Lung Cancer Flashcards
What is primary lung cancer?
Malignant carcinoma which may obstruct bronchi, cause pleural inflammation/malignancy or invade the chest wall
What are the four types of lung cancer?
Small cell carcinoma
Adenocarcinoma
Squamous cell carcinoma
Large cell carcinoma
What kind of tumour is small cell carcinoma?
Neuroendocrine - secretes abnormal hormones
Where in the lung do adenocarcinomas commonly occur?
In the peripheries as they affect bronchioles and alveoli
Where in the lung does squamous cell carcinoma commonly develop?
Central airways (bronchi)
Aetiology
Smoking
Passive smoking
Exposure to asbestos, radon, air pollution, diesel exhaust
Genetics
How does tobacco cause lung cancer?
Epithelial effects and activation of pro-carcinogens
Name 2 biomarkers of lung cancer
KRAS
EGFR
Symptoms
Chronic coughing Haemoptysis Wheezing sound Chest and bone pain Chest infections Difficulty swallowing Raspy hoarse voice Dyspnoea
Name 4 nerves which may be compressed by lung cancer and the effects of this
Left recurrent laryngeal - raspy hoarse voice
Cervical sympathetic - Horner’s syndrome
Brachial plexus - pancoast tumour
Phrenic - diaphragmatic paralysis
Signs
Unexplained weight loss Clubbing Chest signs Lymphadenopathy (palpable lymph nodes) Horner's syndrome (droopy eye) Pancoast tumour Superior vena cava obstruction (prominent veins when hand raised) Hepatomegaly Skin nodules
What are the initial investigations for lung cancer (often by GP)
Chest x-ray Full blood count Renal and liver functions Calcium Clotting screen Spirometry
What do you look for in a chest x-ray?
Key areas - apex, hilum, behind heart, mediastinum, costophrenic angles Pleural effusion Chest wall invasion Collapsed lobe/lung Phrenic nerve palsy
What further imaging would you do for staging etc?
CT thorax and abdomen
MRI
PET CT
What are you looking for in a CT?
Size Mediastinal nodes Metastatic disease Effusion Diaphragmatic involvement
What investigations for tissue diagnosis?
Bronchoscopy EBUS (endobronchial ultrasound) Image guided lung biopsy Image guided liver biopsy FNA (fine needle aspiration) of neck node or skin metastases Excision of cerebral metastases Bone biopsy Mediastinoscopy Surgical excision biopsy
What three things is the treatment of lung cancer decided upon?
Histological type and stage
Performance status of patient
Patient wishes
Name 3 procedures that could potentially be done surgically to remove a tumour
Pneumonectomy (removal of lung)
Lobectomy (removal of a lobe)
Wedge resection (removal of tumour)
What are the non-operative options for lung cancer?
Radiotherapy - radical or palliative Chemotherapy Best supportive care Targeted drugs Immunotherapy
What is the first choice of treatment for small cell cancer?
chemotherapy
What drugs in chemotherapy for small cell carcinoma, adenocarcinoma and squamous cell carcinoma?
Small cell - cisplatin and etoposide
Adeno - cisplatin and pemetrexed
Squamous - cisplatin and gemcibatine
Differential diagnosis
may cause similar looking opacities, masses or nodules on chest x-ray or similar symptoms
Benign tumour - hamartoma, teratoma, granuloma Bacterial infection Tuberculosis Fungal infection Lung abscess Fibrosis
What does the T, N and M tell you in TNM staging?
T - how big it is and how far it has spread
N - lymph node involvement
M - metastases
Tx, T0, Tis ?
Tx - primary tumour cannot be assessed
T0 - no evidence of primary tumour
Tis - carcinoma in situ
T1
Tumour <3cm in greatest dimension, surrounded by lung or visceral pleura, without bronchoscopic evidence of involvement of the main bronchus
T2
Tumour 3-5cm with any of the following features:
- involves main bronchus but not carina
- invades visceral pleura
- associated with atelectasis (collapse of lobe/lung) or obstructive pneumonitis that extends to the hilar region involving part of all the lung
T3
Tumour 5-7cm or directly invades one of the following:
- chest wall
- phrenic nerve
- parietal pericardium
Or separate tumour nodules in same lobe as primary
T4
Tumour >7cm or invades any of the following: - diaphragm - mediastinum - heart - great vessels - trachea - recurrent laryngeal nerve - oesophagus - vertebral body - carina Separate tumour nodules in a different ipsilateral lobe
N0
No regional lymph node metastases
N1
Ipsilateral peribronchial, hilar or intrapulmonary nodes including by direct extension
N2
Ipsilateral mediastinal, subcarinal
N3
Contralateral mediastinal, contralateral hilar, scalene or supraclavicular
M0
No distant metastasis
M1
Distant metastasis
