Lung Cancer Flashcards by Callum Donoher

What are some common presentations of lung cancer?

SOB
Haemoptysis
Weight loss
Hoarse voice
Horners syndrome
Paraneoplastic syndrome
Wheeze
Infection

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What type of wheeze do you get with lung cancer?

Monophonic wheeze

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What type of wheeze do you get with lung cancer?

Monophonic wheeze

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What type of wheeze do you get with COPD and asthma?

Polyphonic wheeze

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Why do you get a polyphonic wheeze with asthma and COPD?

Varying degrees of inflammation and narrowing all around the lungs

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What are some extrapulmonary symptoms/signs of lung cancer?

Hoarseness of voice
SVC obstruction symptoms
Dysphagia
Shoulder/inner arm pain
Chest pain
Facial/upper body swelling
Arrhythmia
Horners syndrome

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What are some signs of SVC obstruction which can be caused by a lung cancer?

Breathlessness
Faint
Headaches
Facial / upper body swelling

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How can you clinically test for SVC obstruction?

What is the name of the sign?

Get patients to raise arms above head, will make have a headache or make headache worse

Pembertons sign

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What is Horner’s syndrome?

What typically causes it?

Triad of:
-partial Ptosis
-miosis
-anhydrosis

Pancoast Tumor (apical lung Tumor) compresses sympathetic chain

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Why does Horners syndrome cause partial Ptosis not full Ptosis?

Sympathetic chain is damaged

Sympathetics supply the smooth muscle part of levator palpebrae superioris, whereas the majority of levator palpebrae superioris is skeletal muscle supplied by the Occulomotor nerve

Majority of LPS still has innervation so not full Ptosis

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What are some extrathoracic symptoms/signs of lung cancer?

Poor appetite
Cachexia
Weight loss
Pain
Neurological issues
Skin nodes and lymph nodes
Palpable liver
Clubbing

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What are essential parts/questions in a Hx where you think it might be lung cancer?

Do you smoke?
Have you ever smoked?
How much for how long?
Do you smoke anything else?

What occupation do you do?
Any exposures to toxins?
Nature of exposure?
How long exposed for?
Who was you employer?
What protective gear was provided?

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What scoring system is used to assess patients with potential lung cancer to aid in management decisions?

Performance status

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What is performance status scored between?

0-4

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What is a 0 performance status score?

Asymptomatic

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What is a 1 performance status score?

Symptomatic but completely ambulatory

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What is a 2 performance status score?

Symptomatic but less than 50% of time in bed during the day

What is a 3 performance status score?

Symptomatic but over 50% of time spent in bed but NOT BED BOUND

What is a 4 performance status score?

BED BOUND

What investigations are done for a potential lung cancer?

U+Es
LFTs
Ca2+
FBC
Clotting
Spirometry + transfer factor

What imaging techniques would you do for a potential lung cancer?

CXR (first line)
Staging CT CAP
Biopsy if possible
PET CT after biopsy if possible
Echo if CVS issues

What techniques can be used to biopsy a ?lung cancer?

Bronchoscopy
Endobronchial US guided transbroncial fine needle lymph node aspiration

What are the 2 categories of lung cancer?

Small cell lung cancer

Non small cell lung cancer

What are the 3 types of Non small cell lung cancer?

Squamous cell carcinoma
Adenocarcinoma
Large cell

What gene does squamous cell carcinoma often have?

PDL1

What genes do adenocarinomas often have?

PDL1 EGFRr ALK ROS1

What is the treatment pathway if a GP suspects lung cancer? What does this mean?

2 week urgent referral Time from GP referral to first hospital admission should be done in 2weeks

Why can you get voice hoarseness with lung cancer?

Lung cancer can compress teh recurrent laryngeal nerve

What type of lung cancer typically has paraneoplastic syndromes?

Small cell lung cancer

What are some syndromes that can be cause by a small cell lung cancer secreting hormones or substances?

SIADH Cushings

What does the small cell carcinoma produce leading to Cushing’s syndrome?

ACTH

What electrolyte imbalance is caused by a small cell lung cancer secreting ADH leading to SIADH?

Hyponatraemia

What type of lung cancer can cause Hypercalcaemia? Why can this happen?

Squamous cell carcinoma Ectopic PTH secretion by the. Tumour

What syndrome can rarely be caused by a small cell lung cancer which can lead to damage to Autonomics, vision, voice and swallowing?

Lambert Eaton myasthenic syndrome

What is the pathophysiology of lambert Eaton myasthenic syndrome?

Antibodies set up against cancer damage voltage gated calcium channels at presynaptic membrane of motor neurones

What is the treatment options for lung cancer?

Surgical resection/ablation Radiotherapy (radical or palliative) Systemic anti cancer therapy (chemo + immunotherapy)

What is a bright area called on a CT image? What is a dark area called on a CT image?

Bright = highly attenuated Dark = low attenuation

What are bright areas on a PET scan called? What are dark areas on a PET scan called?

Bright = has high FDG Avidity (highly avid) Dark = low avidity

What are fluffy opacities on a CXR. Called?

Alveolar shadowing

What are dots and lines called on a CXR?

Nodular or reticular shadowing

What are the bright areas called on an MRI? What are the dark areas called on an MRI?

Bright = hyper intense Dark = hypointense

What is the NICE. Guidelines criteria for referral for an urgent 2 week CXR with ?lung cancer?

Patients over 40 with: -clubbing -lymphadenopathy -persistence / recurrent chest infections -raised platelets (Thrombocytosis) -chets signs of lung cancer