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Respiratory > Lung Cancer > Flashcards

Lung Cancer Flashcards

0
Q

Give some stats about lung cancer in females

A

Exceeds breast cancer as a cause of death
Mortality rate is 40/100,000
Incidence is rising

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1
Q

Give some stats about lung cancer in males

A

Most common male cancer
Mortality rate is 100/100,000
Incidence slowly falling

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2
Q

Aetiological factors of lung cancer?

A 
Smoking (90% cases)
Living in an urban area
Passive smoking
Asbestos
Arsenic
Radom exposure
Genetics
Diet
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3
Q

What can arsenic be found in?

A

Batteries, paints, fertiliser

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4
Q

Symptoms of a primary tumour in the lungs?

A 
Cough
Dyspnoea
Wheezing
Haemoptysis
Chest pain
Weight loss
Lethargy/malaise
Post-obstructive pneumonia
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5
Q

Symptoms of regional metastases in the lungs?

A

Superior vena cava obstruction
Hoarseness
Dyspnoea
Dysphagia

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6
Q

What causes hoarseness in regional metastases in lung cancer?

A

Left recurrent laryngeal nerve palsy

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7
Q

What causes dyspnoea in regional metastases of the lung?

A

Phrenic nerve palsy

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8
Q

What is paraneoplastic syndrome?

A

Presence of a symptom or disease due to presence of cancer in the body, but not due to local presence of cancer cells

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9
Q

What mediates paraneoplastic syndrome?

A

Humoral factors - cytokines and hormones

They are secreted by tumour cells or part of the immune response against tumour cells

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10
Q

How does polyneuropathy occur?

A

When antibodies are produced which are against the myelin sheath, can cause irreversible damage

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11
Q

What other neurological complications are there of lung cancer?

A

Cerebellar degeneration and other encephalopathies
Lambert-Eaton syndrome -> myasthenia gravis
Peripheral neuropathy

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12
Q

What endocrine complications are there of lung cancer?

A

Hypercalcaemia

Cushing’s syndrome

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13
Q

What skeletal complications are there of lung cancer?

A

Finger clubbing - caused by non-small cell carcinoma

Thought to be a result of ectopic hormone secretion

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14
Q

What are some haematological complications of lung cancer?

A

Anaemia
Thrombocytopenia
Disseminated intravascular coagulation

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15
Q

What imaging is used in diagnosis and staging of lung cancer?

A

Chest X-ray - can see symptomatic tumours
Bronchoscopy and CT
PET scan
Isotope bone scan

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16
Q

Why do you need to be careful when using a chest x ray in diagnosing lung cancer?

A

Tumour can be hidden by the heart

Use a bronchoscopy or CT

17
Q

What do each of the number stagings mean in lung cancer?

A

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

18
Q

T part of TNM staying in lung cancer?

A

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
19
Q

Give the N stages of TNM staging

A

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

20
Q

Give the M stages of TNM staging

A

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

21
Q

How is tissue obtained for histological diagnosis?

A

Bronchoscopy
Needle biopsy of lung
Surgically

22
Q

What is a histological diagnosis used for?

A

Confirm if patient has lung cancer

Cell type - important for prognosis and treatment

23
Q

What is the most common type of lung cancer?

A

Squamous cell carcinoma (40% of cases)

24
Q

Give the histological features of squamous cell carcinoma in the lung

A 
Angulate cells
Eosinophilic (pink) cytoplasm 
Keratinisation
Intracellular bridges - 'prickles'
Keratin pearls
25
Q

Give macroscopic features of squamous cell carcinoma in the lung

A

Often central
Occasionally cavitates - central part of tumour undergoes necrosis
Metastases late but frequent

26
Q

Which type of lung cancer is least likely to be linked with smoking?

A

Adenocarcinoma

27
Q

Give microscopic features of adenocarcinoma in lung cancer

A 
Columnar/cuboidal cells
Form glands (acini)
Papillary structures 
May line alveoli
Some produce mucin if they arise from mucous cells in bronchial epithelium
28
Q

Where are adenocarcinomas of the lung most likely to be found?

A

Peripheries

29
Q

Give microscopic features of small cell carcinoma in the lung

A 
Small nuclei (around size of a lymphocyte)
Little cytoplasm
Nuclear moulding
Often necrosis
Lots of mitoses
30
Q

Microscopic features of large cell carcinoma of the lung?

A

Less well differentiated versions of adenocarcinomas and squamous cell carcinomas ie have a longer time to develop before presentation
Metastasise early
Poor prognosis

31
Q

What does prognosis of lung cancer depend on?

A 
Cell type (small cell is worse)
Stage of disease
Performance status of patient
Biochemical markers
Co-morbidities eg cardiac/chronic respiratory disease
32
Q

What proportion of lung cancers at presentation are inoperable?

A

Two thirds

33
Q

What is the difference between radical can palliative radiotherapy?

A

Radical - curative intent

Palliative - symptom control

34
Q

What is combination therapy?

A

Chemo and radiotherapy

35
Q

Examples of what biological targeted therapies target?

A

EGFR

VEGF

36
Q

Name the non-small cell types of lung cancer

A

Large cell carcinoma
Adenocarcinoma
Squamous cell carcinoma

37
Q

How do you manage non-small cell lung cancer?

A

Palliative radiotherapy for symptoms
Chemo (50-60%) response rates
Combination therapy - important in locally advanced disease
Target agents eg EGFR antagonists, immunotherapy

38
Q

What symptoms may you want to relieve with palliative care?

A

Chest wall pain
Cough
Haemoptysis
Airway obstruction

39
Q

How would you manage small cell lung cancer?

A

Systemic disease in >80% cases so rarely operable
Combination therapy can add a year
Palliative chemotherapy

40
Q

Things to know about supportive care in lung cancer?

A

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

Respiratory (17 decks)

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