Lung Cancer Flashcards
Risk factors for lung cancer?
SMOKING-cigarette smoking, also cigars and long term pipe smokers. note their increased risk of oral cancers and lip SCCs. Risk increased the more you smoke-most significantly by increased duration and younger age at starting. passive also a problem-work, home, environmental.
radon gas-released from granite rocks, naturally occurring radioactive gas.
?radiotherapy
chemical exposure-asbestos, silica-silicosis, diesel exhaust, heavy metal exposure-arsenic, chromium
air pollution
previous lung disease e.g. TB-lung scar tissue-increased adenocarcinoma risk
and presence of other lung disease-COPD-risk of lung Ca increased independent of common RF of smoking, possible related to additional effects of a separate tobacco-induced airway inflammation.
?FH
previous Ca-?relation to smoking causing 1st Ca or treatment of the Ca e.g. radiotherapy
previous smoking related Ca e.g. head and neck Ca
lowered immunity
lung cancers most commonly associated with smoking?
small cell lung cancer and squamous cell carcinoma (NSCLC)-subsequently CXR showing a central mass that is lung Ca most likely to be small cell or squamous as cigarette smoke chemical deposition centrally in the lungs (squamous Ca usually found in L or R main bronchus).
bronchioloalveolar carcinoma of the lung (BAC) (NSCLC) appears never to be assoc. with tobacco and mimics a chronic unresolving pneumonia.
how many primary lung Cas do small cell cancers account for?
around 20%
so 80% are NSCLCs
what targeted treatment is available for lung cancers?
EGFR-TK inhibitors e.g. erlotinib and gefitinib for those patients with metastatic NSCLCs who test positive for the EGFR-TK mutation.
symptoms to be aware of in lung cancer?
features from intrathoracic disease, extrathoracic disease and systemic features persistent cough, or changed longstanding cough SOB chest pain haemoptysis hoarse voice unresolving pneumonia weight loss bone pain confusion headache seizures weakness
what syndrome is associated with apical lung tumours, and give the clinical signs and explantion behind these?
Horner’s syndrome-assoc. with a pancoast tumour
partial ptosis, miosis and hemifacial anhydrosis
compression of sympathetic trunk in the chest-lose SNS innervation to superior tarsal muscle but still retain PNS to LPS-so partial ptosis, lose SNS to dilator pupillae, so sphincter pupillae overides-miosis, and lose SNS to facial sweat glands so anhydrosis.
what curative treatment can be given for lung cancer?
surgery-lobectomy or pneumonectomy, considered for stage I or II NSCLC
radical radiotherapy for local NSCLC if pt unfit for surgery.
which cancer are ‘cannon ball’ metastases to the lungs associated with?
renal cell carcinoma-lungs are most common site of metastasis
give 3 causes of a complete white out on CXR
pneumonectomy
large pleural effusion-mediastinal shift away from affected side
complete lung collapse-mediastinal shift towards affected side
classification of differentials for a lung nodule on a CXR?
malignant or non malignant
malignant-primary or secondary, secondary-?breast, ovarian, colorectal, kidney
non malignant-inflammatory e.g. pneumonia, abscess, granuloma, aspergilloma, rheumatoid nodule, wegeners, polyarteritis nodosa, or non inflammatory e.g. seborrhoeic wart, foreign body, AV malformation, hamartoma-a benign tumour considered a developmental error.
why is it so important to make the distinction between small cell and non small cell lung Ca?
determines subsequent treatment and prognosis, as small cell usually has widespread dissemination at presentation so is unsuitable for surgery but often responds very well to chemotherapy (in 80% of cases), where NSCLC can be cured surgically if if it remains local at presentation.
describe the management of patients with locally advanced NSCLC?
too advanced for surgery (at least initially)
so mainstay of treatment=concurrent chemo-irradiation
tumour may then become small enough that surgery is possible, but as chemo/radio is main treatment, then this is NOT neoadjuvant treatment.
why is a PET-CT scan NOT useful for investigating brain metastases in lung cancer?
the brain is such a highly metabolically active organ that it will display the increased brightness seen if metastases are present elsewhere in the body when the brain is not involved.
what test must be performed on all patients with NSCLC before considering surgery or radical radiotherapy?
lung function tests
why should a patient being treated for locally advanced NSCLC be told to avoid taking paracetamol?
as treatment involves chemotherapy patient is at risk of neutropenic sepsis and taking paracetamol may mask the temperature associated with neutropenic sepsis so patient less able to recognise the condition early.
