Lung cancer Flashcards
What is haemoptysis?
Coughing up blood
due to ulceration
What is the link between recurrent pneumonia and lung cancer?
Recurrent pneumonia can be a sign of lung cancer. The obstruction leads to frequent infection.
What is stridor?
Inspiratory wheeze, caused by an obstruction in the upper airway making it difficult to breathe in
(asthma and COPD produce expiratory wheeze)
List 6 structures that neighbour the lungs that lung cancer may effect (local invasion)
- Recurrent laryngeal nerve
- Oesophagus
- Pericardium
- Brachial pleuxus
- Pleural cavity
- Superior vena cava
Explain how a hoarse voice can be a symptom for lung cancer
The tumour may invade the reccurrent laryngeal nerve resulting in paralysis of a vocal cord
Give 3 symptoms of local invasion of the pericardium
Breathlessness
Atrial fibrillation
Pericaridial effusion
What symptom shows local invasion of the oesophagus?
Dysphagia (difficulty/uncomfortable swallowing
What is a Pancoast tumour?
Tumour of the pulmonary apex. It typically spreads to nearby tissues such as ribs and vertebrae
Why would a patient with lung cancer have weakness in their hand?
Invasion of the brachial plexus
What is a common presenting symptom in someone with a pleural effusion?
Breathlessness
What are symptoms of superior vena cava invasion?
Puffy eyelids and headache
Distension of the superficial veins, even when standing upright. Normal pulsation is lost
Anastamoses to inferior vena cava
How can the symptoms of invasion of the superior vena cava be palliated?
Insertion of a stent to open up the occluded vein - must be done before the vein is permanently occluded by thrombosis
What would be the presenting symptom if there was chest wall invasion?
Localised chest pain that is worse on movement
If the tumour has eroded through bone, the pain may be worse at night
Erosion of what structure would cause massive haemoptysis and ultimately death?
If the tumour erodes into the left pulmonary artery and into a major bronchus
What are the 6 commons sites of metastases from a primary lung cancer?
Liver Brain Bone Adrenal Skin Lung
What are the symptoms of cerebral metastases?
Weakness (may mimic a stroke but have gradual onset)
Visual disturbance
Headaches that are non-photophobic and are worse in the morning
Fits (if it involves the cortex)
What symptoms show liver metastasis?
May have liver pain
In rare cases the biliary can be obstructed resulting in obstructive jaundice
Abnormal liver function tests
What are the common presentations of bone metastases?
Localised pain which is worse at night
Pathological fracture due to stress on the bone
What kind of scan can be used to show bone metastases?
Isotope bone scan
What are signs of cancer that are non-metastatic i.e. due to the biochemically active products of the primary tumour?
Finger clubbing Hypertrophic pulmonary osteoarthropathy - HPOA Weight loss Thrombophlebitis Hypercalcaemia Hypoatraemia – SIADH Weakness
What 9 key things should be asked about when taking a history for suspected lung cancer
Cough
Haemoptysis
Weight loss
Breathlessness
Chest wall pain
Cigarette smoker
Tiredness
Recurrent infection
Other smoking related disease
("Anything else worrying you?")What 11 things should be looked for on clinical examination for lung cancer?
Finger clubbing Breathless Coughing Weight loss Bloated face Hoarse voice Lymphadenopathy Tracheal deviation Dull percussion Stridor Enlarged liver
What investigations may be done to diagnose lung cancer?
Chest x-ray CT scan of thorax PET scan Bronchoscopy Endobronchial ultrasound Full blood count Coagulation screen Na, K, Ca, Alk Phos Spirometry, FEV1
What 4 investigations are used to make a tissue diagnosis?
Bronchoscopy
CT guided biopsy
Lymph node biopsy
Aspiration of pleural fluid
What are PET scans?
Positron emission tomography
Scan to asses function rather than structure
Analysis of tissue uptake of radiolabelled glucose
Tissues with high metabolic activity ‘light up’.
The clinical picture is a smoker with haemoptysis and an abnormal chest x-ray, give a list of differential diagnosis
Lung cancer Tuberculosis Vasculitis Pulmonary embolism Secondary cancer Lymphoma Bronchiectasis
What are the 2 classifications of primary lung neoplasms?
Benign and malignant
Other than smoking, what are risk factors for lung cancer?
Asbestos Nickel Chromates Radiation Atmospheric pollution (Genetics)
What are the common smoking-associated 4 lung cancers?
Adenocarcinoma
Sqaumous carcinoma
Small cell carcinoma
Large cell carcinoma
Give 4 reasons for cancer classification
Prognosis
Treatment
Pathogenesis
Epidemiology
What is small cell lung cancer?
The cancer cells are smaller than normal cells and are mostly filled by the nucleus. 12% of lung cancers.
Rapidly progressive disease
Early metastasises
usually caused by smoking
What is non-small cell lung cancer?
Make up around 87% of lung cancers
3 common types - squamous caricinoma, adenocarcinoma and large cell carcinoma
What does cancer prognosis depend on?
Tumour stage and tumour histological subtype
What staging is commonly used in cancer?
TNM staging
- The size and/or extent if the primary tumour (T)
- The amount of spread to nearby lymph nodes (N)
- Presence of metastasis (M) or secondary tumours
Numbers given
What treatment would commonly be given for small cell lung cancer?
Rarely suitable for surgery
Good initial response to chemotherapy (palliative treatment).
Chemo often backed up with radiotherapy.
What treatment would commonly be given for non-small cell lung cancer?
Sometimes cured by surgery of radical radiotherapy
Less responsive than small cell lung cancer to chemotherapy
What is the median survival time and percentage chance of one year survival in non-small cell cancer?
7.7 months
39% chance of one year survival
What is the median survival time and percentage chance of one year survival in small cell cancer?
5.9 months
24%
What are the four main treatment choices for lung cancer?
Surgery
Chemotherapy
Radiotherapy
Palliative care
In pre-operative staging, what would doctors look for during a bronchoscopy that could affect surgery as a option for treatment
Vocal cord palsy
Proximity to the carina
Cell type
What techniques would be used in pre-operative staging to search for metastases?
CT scan or the head and thorax
PET scan
Thoracotomy
Surgical incision into the chest wall
Pneumonectomy
Surgical removal of the lung of the lung, it may be total, partial or of a single lobe (lobectomy)
Other that thoracotomy, how can lung cancer surgery be performed?
Video assisted thoracoScopic surgery (VATS)
Explain cytotoxic chemotherapy; what does it do, what are the effects, how is it given?
It is rarely curative but results in longer survival
Better response in small cell
Major side effects
IV infusions every 3-4 weeks
Whole body treatment that targets rapidly dividing cells
Why can chemotherapy not treat tumours in the brain?
The blood-brain barrier, so radiotherapy is given
What are the side effects of chemotherapy?
Nausea and vomiting Tiredness Hair loss Bone marrow suppression - may result in opportunistic infection and anaemia Pulmonary fibrosis
How does radiotherapy treat cancer?
X-rays are ionising radiation that damage dividing cells
Palliative treatment - a delaying tactic
Useful for metastases
Well tolerated
What are the disadvantages of radiotherapy?
Collateral damage
Maximum cumulative dose
Only goes where the beam is pointed
What is endobronchial therapy?
Patient receives a photo-sensitising drug before this bronchoscopy
Photo-therapy to the tumour - laser activates the drug and the tumour dies within a week
However, patients then has to have limited sun exposure
What treatment could be given for stridor caused by a tumour?
Stent insertion
What 4 main things determine what cancer treatment will be given?
Cell type
Extent of the disease
Co-morbidity
Patients wishes
