Lung Cancer Flashcards
What are the 3 main causes of lung cancer?
Tobacco
Asbestos
Environmental radon (from granite usually)
What are less common example of substances from occupational exposure that can cause lung cancer? (2)
Chromates
Hydrocarbons
Nickel
What are the 2 main types of carcinogenesis in the lung?
Adenocarcinoma
Squamous cell carcinoma
What area does adenocarcinoma affect and what effect does it have on that area?
Lung periphery
Transforms bronchioloalveolar epithelial stem cells
What area does squamous cell carcinoma affect and what effect does it have on that area?
Central lung airways
Transforms bronchial epithelial stem cells
What is the carcinoma sequence of peripheral lung adenocarcinogenesis? (3)
1: Atypical adenomatous hyperlasia
2: Adenocarcinoma in situ
3: Invasive adenocarcinoma
What are the 2 main key driver mutations in adenocarcinogenesis?
KRAS (smoking induced)
EGFR (not smoking related)
What are the 4 main carcinomas of the lung in order of commonness?
Adenocarcinoma
Squamous cell carcinoma
Small cell carcinoma
Large cell carcinoma
Are metastases to the lung common?
Yes
How common are tumours of the bronchial glands and give an example of one?
Very rare
Adenoid cystic carcinoma
What type of lung carcinoma is most likely to cavity?
Squamous
What are 5 examples of the local effects of lung cancer in terms of bronchial obstruction?
Collapse Infection Abscess Bronchiectasis Endogenous lipoid pneumonia
What are 2 examples of the local effects of lung cancer has pleurally?
Inflammation
Malignancy
What are the 3 indicators of horner’s syndrome?
Dry on one side of the face
Droopy eyes
Different sizes of pupil
What type of lung cancer does could a hoarse bovine cough indicate?
Left recurrent laryngeal lung cancer
What 5 organs are most likely to be the sites of distant metastases of lung cancer?
Liver Bone Brain Skin Adrenals
What does paraneoplastic effects of lung cancer mean?
A consequence of cancer not due to the local presence of cancer cells
Give an example of a non-metastatic paraneoplastic effect of lung cancer for each of the following:
- Skeletal
- Endocrine
- Neurological
- Cutaneous
- Haematological
- Cardiovascular
- Renal
- Clubbing
- Carcinoid syndrome
- Polyneuropathy
- Dermatomyositis
- Eosiniphilia
- Thrombophlebitis migrans
- Nephrotic syndrome
What are 3 non-imaging investigations that might be done when identifying lung cancer?
Bronchoscopy
Trans-thoracic fine needle aspiration
Trans-thoracic core biopsy
What is a pulmonary mass?
An opacity in lung that is over 3cm with no mediastinal adenopathy (lymph enlargement) or atelectasis (collapse or incomplete inflation of lung)
What is a pulmonary nodule?
An opacity in lung that is under 3cm with no mediastinal adenopathy (lymph enlargement) or atelectasis (collapse or incomplete inflation of lung)
What is adenopathy?
Enlargement of lymph nodes
what is atelectasis?
Partial collapse or incomplete inflation of the lung
What does the T stand for in TNM staging of tumours?
Size and position of the tumour
What does the N stand for in TNM staging of tumours?
Whether cancer cells have spread into the lymph nodes
What does the M stand for in TNM staging of tumours?
Where the tumour has metastasised
What is the best investigation for identifying the TNM of a tumour?
PET-CT
What do the following stand for in TNM staging A: T0 B: T1 C. T2 D. T3 E. T4
T0 - no evidence of tumour T1 - tumour between 0-3cm T2 - tumour between 3-5cm T3 - tumour between 5-7cm T4 - tumour between of larger than 7cm
What do the following stand for in TNM staging
A: N0
B: N1-3
N0 - no lymph node metastases
N1-3 - lymph node metastases present
What do the following stand for in TNM staging A: M0 B: M1 C. M1b D. M1c
M0 - no distant metastasis
M1 - distant metastasis
M1b - single distant metastasis
M1c - multiple distant metastases
What are 3 investigations that can be used for the tissue diagnosis of tumours?
Bronchoscopy
Endobronchial ultrasound (EBUS)
Percutaneous image guided biopsy
What are the 4 main causes for solitary pulmonary nodules?
Primary lung cancers
Metastases
Infections
Pseudotumour
What is a pseudotumour?
Gives the appearance of a mass that it isn’t (i.e. pleural fluid giving the appearance of a tumour)
Name at least 4 symptoms of lung cancers?
Cough Fatigue Weight loss Dyspnoea Haemoptysis Chest pain Chest infections
What are 4 metastatic symptoms of lung cancer?
Bone pain
Spinal cord compression
Cerebral metastases
Thrombosis
Name 3 paraneoplastic symptoms of lung cancer?
Anaemia
Hypercalcaemia
Dermatomyositis
Name at least 3 signs of lung cancer you may find on investigation?
Finger clubbing Lymphadenopathy Hepatomegally Skin nodules Pleural effusion
What are the 3 main treatment options for lung cancer?
Surgery
Radiotherapy
Chemotherapy
What is the main function of chemotherapy?
To downstage a tumour to make it operable
What use does MRI have for lung cancer?
Determines degree of vascular and neurological involvement in Pancoast tumour
What use does a Bone Scan have for lung cancer?
Indicates chest wall invasion and bony metastases
What use does ECHO have for lung cancer?
Demonstrates presence or absence of pericardial effusion
What are 4 consequences of lung cancer surgery that can lead to peri-operative death?
MI
Pulmonary thromboembolism
Pneumothorax
Intrathoracic bleeding
What are 4 consequences of lung cancer surgery that don’t to peri-operative death?
Arterial fibrillation
Empyema
Wound infection
Constipation
What do the following mean in the ECOG performance status: A:0 B:1 C:2 D:3 E:4
0 - asymptomatic; well
1 - symptomatic; able to do light work
2 - has to rest for less than half the day
3 - has to rest for more than half the day
4 - bedbound
What does stage IV NSCLC mean?
Distant metastases
What is clinically significant about stage IV NSCLC?
It is incurable and requires pallation
What targeted drugs are used for adenocarcinoma with driver mutation:
A - EGFR
B - ALK
EGFR - erlotinib
ALK - certinib
What is second line treatment for adenocarcinoma with progression?
Docetaxel + erlotinib
What is the main treatment for SCLC (small cell)?
Chemotherapy
What is the drug treatment for SCLC?
Cisplatin + etoposide
