Lung Cancer Flashcards

1
Q

Name four types of Lung Cancer

A

Squamous Cell
Small Cell
Large Cell
Adenocarcinoma

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2
Q

Which is the most common?

A

Adenocarcinoma

used to be squamous cell

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3
Q

Which has the poorest prognosis?

A

Small cell

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4
Q

Name the major risk factors

A

Smoking- chemicals in nicotine cause mutations
Genetic - less ability to repair, more addiction to nicotine
Asbestos
Environmental- pollution, radon decay (granite)

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5
Q

How does smoking affect the type of cancer?

A

Chemicals in cigarette smoke;
PAH- squamous cell
N-N- adenocarcinoma

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6
Q

What are the two different cell lines affected?

A

Periphery- adenocarcinoma- bronchoalveolar stem cells

Central- squamous cell- bronchial stem cells

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7
Q

What is oncogene addiction and how can it be used?

A

Some cancers are controlled specifically by one gene mutation- if we can detect it then we can target directly.

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8
Q

Give examples of Oncogenes that can be targeted.

A

KRAS, EGFR, HER2, ALK translocations

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9
Q

‘tumours’ are not always cancer, give examples;

A
COP- cryptogenic organising pneumonia
Chondroma- cartilage
Hamartoma
Metastasis- kidney
TB- caseous necrosis fills with fungi 
Vascular Haematoma
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10
Q

Where can lung cancer metastasise to?

A

Skin, Bone, Adrenals, Brain, Liver

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11
Q

Name another type of Lung Cancer

A

Adenocarcinoma in situ- alveolar cell carcinoma

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12
Q

What are the local effects of Tumours?

A
  • Bronchial Obstruction (bronchiectasis, bronchiolitis, ELP)
  • Pleural invasion or malignancy
  • Chest wall invasion (mediastinal structures)
  • Nerve invasion (phrenic, l recurrent laryngeal)
  • Invasion of sympathetic trunk (horner’s syndrome)
  • Spread to lymph nodes
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13
Q

Which two biomarkers can be treated?

A

EGFR and ALK translocations

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14
Q

What is PD-L1

A

These are immune checkpoints which tumours an switch off and prevent the immune system from reacting. If we can block these receptors then the immune system will be able to fight the cancer.

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15
Q

Name the symptoms of Lung Cancer

A
Cough, Haemoptosis
Breathlessness- worsening
Wheeze
Pleuritic Chest Pain
Nail Clubbing
Bone pain
Reduced Pulmonary function
Hoarse voice
weight loss
Chest infections
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16
Q

What other conditions may run alongside the cancer?

A

Hyponatraemia
Anaemia
Hypercalcaemia
Eaton- Lambert Syndrome

17
Q

What investigations should be done?

A
CXR
Pulmonary Function
CT
FBC
LFT (kidney function for CT)
Clotting screen
tissue diagnosis
CTPET- look for mets
18
Q

Name three ways to obtain a tissue diagnosis

A

Bronchoscopy - central
EBUS- lymph node aspiration
Image guided Biopsy- peripheral
Mediastinoscopy- sample lymph nodes

19
Q

Treatment

A

Surgery- no metastasis (M0)
Radiotherapy/ Chemo- radical or palliative
Supportive care if unfit/ unwilling to treat

20
Q

How is the cancer graded?

A

TNM staging
T- size, location, spread
N- nodal involvement, same side, contralateral
M- metastasis, present, distal or proximal.

21
Q

How many stages?

A

I a/b- T only
II a/b- T + N1
III a/b- any T, N up to 3
IV - any T, any N, M1 (a/b/c)= 1% survival

22
Q

What other tests can be done before surgery?

A

MRI- blood vessels
ECHO - assess for pericardial effusion
Bone Scan- bone mets

23
Q

How can we assess respiratory function?

A

Spirometry- FEV1/FVC
Diffusion study- assess alveolitis
ABG on air- check Pa CO2
V/Q scan- if it is the tumour causing low FEV1 then resection will not impact on overall FEV1

24
Q

Why is FEV1 important?

A

Needs to be >1.5l in lobectomy

>2l in pneumonectomy

25
Q

Possible complications in Pneumonectomy

A
ARDS- acute respiratory distress syndrome
PE- Pulmonary embolism
Pneumothorax
MI- clot dislodged
Bleeding