Q

Where do squamous cell carcinomas and adenocarcinomas develop in the lung?

A

Squamous
Develop centrally from epithelial cells lining airways
Take longer to metastasise

Adenocarcinomas
Develop from peripheral mucous secreting cells
Bronchial or alveolar wall
More common in women than men

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11
Q

What are squamous cell cancers more likely to do?

A

Lobar collapse or infection due to blockage of airways

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12
Q

Where do large cell carcinomas develop?

A

Throughout the lung
Undifferentiated structure
Centrally or peripherally

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13
Q

Where do Small cell cancers arise from?

A

APUD cells
Central carcinomas
Fast growing and metastasise early

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14
Q

Why do small cell lung cancers cause paraneoplastic syndromes?

A

They contain neurosecretory granules which can release neuroendocrine hormones

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15
Q

What are some differential diagnoses for symptoms of lung cancer?

A

Pneumonia
Pulmonary TB
PE
Heart failure

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16
Q

What is a mesothelioma?

A

Lung malignancy affecting mesothelial cells of the pleura

Strongly linked to asbestos

Latent period of up to 45 years

Poor prognosis, chemotherapy can improve survival but mainly palliative

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17
Q

How does lung cancer present?

A

SOB
Cough
Haemoptysis
Finger clubbing
Recurrent pneumonia
Weight loss
Lymphadenopathy- supraclavicular nodes

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18
Q

What causes haemoptysis and coughing in lung cancer?

A

Unstable tumours cause blood vessels to break and bleed

Tumour irritates airways activating cough reflex

19
Q

What type of wheeze is heard in lung cancer?

A

Monophonic wheeze
Tumour causes narrowing of single airway

20
Q

What extrapulmonary manifestation is indicated by a hoarse voice?

A

Recurrent laryngeal nerve palsy

Tumour presses on the recurrent laryngeal nerve as it passes through the mediastinum

21
Q

What causes a phrenic nerve palsy in lung cancer?

A

Nerve compression by tumour

Causes diaphragm weakness and SOB

22
Q

What happens in a SVC obstruction?

A

Direct compression of the tumour on the SVC

Facial swelling
Difficulty breathing
Distended neck veins and upper chest veins

23
Q

What is Pemberton’s sign?

A

Raising hands over head causes facial congestion and cyanosis

This is because there is increased obstruction to SVC drainage due to mass pushing against the SVC

24
Q

What causes Horner’s syndrome?

A

Pancoast tumour

Ptosis
Anhidrosis
Miosis

Tumour presses on the sympathetic ganglion

25
Q

What causes SIADH?

A

Ectopic ADH secreted by small cell lung cancer

Hyponatraemia

26
Q

What causes Cushing’s syndrome in lung cancer?

A

Ectopic ACTH by small cell lung cancer

27
Q

What causes hypercalcaemia in lung cancer?

A

Ectopic PTH by squamous cell carcinoma

28
Q

What is limbic encephalitis?

A

Paraneoplastic syndrome

Small cell lung cancer causes immune system to make antibodies which attack the limbic system in the brain

Leads to :
- Short term memory loss
- Hallucinations
- Confusion
- Seizures

anti-Hu antibodies

29
Q

What happens in Lambert-Eaton myasthenic syndrome?

A

Antibodies produced by immune system against small cell lung cancer

Antibodies also target and damage voltage-gated calcium channels on presynaptic terminals in motor neurones

Weakness in proximal muscles, intraocular muscles and pharyngeal muscles
- Diplopia
- Ptosis
- Slurred speech
- Dysphagia
- Proximal muscle weakness

Other symptoms
- Dry mouth
- Blurred vision
- Impotence
- Dizziness

30
Q

What is the referral criteria for lung cancer?

A

CXR within 2 weeks to patients over 40 with :
- Clubbing
- Lymphadenopathy (supraclavicular)
- Recurrent or persistent chest infections
- Thrombocytosis
- Chest signs of lung cancer

31
Q

When should patients also be given a CXR?

A

Over 40 with :
- Two or more unexplained symptoms that have never smoked
- One or more unexplained symptoms that have smoked

32
Q

What are unexplained symptoms in relation to lung cancer?

A

Cough
SOB
Fatigue
Chest pain
Weight loss
Loss of appetite

33
Q

What is the first line investigation in suspected lung cancer?

A

Chest x-ray
Hilar enlargement
Peripheral opacity (visible lesion in lung field)
Pleural effusion (unilateral usually)
Colapse

FBC and CRP - exclude infectious causes
U&Es and bone profile

34
Q

What other investigations can be used in confirmed lung cancer?

A

Contrast CT CAP with contrast
- Assess TNM status
- Using contrast gives more information about different tissues

PET-CT
- Radioactive tracer, images taken with a CT scanner and gamma-ray detector
- Useful to see if cancer has spread by showing increased metabolic activity

Bronchoscopy with endobronchial USS (EBUS)
- Endoscopy with USS on scope
- Allows details tumour assessment and USS guided biopsy

Histological diagnosis
- Biopsy to check type of cells in tumour
- By bronchoscopy or percutaneous biopsy

35
Q

How is lung cancer treated?

A

MDT meeting

Surgery
First-line in non-small cell lung cancer
Disease isolated in single area
Entire tumour removed

Radiotherapy
Can be curative in non-small cell lung cancer when diagnosed early

Chemotherapy
Can be offered in addition to surgery or radiotherapy in certain patients to improve outcomes
Or palliative to imrpove survival and QoL in later stages of non-small cell lung cancer

Endobronchial stenting or debulking
Can be used as part of palliative to relieve bronchial obstruction from lung cancer

36
Q

How is small cell lung cancer treated?

A

Chemotherapy and radiotherapy

Prognosis is worse than non-small cell

37
Q

Before thoracic surgery what should be done in all patients?

A

Lung function testing

Calculate predicted post-operative respiratory capacity to guide the type or resection

Pneumonectomy - 50% reduction in FEV1
Lobectomy - 20% reduction

Therefore >1L in lobectomy
>2L in pneumonectomy

38
Q

What options are there for removing a lung tumour?

A

Segmentectomy or wedge resection

Lobectomy
Entire lobe containing tumour removed (most common)

Pneumonectomy
Removing entire lung

Sleeve resection
Removing one lobe and part of the bronchi

39
Q

What are the different types of surgery for lung cancer?

A

Thoracotomy
Open surgery, incision and separation of rib to access thoracic cavity

Video-assisted thorascopic surgery (VATS)
Keyhole surgery

Robotic surgery

40
Q

What type of surgery is preferred in lung cancer?

A

Minimally invasive e.g. VATS or robotic

Faster recovery and fewer complications

41
Q

What are the main thoracotomy incisions?

A

Anterolateral thoractomy
Incision around front and side

Axillary thoracotomy

Posterolateral thoracotomy
Incision around back and side (most common)

42
Q

What indicates a pneumonectomy vs lobectomy on examination?

A

If there is a thoracotomy scar and there is no breath sound on that side

Indicates entire lung removal rather than lobectomy

If absent lung sounds in a specific area, indicates a lobectomy

43
Q

Why is a chest drain left in after thoracic surgery?

A

Allows air and fluid to leave the thoracic cavity and lungs to expand

Chest drain pump can be used to suck fluid and air out of chest

44
Q

How does a chest drain work?

A

External end placed underwater

Creates a seal to prevent air going back through drain into chest

Air can still exit chest and bubble through water, but water prevents air re-entering

Water in drain will rise and fall due to changes in chest pressure - swinging

Year 4 - Cancer Care (17 decks)

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