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CCC > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

How common is lung cancer?

A

Second most common cancer in the UK
W: Breast
M: Prostate

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2
Q

What are the risk factors for lung cancer?

A
  • Age: Inc above 40
  • Smoking: 80-90% cause
  • Occupation: Asbestos exposure, uranium mining, ship building, petrol refining
  • Deprivation: Higher rates of smoking, later presentation
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3
Q

What is the aetiology for lung cancer?

A

Chromosomal deletions of 3p (& 13q & 17p)
Loss of tumour suppressor genes
Lead to malignant transformation & tumour progression
Also over expression of oncogenes (as, my,c-erb)
Activating mutations in EGFR associated with some lung cancers (some adenocarcinomas)

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4
Q

What are the 2 main types of lung cancers and their subtypes? Any other types of lung cancer?

A 
-Non-small cell: 82%
SCC
Adenocarcinoma 50%
Large cell carcinoma
-Small Cell:
Mesothelioma
Sarcoma
Carcinoid
Lymphoma
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5
Q

What is the histology of lung cancer?

A

Arise from epithelium of large & medium bronchi

Rarely lung parenchyma

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6
Q

What are small cell lung cancers derived from?

A

Neuroendocrine cells within the lung

associated w/neuropeptide secretion-ACTH,ADH

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7
Q

What does small cell lung cancer look like?

A

Big purple blobs
Absent nucleoli
Frequent mitosis

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8
Q

What is the average survival for small cell lung cancer with treatment?

A

Aggressive

Lots of chemical changes: HypoN, inc ACTH

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9
Q

Where do adenocarcinomas of the lung often arise?

A

Areas of lung damage
Often peripheral
Commonly associated with activating mutations on EGFR

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10
Q

What are the symptoms of lung cancer?

A 
Chronic cough
Dyspnoea
Chest pain
Haemoptysis
Recurrent chest infections
Weight loss
RUQ pain
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11
Q

What sign is produced with apical tumours?

A

Horner’s syndrome (ptosis, miosis, anhidrosis), pain in nerve distribution (weakness is small muscles of the hand)

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12
Q

When is weakness of the small muscles of the hand seen?

A

Pancoast syndrome

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13
Q

What may be associated with mediastinal disease?

A

Recurrent laryngeal nerve palsy

SVCO

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14
Q

In what cancer is clubbing most common

A

SCC

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15
Q

In which cancer may sputum production be excessive?

A

Bronchiolo-alveolar carcinoma

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16
Q

What investigations should be done for lung cancer?

A 
CXR-95% visible
Sputum cytology- 80% malignant cells
Bronchoscopy- biopsy, visualisation, bronchial washings
CT chest & upper abdo
PET scan-mets
Other biopsy- Trans-thoracic
Tumour markers- NSE, LDH
17
Q

How is staging assessed in lung cancers?

A

CT chest & upper abdo

Isotope bone scans/head scans

18
Q

How can SCLC be classified?

A

Limited: Tumour confined to one hemi-thorax w/local extension confined to ipsilateral/contralateral mediastinal nodes or ipsilateral supraclavicular nodes
Extensive: Disease at sites beyond defined limit. 2/3rds present with extensive disease

19
Q

What is the treatment for small cell lung cancer?

A

Usually: Chemo as first cycle 90% respond but most relapse in 12months
RT to chest & brain
Limited stage: RT & chemo
Palliative: RT

20
Q

Why is RT given to the brain in lung cancer?

A

Commonest place for first mets

21
Q

What are the indications for radiotherapy in the management of small cell lung cancer?

A
  • Tx primary: thoracic after/concurrent with chemo
  • Prophylaxis to cranium: associated with toxicities (memory impairment, dementia, functional deficit)
  • Palliative
22
Q

Which group of lung cancers has the worst prognosis?

A

SCLC worse than nSCLC

23
Q

How is non-small cell cancer treated with surgery?

A 
Stage 1&2: resection
Pneumonectomy
Lobectomy
Wedge resection
Adjuvant chemo after surgery
24
Q

What is a contraindication for surgery in non-small cell cancer?

A

Mediastinal involvement

25
Q

When is RT used in the treatment of non-small cell lung cancer?

A

Not suitable for surgery
stage 1&2: Radical radiotherapy (CHART)
Palliative: Symptoms
First line Tx for brain mets, SVCO, SCC

26
Q

When is chemo used in the treatment of non-small cell lung cancer?

A

Palliative
Bulky tumours shrunk with chemo then radical RT
Adjuvant to surgery

27
Q

How can targeted therapies be used in non-small cell lung cancers?

A

Tyrosine Kinase inhibitors (Erlotinib)
Target EGFR
Palliative setting
First line alternative to chemo

CCC (21 decks)

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