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Resp-K -Year 3 > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

Whats the pathogenesis of LC?

A

Arises from bronchial epethilial mucosa + can also come from lung parenchyma.
Histological divisions: SCLCs or NSCLCs
Current or prev smokers:90% of cases.
Risk: dose dependent +’tar cntnt.

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2
Q

What are the 3 types of NSCLcs?

A

78%
Squamous cell,32% (⬆️ Ca2+ secretions)
Large cell + NOS (not otherwise specified)-35%
Adenocarcinoma 26%

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3
Q

RF of LC?

A 
Smoking, passive
Asbestos, nickel, chromium
Arsenic 
IPF
Radon
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4
Q

CF of LC?

A

Haemoptysis, wt loss, poor ️apetite, imcreasing breathlessness and cough esp > 50 .
May: diffuse chest pain caused by mediastinal displacement
Localalised pain: pleural or bony metastaisis.

Metastatic disease
Bone pain
Epilepsy or focal neurological signs- brain metastasis

Non metastatic manifestations
Finger clubbing
Malaise, lethargy and wt loss

O/E chest-
Lymphadenopathy, pleural effusion,
Lobar collapse,
Unresolved pneumonia.

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5
Q

What countries have high LC incidence?

A

Developing, where they smoke…….
LCancer is the most common cause of cancer death in the UK.
Low socioeconomic status: poor survival.

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6
Q

Why do lung cancer patients die early?

A

There is a late onset presentation. When it already has metastised.
4deaths per hour. 114 new cases every day.
Pain : late stage- when might reach viscera lets say.
In 1 year 1/3 survive.
Women respond to tx better.
3rd cancer death : after breast (85%), colorectal (55%) and lung (5%) 5Y survival.

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7
Q

What happens in SCLC?

A

12%
Grows rapidly
Very closely linked to cigarettes smoking

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8
Q

How do you stage NSCLC?

A

Stage1- small 7cm, involves lymph nodes or other parts of chest or lung.
Stage 4 - spread to both lungs, other parts of the body or within a pleural effusion.

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9
Q

How is SCLC staged?

A

Limited- within one lung field

Extensive- outside one lung field

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10
Q

Whats an MDT for lung cancer?

A 
Radiologist
Pallative 
Medical oncologist 
Respiratoty oncologist 
Surgeon
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11
Q

How would you treat NSCLC?

A

Surgery for stage 1+2

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12
Q

How is small cell lung cancer treated?

A

Surgery- very selected cases- cant usually tx w/ surgery
CT head - prophylactic
Radiotherapy
-Radical for limited stage - combined with chemo
- Pallative prophylactic for extensive stage
Chemo ❗️
-radical for limited stage w/ radiotherapy
-pallative for extensive stage

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13
Q

How do you go about -lung cancer tx- surgery?

A

NSCLC
PET-CT- pre-op
- metastised? Where, how extensive, reoccurrence in other lymph nodes
Specialist lung cancer surgeons
Video assisted thoracic surgery- VATS lobectomy
Adjuvant chemo

SCLC
- only if very localised- surgery.
Otherwise not usually.

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14
Q

How is a PET scan used?

A

Cells that divide rapidly and consume ⬆️⬆️ glucose
BUT-
In inflammation and infx - highly metabolic cells- metabolically active.
So low sensitivity for
Infx
Infl
Malignancy

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15
Q

Whatbare the advantages of VATS lobectomy?

A

Its like key-hole surgery-
3 probes in- faster recovery
⬇️ post op pain

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16
Q

In what age do you have to stop smoking to only have a small chance of death?

A
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17
Q

When is SCLC usually presented?

A

Higher incidence in winter and spring due to ⬆️ prevalences of pneumonia s well.
So do CXR to see.

18
Q

What are the s+S of lung cancer?

A

Depends on location–> usually late finding
Only found on routine XR
Same sx might be caused by other conditions
1. Size
2. Location
3. Degree of obstruction
4. Existance of metastasis.

Pain- near pleura
Haemoptysis- bleeding

>3w + smoker chronic cough --> CXR
1. Localised- in lung,
2. Generalised- metastasised 
PE-- SOB
Tirdness, fatigue,
Fractures( bone m) 
Stroke (brain metasti) 
Stridor
Repeated lung infx despite Antibiotics
New onset hoarseness- Left Laryngeal nerve implicated - near bronchus
Persistsent Hiccups- phrenic nerve implicated.
19
Q

What are the localised S+S of LC?

A 
Cough
Breathing probs- stridor and SOB
Change in phlegm
Lung infx, haemoptysis
Hoarsness, hiccups,
Wt loss
Chest pain and tightness
Pancoats syndrome. 
Horners syndrome
Pleural effusion
SVC syndrome
Fatigue-- anaemia?
20
Q

Whats Pancoast syndrome? What complications could this have? What other syndrome is associated?

A

/ pulm sulcus tumor/ superior sulcus tumor- pulm apex- most are NSCLC-nusually squamous cells
Brachial plexus involved- pt holds arm.

Severe pain in shoulder refiom radiating toward axilla and scapula and ulnar aspect of hand muscles
Atrophy of hand and arm muscles - compression of- phrenic nerve, recurrent laryngeal nerve, vagus nerve
Compression of the blood vessles (brachiocephalic vein, subclavian artery) leading to oedema.

  • Caviating mass on CxR
  • Paratracheal nodes?
  • 2nd rib destruction?
  • calcified nodes? Silicosis

Compression of the sympathetic ganglion –> Horners syndrome
(Ptosis e.g. Left upper eyelid drops, meiosis e.g left pupil constrictes, hemianhydrosis, enopthalmos.
Would also expect to observe abscence of sweating, dilation of blood vessles in face.
Extension of tumour in- parietal pleura, endothoracic fascia, 1+2nd ribs, or vertebral bodies.

Usually these pts receive tx for presumed cervical osteaoarthritis or shoulder brusitis, resulting in the delay of diagnosis of 5-10M.

21
Q

Whats superior vena cava syndrome?

A

SVC obstrtuction.
Medical emergency
Lumg cancer particularly adenocarcinomas are a common underlying cause. 70%
40% of cases not attributable to malignancies tho.
CF
Dyspnoea most common
Facial swelling
Head fullness. Cough, arm swelling, chest pain, headache, nausea, pleural effusiom, nausea, nasal stuffness, disorted vision, orthopnoea, dysphagia.

22
Q

What are some generalised S+S?

A

Bone pain,
Headaches, mental status changes, or neurological findings
Abdo pain, elevated liver FTs, enlatged liver, GI disturbances (anorexia, cachexia-wasting syndrome- loss of wt
Hypercalcaemia
Paraneoplastic syndrome.
Jaundice, hepatomegaly, r/t liver involvment
Wt loss.

23
Q

Whats paraneoplastic syndrome?

A
  • altered immune response to neoplasm. CF - They are defined as non,etastatic systemic effects accompyining malignant disease. Result of substances produced by tumour.
    Sx may be endocrine, neuromascular, MSK, CVS, cutaneous, GI, hematologic, renal
24
Q

What are some eaely signs of LC?

A 
Cough/chronic cough
Dyspnoea
Hemoptysis
Chest/shoulder pain
Recurring temperature
Recurring resp infx
25
Q

What are some late signs of LC?

A 
Bone pain m spinal cord compression
Chest pain/tightness
Dysphagia
Head and neck oedema (SVC syndrome?)
Blurred vision, headaches
Weakness, anorexia, wt loss, cachexia
Pleural effusion
Liver metastasis/ regional spread.
26
Q

How would you diagnose LC?

A 
CXR
CT scans
MRI- mediastinum stage 3-4- or on pericardial line? Open chest up or radical tx? 
Mediastinoscopy? 
Sputum cytology (main bronchus) 
Fibreoptic bronchoscopy- flexible br
Transthoracic fine needle aspiration 
CT lung biopsy ! Gold.
27
Q

Is there screening for lung cancer?

A

Not in UK
In UsA
Blood test- no Dx tho
ONCE - immune test- antigen on blood cells + shadowing..

28
Q

What are some complications of CT lung biopsies?

A

Haemorrhage
Infx
Pneumothorax- lung collapse
Disperse tumot by needle!!! Help Metastasis

29
Q

How is radiotherapy used in Lc?

A

NSCLC
Concurrent chemo- only on sensitised patients
Stereotactic body radiotherapy
Surgery ❗️

SCLC
Prophylactic cranial irradiation
Concurrent chemoradiotherapy ❗️

30
Q

How is concurrent chemo used?

A

Stage 3- NSCLC

  • improves median overall survival by 3-4M to 17M
  • improves 5Y survival from 9-16%

Limited stage SCLc
Improves 5Y survival from 18-24%

More SE
Myelosupression,
Oesophagitis, pneumonitis.

31
Q

What happems when pts are EGFR +ve?

A

Usually adenocarcinomas due to EGFR mutation
Oral medication:⬆️ surviabal by 6M ! Gefitinib.
CXR- rounded shadow, 2o.

32
Q

How do you might distinguish pneumonia and LC from a CXR?

A

Pneumonia- lobar

Cancer- crosses fissures

33
Q

What are some medications used?

A

ALK inhibitors
Crizotinib

DEXA scan for bone pains- see if metastisised.

34
Q

Chemotherapy used in SCLC?

A

Cisplatin/Carboplatin+ etoposide
Response rates :60-90%
Median duration of response- 6-8M

35
Q

What are some SE of surgery?

A 
Pain
Hematomas
Haemorrhage
Altered rsp fx
Risk for pneumonia, hypoxia, 
DVT risk- pe?
36
Q

What are the SE of radiation?

A 
Fatigue
Decresed nutritional intake
Radiodermatitis- red skin :( 
⬇️ haematopoietic fx
Risk for pneumonitis, oesophagitis, cough
N+V
Grief
37
Q

Chemo SE?

A 
Anaemia, thrombocytopenia
Fatigue
SOB
Cold, pale
Tingling
Irritable
Dizzy, weak
Loss of hair- cz they are rapidly dividing.
38
Q

When would the ONC Immune- serology testing be done?

A 
In high risk pts
Smokers,
Older
Asbestos
FHx
Previous cancer -12-18M 
Lung nodule- follow it for 2Y, if more than 5mm
39
Q

What are some common lung resections performed?

A

Lobectomy- single lobe removed

Bilonecromy- 2 lobes removed- only in R side

Sleeve resection - cancerous lobe removed and segment of bronchus is resected

Pneumonectomy- entire lung out

Segmentectomy- segment of lung removed

Wedge resection- removal of small, pie shaped area of segment.

Chest wall resection with removal of cancerous lung tissue:
For cancer that invafed chest wall.

40
Q

How would u investigate lung cancer?

A

Confirm diagnosis, determine histolosy, asses tumour spread
1. CXR intilal1-2cm recognises it. Round shadow, cavitation, lobar collapse, pleural effusion or 2o pmeumonia.
Spread through lymphatics -> lumphanhitis carcinomatosis- streaky shadow thoughout lung

Histology
-sputum ecpxamined by cytologist for malignat cells
Bronschospcopy(histology) + washings (cytology)
Peripheral lesions- transthoracic fine needle aspiration biopsy under radiography or CT scanning

Asses tumour spread
At bronchoscopy- 2cm involvment of main bronchus or of recurrent laryngeal nerve (vocal cord paresis) -> inoperability.

Surgery- PET before- high metabolic structures ! Cancer, inflammation, infx.
CT of liver, adrenal, mediastinum also- to asses spread.

Mediastinoscopy or lymph node biopsy before surgery if scans show lymphadenopathy.

SCLC- highly metastistatic- so if surgery, scanning of bones and brain and iliac crest sampling.

Resp-K -Year 3 (10 decks)

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