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Cancer Care > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

What are the common risk factors for lung cancer?

A 
Family History
Smoking - active and passive
Asbestos
Chemical Agents - radon, nickel, chromate
Chest radiotherapy
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2
Q

What are the different types of primary lung cancers?

A

Small Cell (15%)

Non Small Cell

  • Squamous Cell (40%)
  • Large Cell (10%)
  • Adenocarcinoma (40%)
  • Alveolar cell carcinoma
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3
Q

From what cells do Small Cell Lung Cancers originate?

A

Kulchitsky cells

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4
Q

What is the characteristic growth pattern of SCLC?

A

Centrally located
Rapid growing
Highly Malignant

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5
Q

How does squamous cell lung cancer commonly present?

A

Bronchial obstruction leading to recurrent infections

Finger clubbing

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6
Q

What can be seen on CXR with Squamous cell lung cancer?

A

Cavitations so a CT is needed to rule out TB

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7
Q

What paraneoplastic syndromes are associated with squamous cell lung cancer?

A

PTHrP = hypercalcaemia
Ectopic TSH = hyperthyroid
Hypertrophic osteoarthropathy

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8
Q

Which type of lung cancer is most common in non-smokers?

A

Adenocarcinomas

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9
Q

Why do adenocarcinoma’s tend to present with fewer symptoms?

A

They are more likely to be located in the peripheries

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10
Q

What is the growth pattern of lung adenocarcinomas

A

Peripherally located
Less differentiated
Metastasise early
Have a poor prognosis

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11
Q

What is a pancoast tumour? What does it present with/ what structures becomes involved?

A

An apical lung tumour (commonly squamous)

Horners Syndrome (sympathetic ganglion)
Arm and hand pain (Brachial Plexus)
Hoarse voice (Recurrently Laryngeal Nerve)
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12
Q

What signs does horners syndrome present with?

A

anhidrosis
miosis
ptosis

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13
Q

What is the pathophysiology behind horners syndrome?

A

Sympathetic ganglion are affected leading to decreased sympathetic input.

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14
Q

How can lung cancer present?

  • symptoms
  • examination
  • bloods
A 
Cough
Dyspnoea
Haemoptysis
Chest Pain
Recurrent chest infections
Weight loss and reduced appetite

Clubbing
Pleural effusion
Fixed monophonic wheeze
Supraclavicular/ cervical lympadenopathy

Thrombocytosis

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15
Q

What are signs/symptoms of Superior Vena Cava Obstruction?

A

Early morning headache
Arm and Face Oedema
Jugular distention

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16
Q

What paraneoplastic syndromes can small cell lung cancer cause?

A

ACTH = HTN and high glucose (as opposed to classic cushingoid appearance)

ACTH = increased cortisol = hypokalaemic alkalosis

SIADH = hyponatraemia

Lambert Eaton Myasthenic Syndrome - proximal muscle weakness

17
Q

What paraneoplastic syndromes are associated with adenocarcinomas?

A

Gynaecomastia

Hypertrophic osteoarthropathy (painful and stiff wrist and ankle)

18
Q

What are the indications for an urgent CXR referral from GP for lung cancer?

When would you refer straight to 2ww?

A

> 40 yo and 2 suspicious symptoms

> 40yo + 1 suspicious symptom + smoker

2ww if >40 with unexplained haemoptysis

19
Q

What investigations are used for diagnosing lung cancer?

A

Chest X-Ray - initial

CT - gold standard for ?lung cancer

Bronchoscopy - histological diagnosis

Transthoracic needle biopsy

PET-CT Scan - before treatment if potentially curable

Mediastinoscopy - assessment of mediastinal lymph nodes

20
Q

What do you look for on CXR for lung cancer?

A

Opacities (or can be cavitating if squamous cell)
Hilar Enlargement
Pleural Effusion
Lung Collapse

21
Q

Describe the staging system used for Non Small Cell Lung Cancers

A 
TNM Staging
1 = single tumour <3cm
2 = ipsilateral lymph nodes
3 = contralateral lymph nodes or invasion of organs, nerves
4 = Metastatic spread
22
Q

What is the mainstay of treatment for stage 1+2 lung cancers?

A

Surgical Resection with Hilar and Mediastinal Lymph Node sampling

23
Q

What are the complications of a lobectomy?

A

Respiratory failure
Air leakage
AF
Broncho-pleural fistula

24
Q

On examination, what would indicate someone had had a lobectomy?

A

Thoracotomy scar
Absent breath sounds
Reduced chest expansion
Dull to percuss

25
Q

What is the mainstay of treatment for advanced NSCLC?

A

Chemo-radiotherapy as most are inoperable

26
Q

What additional treatment is needed in lung cancer treatment?

A

Cranial radiation due to risk of brain metastasis

27
Q

What defines whether a SCLC is limited or extensive?

A

Tumour in 1 hemithorax and regional lymph nodes. The area can be covered by a tolerable radiotherapy field.

Beyond this it is considered extensive

28
Q

What is the mainstay of small cell lung cancer treatment?

A

chemo-radiotherapy

surgery can be used in very early stages with no nodal involvement

29
Q

What paraneoplastic syndrome is associated with large cell lung cancers?

A

B-HCG

30
Q

What specific symptom would suggest alveolar cell carcinoma?

A

+++ sputum

31
Q

What are the contraindications to surgical management of lung cancer?

A 
Peak flow <1.5L
Pleural effusion
Tumour located near the hilum
Metastasis (i.e. late stage 3 or stage 4)
SVCO
Vocal cord paralysis

Cancer Care (25 decks)

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