Lung Cancer Flashcards
Give some stats about lung cancer in females
Exceeds breast cancer as a cause of death
Mortality rate is 40/100,000
Incidence is rising
Give some stats about lung cancer in males
Most common male cancer
Mortality rate is 100/100,000
Incidence slowly falling
Aetiological factors of lung cancer?
Smoking (90% cases) Living in an urban area Passive smoking Asbestos Arsenic Radom exposure Genetics Diet
What can arsenic be found in?
Batteries, paints, fertiliser
Symptoms of a primary tumour in the lungs?
Cough Dyspnoea Wheezing Haemoptysis Chest pain Weight loss Lethargy/malaise Post-obstructive pneumonia
Symptoms of regional metastases in the lungs?
Superior vena cava obstruction
Hoarseness
Dyspnoea
Dysphagia
What causes hoarseness in regional metastases in lung cancer?
Left recurrent laryngeal nerve palsy
What causes dyspnoea in regional metastases of the lung?
Phrenic nerve palsy
What is paraneoplastic syndrome?
Presence of a symptom or disease due to presence of cancer in the body, but not due to local presence of cancer cells
What mediates paraneoplastic syndrome?
Humoral factors - cytokines and hormones
They are secreted by tumour cells or part of the immune response against tumour cells
How does polyneuropathy occur?
When antibodies are produced which are against the myelin sheath, can cause irreversible damage
What other neurological complications are there of lung cancer?
Cerebellar degeneration and other encephalopathies
Lambert-Eaton syndrome -> myasthenia gravis
Peripheral neuropathy
What endocrine complications are there of lung cancer?
Hypercalcaemia
Cushing’s syndrome
What skeletal complications are there of lung cancer?
Finger clubbing - caused by non-small cell carcinoma
Thought to be a result of ectopic hormone secretion
What are some haematological complications of lung cancer?
Anaemia
Thrombocytopenia
Disseminated intravascular coagulation
What imaging is used in diagnosis and staging of lung cancer?
Chest X-ray - can see symptomatic tumours
Bronchoscopy and CT
PET scan
Isotope bone scan
Why do you need to be careful when using a chest x ray in diagnosing lung cancer?
Tumour can be hidden by the heart
Use a bronchoscopy or CT
What do each of the number stagings mean in lung cancer?
Stage 1 - small cancer in one area of the lung
Stage 2 + 3 - larger cancer may have grown to surrounding lymph nodes or tissue
Stage 4 - cancer has metastasised
T part of TNM staying in lung cancer?
T = size and position of tumour
T1: contained within the lung (7cm
- invaded chest wall, mediastinal pleura, diaphragm, pericardium
- complete lung collapse
- > 1 cancer nodule in same lobe of lung
T4:
- cancer invading mediastinum, heart, major blood vessel, trachea, carina, oesophagus, spine, recurrent laryngeal nerve
- cancer nodules in more than one lobe of the same lung
Give the N stages of TNM staging
N = lymph node involvement
N0: not in lymph nodes
N1: in lymph nodes nearest infected lung
N2: in lymph nodes in mediastinum on the same side
N3: in lymph nodes on opposite side of mediastinum/supra clavicular lymph nodes
Give the M stages of TNM staging
M = metastases
M0: no evidence of distal cancer spread
M1: lung cancer cells in distant part of the body such as pleura, opposite lung, liver, bones etc
How is tissue obtained for histological diagnosis?
Bronchoscopy
Needle biopsy of lung
Surgically
What is a histological diagnosis used for?
Confirm if patient has lung cancer
Cell type - important for prognosis and treatment
What is the most common type of lung cancer?
Squamous cell carcinoma (40% of cases)
Give the histological features of squamous cell carcinoma in the lung
Angulate cells Eosinophilic (pink) cytoplasm Keratinisation Intracellular bridges - 'prickles' Keratin pearls
Give macroscopic features of squamous cell carcinoma in the lung
Often central
Occasionally cavitates - central part of tumour undergoes necrosis
Metastases late but frequent
Which type of lung cancer is least likely to be linked with smoking?
Adenocarcinoma
Give microscopic features of adenocarcinoma in lung cancer
Columnar/cuboidal cells Form glands (acini) Papillary structures May line alveoli Some produce mucin if they arise from mucous cells in bronchial epithelium
Where are adenocarcinomas of the lung most likely to be found?
Peripheries
Give microscopic features of small cell carcinoma in the lung
Small nuclei (around size of a lymphocyte) Little cytoplasm Nuclear moulding Often necrosis Lots of mitoses
Microscopic features of large cell carcinoma of the lung?
Less well differentiated versions of adenocarcinomas and squamous cell carcinomas ie have a longer time to develop before presentation
Metastasise early
Poor prognosis
What does prognosis of lung cancer depend on?
Cell type (small cell is worse) Stage of disease Performance status of patient Biochemical markers Co-morbidities eg cardiac/chronic respiratory disease
What proportion of lung cancers at presentation are inoperable?
Two thirds
What is the difference between radical can palliative radiotherapy?
Radical - curative intent
Palliative - symptom control
What is combination therapy?
Chemo and radiotherapy
Examples of what biological targeted therapies target?
EGFR
VEGF
Name the non-small cell types of lung cancer
Large cell carcinoma
Adenocarcinoma
Squamous cell carcinoma
How do you manage non-small cell lung cancer?
Palliative radiotherapy for symptoms
Chemo (50-60%) response rates
Combination therapy - important in locally advanced disease
Target agents eg EGFR antagonists, immunotherapy
What symptoms may you want to relieve with palliative care?
Chest wall pain
Cough
Haemoptysis
Airway obstruction
How would you manage small cell lung cancer?
Systemic disease in >80% cases so rarely operable
Combination therapy can add a year
Palliative chemotherapy
Things to know about supportive care in lung cancer?
Early involvement of palliative care services
Specific palliative is best done by a specialist eg resp physician, oncologist
Communication and co-ordination of treatment agencies is vital
