Lung Cancer Flashcards
How common is lung cancer?
3rd most common
Who is often affected by lung cancer?
M>F
People over 75 years
What are the types of lung cancer?
Non small cell Small cell Mesothelioma Neuroendocrine tumours (Mets)
What are the risk factors for lung cancer?
SMOKING! Other lung disease Radiotherapy Toxins Pulmonary fibrosis HIV FHx
What toxins are associated with lung cancer?
Asbestos
Radon gas
Arsenic
What is the problem with small cell lung cancer?
It is fast onset so treatment needs to be initiated immediately
What are the non small cell lung cancers?
Squamous cell
Adenocarcinoma
What kind of lung tumours make up the majority?
Non small cell
What are the issues associated with mesothelioma?
It isn’t chemo sensitive
Surgery is very difficult as disease affects pleura
What is a bit different about neuroendocrine tumours?
They are not related to smoking.
More common in women.
If someone has lung disease anyway, what is the issue?
Symptoms can be masked e.g. by COPD
Tell me about Horner’s syndrome/triad.
Triad of miosis, partial ptosis, and anhidrosis.
In context of lung cancer, it is caused by Pancoast’s tumour
What is a Pancoast’s tumour?
A tumour located in the apex of the lung
Which type of lung cancer can develop Pancoast tumours?
Non small cell
What are the common paraneoplastic syndromes associated with small cell lung cancer?
- SIADH
- ACTH excess
- Lamberton-Eaton Syndrome
What is Lamberton-Eaton syndrome?
Rare, autoimmune paraneoplastic syndrome associated with small cell lung cancer that causes weakness of the muscles in the proximal arms and legs. Weakness improves slowly with exertion.
What are the paraneoplastic syndromes associated with squamous cell lung cancer?
- PTH-rp secretion -> hypercalcaemia
- Clubbing
- Hypertrophic pulmonary osteoarthropathy
- Hyperthyroidism (ectopic TSH)
What are the paraneoplastic syndromes associated with adenocarcinoma of the lung?
- Gynaecomastic
- Hypertrophic pulmonary osteoarthropathy
What are the guidelines for an unexplained cough?
Send for a chest x-ray after 3 weeks of an unexplained cough
Why is the prognosis poor for small cell lung cancers?
They grow rapidly and are highly malignant, spreading early.
A pt with a 40yr pack history of smoking presents to the GP with a chronic cough, weight loss, and haemoptysis.
What other symptoms/signs might this pt have?
SoB Chest pain Bone pain Finger clubbing Fever Weakness Hoarse voice SVCO Dysphagia Headache N+V Wheezing and stridor
A pt with a 40yr pack history of smoking presents to the GP with a chronic cough, weight loss, and haemoptysis.
What is your list of differentials?
Lung cancer
Lung mets
TB
Benign lung disease
A pt with a 40yr pack history of smoking presents to the GP with a chronic cough, weight loss, and haemoptysis.
On a CXR there is a solitary round shadow in the lung. What are th differentials?
Cancer - primary or secondary AV malformation Pulmonary harmatoma Bronchial adenoma Abscess Cyst TB/Granuloma Foreign body
What are the 2ww guidelines for referral of suspected lung cancer?
- CXR suggesting lung cancer or mesothelioma
- Pt over 40 with unexplained haemoptysis
What might a lung cancer pts CXR look like?
There may be:
- Peripheral circular opacity
- Hilar enlargement
- Consolidation
- Pleural effusion
- Bony secondaries
How is lung cancer staged?
Contrast enhanced CT chest
When should a lung cancer pt be offered a PET can?
If they are potentially curable. Offer it before treatment for precise location of pathology.
What procedures can we do for histological samples of lung cancer?
Bronchoscopy Needle biopsy Surgical biopsy Thoracentesis Sputum cytology
Where does lung cancer metastasise to commonly?
Brain Bone Liver Other areas of the lung Adrenal glands
What system is used to stage lung cancer?
TNM
What are the general steps to management of lung cancer?
Lifestyle changes Lung function tests for monitoring Surgical resection Radiotherapy Chemotherapy Immunotherapy
What lifestyle changes should a lung cancer pt be advised to make?
Stop smoking
Nicotine replacement
Nutritional support
What surgical option is first line for early stage disease?
Lobectomy
What should happen to all pts who undergo surgical resection for lung cancer?
Hilar and mediastinal lymph node sampling for accurate staging.
If a pt is not suitable for surgery, what can we offer to treat lung cancer?
Radiotherapy
When is chemotherapy offered for lung cancer?
Stage III and IV disease
What blood tests are done to help stage small-cell lung cancer?
Lactate dehydrogensase
LFTs
Na
A pt with terminal lung cancer says they have some symptoms that are bothering them.
What symptoms might they need treating?
Breathlessness Haemopytsis Cough Chest pain Hoarse voice Face/upper limb swelling Confusion/headache Lower neurological symptoms Bone pain
A pt with terminal lung cancer says they have some symptoms that are bothering them.
What conditions might they need treating?
SVCO Spinal cord compression Bone mets Cerebral mets Bronchial obstruction Pleural effusion
What complications can arise from the local presence of lung cancer?
- Recurrent laryngeal palsy
- Phrenic nerve palsy
- SVCO
- Pericarditis
- AF
- Rib erosion
A pt with lung cancer comes into A+E having had a fit. What are we worried about most here?
Brain mets
What consequences can arise from lung cancer metastasising to the adrenal glands?
Addison’s (adrenal insufficiency)
What non-metastatic endocrine consequences are there of lung cancer?
SIADH Hypercalcaemia Cushing's Gynaecomastia Hypoglycaemia Hyperthyroidism
What is the prognosis like for lung cancer?
Getting gradually better, but ten year survival is about 6%.
Prognosis is worse for small cell lung cancer.
How can we help prevent lung cancer?
Actively discourage smoking and encourage smoking cessation.
What is malignant mesothelioma?
Aggressive tumour of mesothelial cells of the lung that usually occurs in the pleura usually related to asbestos exposure.
What are the symptoms of malignant mesothelioma?
SoB
Chest pain
Weight loss
Hx of asbestos exposure
How do pts with mesothelioma describe their chest pain?
Dull
Diffuse
Progressive
Sometimes pleuritic
Why does clubbing occur in mesothelioma?
Due to underlying asbestosis
How should suspected malignant mesothelioma be investigated?
CXR and CT chest
Pleural fluid = straw-coloured/bloodstained
How is malignant mesothelioma managed?
- Symptom control
- Surgery only effective in extremely early disease
What is the prognosis associated with mesothelioma?
Poor, typically survival is only one year. It is almost always fatal.
