lung cancer Flashcards
1
Q
what is the presentation of lung cancer?
A
- primary tumour
- local invasion
- metastases
- non-metastatic (paraneoplastic)
2
Q
what are the symptoms of lung cancer?
A
- haemoptysis
- recurrent pneumonia on the same side
- stridor = wheeze on inspiration
- shortness of breath
3
Q
what are the local invasions of tumours that can cause symptoms?
A
- recurrent laryngeal nerve
- pericardium = breathless, atrial fibrillation, pericardial effusion
- oesophagus = dysphagia
- brachial plexus
- pleural cavity
- superior vena cava
4
Q
what are the signs of anastomoses to inferior vena cava?
A
torturous veins on abdominal
5
Q
what happens when with a tumour encasing left pulmonary artery?
A
- breathlessness and haemoptysis
6
Q
what are the common sites for metastases in lung cancer?
A
liver, brain, bone, adrenal , skin, lung
7
Q
what happens with cerebral metastases?
A
- insidious onset
- weakness
- visual disturbance
- headaches = worse in morning, not photophobic
- fits
8
Q
what does cerebral metastases look like on a CT scan?
A
ringed
9
Q
what symptoms are associated with liver metastases?
A
- capsulated pain
10
Q
what are the symptoms or bone metastases?
A
may have no pain at all
11
Q
what are the non-metastatic (paraneoplastic) symptoms?
A
- finger clubbing
- hypertrophy pulmonary osteoarthropathy - HPOA = bone scan
- weight loss
- thrombophlebitis = inflammation of superficial veins with blood clots in them
- hypercalcaemia
- hyponatrawmina - SIADH
- weakness - eaton lambert syndrome
12
Q
what is hypercalcaemia?
A
- high calcium
- sones (renal/bilary calculi)
- bones (bone pain)
- groans (abdomnial pain,
- constipation, N+V)
- thrones (polyuria)
- phychiatric overtones (depressoins, anxiety, reduced GCS, coma)
- cardiac arrythmias
13
Q
what is the treatment of hyercalcaemia?
A
- initial treatment is rehydration
- if calcium is high on admission (>4) or does not correct with fluid then also use IV bisphosphonate
- treat underlying cancer - usually squamous cell
14
Q
what is SIADH?
A
- syndrome of inappropriate antidiuretic hormone
- usually small cel lung cancer
- results in low sodium concentration
- generalised non-specific symptoms
15
Q
what is the treatment of SIADH?
A
- treat underlying cause
- fluid restriction - 1.5L/day
- somtimes need demeclocycline
16
Q
how to take a history of lung cancer
A
- cough
- haemoptysis
- cigarette smoker
- breathelssness
- weight loss
- chest wall pain
- tiredness
- recurrent infection
- other smoking related disease
- is there anything you’re worried about?
17
Q
how to examine for lung cancer?
A
- finger clubbing
- breathlessness
- cough
- weight loss
- bloated face
- hoarse voice
- lymphadoneopathy
- trachael deviation
- dull percussion
- stridor
- enlarged liver
18
Q
how do we investigate lung cancer?
A
- full blood count
- coagulation screen
- Na, K, Ca, Alk phos
- spirometry, FEV1
- chest xray
- CT scan of thorax
- PET scan
- bronchoscopy
- endobronchial ultrasound (EBUS)
- not sputum cytology
19
Q
what is a PET scan in relation to lung cancer?
A
- scan to asses function rather than structure
- analysis of tissue uptake of radiolabelled glucose
- tissues with high metabolic activity “light up”
20
Q
how do you make a tissue diagnosis?
A
- bronchoscopy
- CT guided biopsy
- lymph node aspirate
- aspiration of pleural fluid
- endobronchial ultrasound
- thoracoscopy
21
Q
local effects of lung cancaer
A
- obstruction of airway (pneumonia)
- invasion of chest wall (pain)
- ulceration (haemoptysis)
22
Q
what are the classifications of lung tumours?
A
- very heterogeneous
- smoking associated =
- adenocarcinoma
- squamous carcinoma
- small cell carcinoma
- large cell carcinoma
- neuroendocrine tumours
- bronchial gland tumours
23
Q
survival of small cell
A
worst, almost all dead in one year
24
Q
survival of large cell
A
worse than squamous or adenocarcinoma
25
what kind of lung cancer is chemosensitive?
small cell but it has rapidly emerging resistance
26
what is the other type of treatment instead of chemotherapy?
surgery
27
what does adenocarcinoma express?
TTF
| it is also expressed in small cell carcinoma
28
what do squamous carcinoma express?
nuclear antigen p63 and high molecular wt. cytokeratins
29
bronchial tumours
- squamous metaplasia
- dysplasia
- carcinoma in situ
- invasive malignancy
30
peripheral adenocarcniomas
- atypical adenomatous hyperplasia
- spread of neoplastic cells along alveolar walls
- true invasive adenocarcinoma
31
what are the prognostic indicators in lung cancer?
tumour stage
| tumour histological subtype
32
what cells give rise to small cell carcinoma?
neuroendocrine cells
33
which lung cancer is most common in non-smokers?
adenocarcinoma
34
which is the most common type of lung cancer?
squamous cellcarcinoma
35
who gets radical radiotherapy?
early NSLC patients with adequate lung function but where surgery is not possible
36
what is small cell?
- small percentage of lung cancer
- rapidly progressive disease
- early metastases
- rarely suitable for surgery
- good response to chemotherapy
37
what is non-small cell?
- large percentage of lung cancer
- includes squamous and adenocarcinomass
- curative options are surgery or radical radiotherapy
- palliative chemotherapy and new targeted treatment
38
what type of treatment has the best survival rate?
surgery - median survival = 42.7
39
what are the stagings for surgery?
- bronchoscopy = vocal cord palsy (wrapped in vocal cords), proximity to the carina
- mediastinoscopy = lymph nodes
- CT scan of brain = metastases
- CT scan of thorax = tumour size
- PET scan = metastases
40
what are the surgerys for lung cancer?
- pneumonectomy
| - lobectomy
41
what are the stagings for chemotherapy?
- bronchoscopy = small/non-small
- CT scan = tumour size, local invasion, nodes, metastases
- performance status ECOG score
42
what is cytotoxic chemotherapy?
- rarely curative but longer survival
- better response in small cell cancer
- major side effects
- intravenous infusions every 3-4 weeks = outpatients
- more detailed imaging
- whole body treatment
- targets rapidly dividing cells
43
what are the side effects of chemotherapy?
- nausea and vomiting
- tiredness
- bone marrow suppression
- anaemia
- hair loss
- pulmonary fibrosis
44
how can radiotherapy be used?
- ionising radiation = xrays, external beams
- radical = curative intent
- palliative = delaying tactic, useful for mestastases
- well tolerated
45
what are the disadvantages of radiotherapy?
- maximum cumulative dose
- collateral damage = spinal cord, oesophagus, adjacent lung tissue
- only goes where you point the beam = not good for metastases
46
what is SABR?
- sterotactic ablative radiotherapy
- many more beams, each beam is less powerful so there is less collateral damage
- increased total dose delivered to tumour so more effective
47
what is endobronchial therapy?
- stent insertion for stridor
- phtotodynamic therapy
- other laser therapy
48
what is the treatment of lung cancer determined by?
- the cell type
- the extent of the disease
- co-morbidity
- the patient's wishes
49
what are the causes of lung cancer?
- smoking
- asbestos
- radon
