Lung Cancer Flashcards by Elizabeth Stevens

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

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Give some stats about lung cancer in males

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

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Aetiological factors of lung cancer?

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

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What can arsenic be found in?

Batteries, paints, fertiliser

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Symptoms of a primary tumour in the lungs?

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

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Symptoms of regional metastases in the lungs?

Superior vena cava obstruction
Hoarseness
Dyspnoea
Dysphagia

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What causes hoarseness in regional metastases in lung cancer?

Left recurrent laryngeal nerve palsy

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What causes dyspnoea in regional metastases of the lung?

Phrenic nerve palsy

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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

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What mediates paraneoplastic syndrome?

Humoral factors - cytokines and hormones

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

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How does polyneuropathy occur?

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

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What other neurological complications are there of lung cancer?

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

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What endocrine complications are there of lung cancer?

Hypercalcaemia

Cushing’s syndrome

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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

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What are some haematological complications of lung cancer?

Anaemia
Thrombocytopenia
Disseminated intravascular coagulation

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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

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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