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Tim CP3 @ UoN - Medicine & Surgery > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

Describe the epidemiological distribution of lung cancer?

A

Most common cause of death from cancer in UK

Peak incidence at 65yrs, 3:1 male predominance

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2
Q

What are the main risk factors for lung cancer?

A

Smoking (passive)
Urban living
Occupational exposure

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3
Q

What are the two main classifications of lung cancer?

A 
Small cell (20%)
Non-small cell (80%)
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4
Q

Where do tumours tend to arise anatomically?

A

Main bronchi/hilum (70%)

Peripherally (30%)

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5
Q

What are the common types of non-small cell lung cancer?

A

SCC (50%)
Adenocarcinoma (20%)
Large cell anaplastic (10%)

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6
Q

What is the underlying pathology behind SCCs?

A

Arise from sq metaplasia of pseudostratified ciliated columnar epithelium
Response to smoking

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7
Q

Describe SCCs

A

Most present as obstructive lesions of bronchus leading to infection
Local spread common
Friable
Slow going, metastases occur relatively late

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8
Q

Describe Adenocarcinomas

A

Equal gender incidence, less related to smoking

Originate peripherally

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9
Q

Describe Large-cell anaplastic carcinomas

A

Not differentiated enough to be classified
Poor prognosis
Widely disseminated at diagnosis

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10
Q

Describe Small-cell anaplastic carcinomas (oat-cell)

A

Centrally located, rapidly growing

Highly malignant, often metastasised at dx

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11
Q

What is the underlying pathology behind small-cell anaplastic carcinomas?

A

Originate from bronchial epithelium
Differentiate into neuroendocrine cells, secrete
-ADH - sx of SIADH (dilutional hyponatremia, muscle weakness, cheynes-stokes, neurological sx)
-ACTH - Cushing’s

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12
Q

Describe Bronchoalveolar cell carcinomas

A

Type of adenocarcinoma (<5%)

Better prognosis

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13
Q

What is the prognosis for SCLCs?

A

Median survival

  • 3 months untreated
  • 18 months treated
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14
Q

What is ‘Eaton-Lambert’ syndrome?

A

Myasthenia Gravis like sx
Scapular/pelvic girdles, reduced tendon reflexes
Dry eyes, sexual impotence, neuropathy

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15
Q

What is Mesothelioma?

A

Tumour of mesothelial cells occurring in the pleura/peritoneum
Caused by asbestos

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16
Q

What are the typical presenting symptoms of lung cancer?

A 
Persistent cough (80%)
Haemoptysis (70%)
Dyspnoea (60%) 
Chest pain (40%)
B sx - Lethargy, anorexia, wt. loss
17
Q

What are the typical presenting signs of lung cancer?

A 
Cachexia
Anaemia
Clubbing
HPOA (causing wrist pain)
Supraclavicular/Axillary nodes
Collapse/consolidation/effusion
18
Q

What are the presenting signs/symptoms of metastases?

A 
Bone tenderness
Hepatomegaly
Confusion
Fits
Focal CNS signs
Cerebellar syndrome
Proximal myopathy
Peripheral neuropathy
19
Q

What investigations are appropriate in suspected lung cancer?

A 
FBCs (anaemia, 2o polycythaemia)
LFTs (mets)
U&amp;Es (hypercalcaemia, hyponatremia)
CXR
Sputum/pleural fluid cytology
Staging CT (head-pelvis)
Biopsy (CT guided/bronchoscopy)
PET scan/radionucleotide bone scan
20
Q

What signs of lung cancer are present on a CXR?

A 
Peripheral nodules
Hilar enlargement
Consolidation
Lung collapse
Pleural effusion
Bony secondaries
21
Q

Describe the local complications of lung cancer

A 
Recurrent laryngeal nerve palsy
Phrenic nerve palsy
SVC obstruction
Horner's syndrome
Rib erosion
Pericarditis
AF
22
Q

Describe recurrent laryngeal nerve palsy

A

Tumour compresses recurrent laryngeal nerve
Causes vocal changes (change in voice, left vocal cord paresis)
Left more susceptible

23
Q

Describe phrenic nerve palsy

A 
Compression of phrenic nerve
Dyspnoea
Orthopnoea
Bilat worse when supine
Asymptomatic if unilateral
24
Q

Describe Horner’s syndrome

A 
Caused by a tumour of the apex (Pancoast) causing trauma to brachial plexus
Classic triad
-Miosis
-Partial ptosis
-Loss of hemifacial sweating
25
Q

What is a Pancoast sumour?

A

Tumour of the apex causing trauma to brachial plexus

  • Horner’s syndrome
  • Shoulder pain
  • Atrophy of hand/arm muscles
  • Oedema
26
Q

Where do distant metastases from lung cancer go?

A

Brain
Bone
Liver
Adrenal gland (Addison’s)

27
Q

What dermatological sx indicate underlying malignancy?

A

Acanthosis nigricans

Dermatomyositis

28
Q

What are the treatment options for non-small cell lung cancer?

A 
Surgical excision (w/ adjuvant chemo)
Curative radiotherapy (if poor resp reserve w/ adjuvant chemo)
Chemo-radio (advanced disease)
29
Q

What are the indications for surgical excision?

A

Peripheral
No lymph node involvement/metastatic spread
>2cm from carina

30
Q

What are the treatment options for small-cell lung cancer?

A

Usually disseminated at dx
May respond to chemo +/- radio
Prophylactic cranial radio

31
Q

What are the palliative treatment options for lung cancer?

A

Radiotherapy for obstructive sx (SVC/bronchial) or bone pain
SVC stenting
Pleural drainage/pleurodesis for symptomatic effusions

Tim CP3 @ UoN - Medicine & Surgery (136 decks)

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