Lung Cancer Flashcards
Name four types of Lung Cancer
Squamous Cell
Small Cell
Large Cell
Adenocarcinoma
Which is the most common?
Adenocarcinoma
used to be squamous cell
Which has the poorest prognosis?
Small cell
Name the major risk factors
Smoking- chemicals in nicotine cause mutations
Genetic - less ability to repair, more addiction to nicotine
Asbestos
Environmental- pollution, radon decay (granite)
How does smoking affect the type of cancer?
Chemicals in cigarette smoke;
PAH- squamous cell
N-N- adenocarcinoma
What are the two different cell lines affected?
Periphery- adenocarcinoma- bronchoalveolar stem cells
Central- squamous cell- bronchial stem cells
What is oncogene addiction and how can it be used?
Some cancers are controlled specifically by one gene mutation- if we can detect it then we can target directly.
Give examples of Oncogenes that can be targeted.
KRAS, EGFR, HER2, ALK translocations
‘tumours’ are not always cancer, give examples;
COP- cryptogenic organising pneumonia Chondroma- cartilage Hamartoma Metastasis- kidney TB- caseous necrosis fills with fungi Vascular Haematoma
Where can lung cancer metastasise to?
Skin, Bone, Adrenals, Brain, Liver
Name another type of Lung Cancer
Adenocarcinoma in situ- alveolar cell carcinoma
What are the local effects of Tumours?
- 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
Which two biomarkers can be treated?
EGFR and ALK translocations
What is PD-L1
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.
Name the symptoms of Lung Cancer
Cough, Haemoptosis Breathlessness- worsening Wheeze Pleuritic Chest Pain Nail Clubbing Bone pain Reduced Pulmonary function Hoarse voice weight loss Chest infections
What other conditions may run alongside the cancer?
Hyponatraemia
Anaemia
Hypercalcaemia
Eaton- Lambert Syndrome
What investigations should be done?
CXR Pulmonary Function CT FBC LFT (kidney function for CT) Clotting screen tissue diagnosis CTPET- look for mets
Name three ways to obtain a tissue diagnosis
Bronchoscopy - central
EBUS- lymph node aspiration
Image guided Biopsy- peripheral
Mediastinoscopy- sample lymph nodes
Treatment
Surgery- no metastasis (M0)
Radiotherapy/ Chemo- radical or palliative
Supportive care if unfit/ unwilling to treat
How is the cancer graded?
TNM staging
T- size, location, spread
N- nodal involvement, same side, contralateral
M- metastasis, present, distal or proximal.
How many stages?
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
What other tests can be done before surgery?
MRI- blood vessels
ECHO - assess for pericardial effusion
Bone Scan- bone mets
How can we assess respiratory function?
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
Why is FEV1 important?
Needs to be >1.5l in lobectomy
>2l in pneumonectomy
Possible complications in Pneumonectomy
ARDS- acute respiratory distress syndrome PE- Pulmonary embolism Pneumothorax MI- clot dislodged Bleeding
