Lung Cancer Flashcards
How common is lung cancer?
Second most common cancer in the UK
W: Breast
M: Prostate
What are the risk factors for lung cancer?
- Age: Inc above 40
- Smoking: 80-90% cause
- Occupation: Asbestos exposure, uranium mining, ship building, petrol refining
- Deprivation: Higher rates of smoking, later presentation
What is the aetiology for lung cancer?
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)
What are the 2 main types of lung cancers and their subtypes? Any other types of lung cancer?
-Non-small cell: 82% SCC Adenocarcinoma 50% Large cell carcinoma -Small Cell: Mesothelioma Sarcoma Carcinoid Lymphoma
What is the histology of lung cancer?
Arise from epithelium of large & medium bronchi
Rarely lung parenchyma
What are small cell lung cancers derived from?
Neuroendocrine cells within the lung
associated w/neuropeptide secretion-ACTH,ADH
What does small cell lung cancer look like?
Big purple blobs
Absent nucleoli
Frequent mitosis
What is the average survival for small cell lung cancer with treatment?
Aggressive
Lots of chemical changes: HypoN, inc ACTH
Where do adenocarcinomas of the lung often arise?
Areas of lung damage
Often peripheral
Commonly associated with activating mutations on EGFR
What are the symptoms of lung cancer?
Chronic cough Dyspnoea Chest pain Haemoptysis Recurrent chest infections Weight loss RUQ pain
What sign is produced with apical tumours?
Horner’s syndrome (ptosis, miosis, anhidrosis), pain in nerve distribution (weakness is small muscles of the hand)
When is weakness of the small muscles of the hand seen?
Pancoast syndrome
What may be associated with mediastinal disease?
Recurrent laryngeal nerve palsy
SVCO
In what cancer is clubbing most common
SCC
In which cancer may sputum production be excessive?
Bronchiolo-alveolar carcinoma
What investigations should be done for lung cancer?
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
How is staging assessed in lung cancers?
CT chest & upper abdo
Isotope bone scans/head scans
How can SCLC be classified?
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
What is the treatment for small cell lung cancer?
Usually: Chemo as first cycle 90% respond but most relapse in 12months
RT to chest & brain
Limited stage: RT & chemo
Palliative: RT
Why is RT given to the brain in lung cancer?
Commonest place for first mets
What are the indications for radiotherapy in the management of small cell lung cancer?
- Tx primary: thoracic after/concurrent with chemo
- Prophylaxis to cranium: associated with toxicities (memory impairment, dementia, functional deficit)
- Palliative
Which group of lung cancers has the worst prognosis?
SCLC worse than nSCLC
How is non-small cell cancer treated with surgery?
Stage 1&2: resection Pneumonectomy Lobectomy Wedge resection Adjuvant chemo after surgery
What is a contraindication for surgery in non-small cell cancer?
Mediastinal involvement
When is RT used in the treatment of non-small cell lung cancer?
Not suitable for surgery
stage 1&2: Radical radiotherapy (CHART)
Palliative: Symptoms
First line Tx for brain mets, SVCO, SCC
When is chemo used in the treatment of non-small cell lung cancer?
Palliative
Bulky tumours shrunk with chemo then radical RT
Adjuvant to surgery
How can targeted therapies be used in non-small cell lung cancers?
Tyrosine Kinase inhibitors (Erlotinib)
Target EGFR
Palliative setting
First line alternative to chemo
