LUNG CANCER Flashcards
What is the most common type of cancer worldwide in terms of incidence?
Diagnosed - Lung cancer
Undiagnosed - maybe prostate cancer
What is the most common type of cancer worldwide in terms of mortality?
Lung cancer
What type of lung cancer makes up the majority of cases?
Non-small cell lung cancers make up 80% of cases. The most common non-small cell lung cancer is Adenocarcinoma (40% of all cases)
What proportion of lung cancer patients will be alive 5 years after diagnosis?
14%
What are the agents that people might be exposed to in the workplace that might increase their risk of developing lung cancer?
Asbestos Arsenic Chromium Nickel Radion
At what stage of cancer are most patients with lung cancer diagnosed?
Advanced or metastatic
What are the main different histological types of lung cancer?
Squamous cell carcinoma
Adenocarcinoma
Small cell carcinoma
Large cell carcinoma
What proportions of lung cancers do squamous cell carcinomas account for?
30-35%
What proportions of lung cancers do adenocarcinomas account for?
40%
What proportions of lung cancers do small cell carcinomas account for?
20%
What proportions of lung cancers do large cell carcinomas account for?
9%
Which histological subtype of lung cancer is most associated with never-smokers?
Adenocarcinoma
In terms of histological subtype, what is the most important distinction to make from a clinical point of view?
Whether it is small cell or non-small cell.
How might someone with suspected lung cancer present? (Name at least 7 symptoms)
Respiratory symptoms: Cough Haemoptysis Dyspnoea Chest pain Recurrent or slow resolving pneumonia
Extra pulmonary symptoms: Weight loss/Anorexia Fatigue/malaise Dysphagia Weak arm Wrist pain Bone pain
On examination, what signs might be noticed in someone with suspected lung cancer?
Extra thoracic signs: Cachexia Clubbing Anaemia Enlarged supraclavicular and axillary lymph nodes Drooping eye lids Unilateral constricted pupil
Pulmonary signs:
Consolidation
Collapse
Pleural effusion
Metastatic signs:
Bone tenderness
Hepatomegaly
Confusion
What are possible complications of lung cancer, other than death?
Pulmonary complications:
Pneumonia
Lobar collapse
Extra-pulmonary but intra-thoracic complications: Horner's syndrome SVC obstruction Recurrent laryngeal nerve palsy Phrenic nerve palsy Rib erosion Pericarditis Atrial fibrillation
Extra-thoracic complications: SIADH HPOA PTH related peptide ACTH Lambert-Eaton
Metastatic disease
What are the most common sites for metastases of lung cancer?
Brain Bone Adrenal glands Opposite lung Liver Pericardium Kidney
How does lung cancer lead to pneumonia?
Obstruction of airway leads to accumulation of secretions leading to pneumonia.
How does lung cancer lead to unilateral arm weakness?
Damage to the brachial plexus due to obstructive growth.
How does lung cancer lead to drooping eyelids and constricted pupil?
Tumours at the top of the lung (called Pancoast tumours) may invade local part of the sympathetic nervous system, leading to Horner’s syndrome.
What is the name of the tumour of the lung that can cause Horner’s syndrome?
Pancoast tumour (found in the apex of the lung)
How many known carcinogens are found in cigarettes?
73
What is the mutation which was found to be responsible for 10-30% of adenocarcinomas of the lung?
Mutations in K-ras proto-oncogene
What must occur for metastases of lung cancer to survive elsewhere?
Transition from epithelial to mesenchymal cell type
What is the gene which was found to be involved in 4% of cases of non-small cell lung cancers?
EML4-ALK tyrosine kinase fusion gene
What is the receptor which is amplified and mutated in roughly 15% of patients with adenocarcinoma of the lung, and also provide the basis for some treatment?
Epidermal growth factor receptor (EGFR)
What is the role of epidermal growth factor receptor (EGFR) in lung cancer?
Regulates cell proliferation, apoptosis, angiogenesis, and tumor invasion.
What distinguishes adenocarcinomas of the lung from other types of lung cancer?
Glandular tissue
Duct formation
Production of significant amounts of mucus
What will be stain positive in an adenocarcinoma of the lung?
Tissue tends to stain mucin positive as it is derived from mucus producing glands of the lungs.
TTF-1 will also stain in adenocarcinoma and can be used to distinguish these histologically.
Is squamous cell lung carcinoma more common in men or women?
Men
What is the pathogenesis of squamous cell lung carcinoma?
The normal cell type of the airway are cilia lined columnar cells. However, smoking leads to metaplasia of these cells and they become squamous in nature. Further smoking leads to more mutations which eventually results in squamous cell carcinoma.
What is the relative risk of someone who has smoked for 30-40 years of developing squamous cell lung carcinoma, compared to a never smoker?
16
What is the relative risk of someone who has smoked for more than 40 years of developing squamous cell lung carcinoma, compared to a never smoker?
22
Where does squamous cell lung carcinoma most often arise?
Large bronchi
Where does small cell lung carcinoma often spread to?
Brain
What are you worried about when a lung cancer patient with shivering and a temperature?
Neutropenic sepsis
