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lung cancer Flashcards

1
Q

what is the presentation of lung cancer?

A
  • primary tumour
  • local invasion
  • metastases
  • non-metastatic (paraneoplastic)
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2
Q

what are the symptoms of lung cancer?

A
  • haemoptysis
  • recurrent pneumonia on the same side
  • stridor = wheeze on inspiration
  • shortness of breath
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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
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4
Q

what are the signs of anastomoses to inferior vena cava?

A

torturous veins on abdominal

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5
Q

what happens when with a tumour encasing left pulmonary artery?

A
  • breathlessness and haemoptysis
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6
Q

what are the common sites for metastases in lung cancer?

A

liver, brain, bone, adrenal , skin, lung

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7
Q

what happens with cerebral metastases?

A
  • insidious onset
  • weakness
  • visual disturbance
  • headaches = worse in morning, not photophobic
  • fits
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8
Q

what does cerebral metastases look like on a CT scan?

A

ringed

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9
Q

what symptoms are associated with liver metastases?

A
  • capsulated pain
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10
Q

what are the symptoms or bone metastases?

A

may have no pain at all

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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
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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
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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
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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
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15
Q

what is the treatment of SIADH?

A
  • treat underlying cause
  • fluid restriction - 1.5L/day
  • somtimes need demeclocycline
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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?
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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
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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
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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”
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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
Q

what kind of lung cancer is chemosensitive?

A

small cell but it has rapidly emerging resistance

26
Q

what is the other type of treatment instead of chemotherapy?

A

surgery

27
Q

what does adenocarcinoma express?

A

TTF

it is also expressed in small cell carcinoma

28
Q

what do squamous carcinoma express?

A

nuclear antigen p63 and high molecular wt. cytokeratins

29
Q

bronchial tumours

A
  • squamous metaplasia
  • dysplasia
  • carcinoma in situ
  • invasive malignancy
30
Q

peripheral adenocarcniomas

A
  • atypical adenomatous hyperplasia
  • spread of neoplastic cells along alveolar walls
  • true invasive adenocarcinoma
31
Q

what are the prognostic indicators in lung cancer?

A

tumour stage

tumour histological subtype

32
Q

what cells give rise to small cell carcinoma?

A

neuroendocrine cells

33
Q

which lung cancer is most common in non-smokers?

A

adenocarcinoma

34
Q

which is the most common type of lung cancer?

A

squamous cellcarcinoma

35
Q

who gets radical radiotherapy?

A

early NSLC patients with adequate lung function but where surgery is not possible

36
Q

what is small cell?

A
  • small percentage of lung cancer
  • rapidly progressive disease
  • early metastases
  • rarely suitable for surgery
  • good response to chemotherapy
37
Q

what is non-small cell?

A
  • large percentage of lung cancer
  • includes squamous and adenocarcinomass
  • curative options are surgery or radical radiotherapy
  • palliative chemotherapy and new targeted treatment
38
Q

what type of treatment has the best survival rate?

A

surgery - median survival = 42.7

39
Q

what are the stagings for surgery?

A
  • 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
Q

what are the surgerys for lung cancer?

A
  • pneumonectomy

- lobectomy

41
Q

what are the stagings for chemotherapy?

A
  • bronchoscopy = small/non-small
  • CT scan = tumour size, local invasion, nodes, metastases
  • performance status ECOG score
42
Q

what is cytotoxic chemotherapy?

A
  • 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
Q

what are the side effects of chemotherapy?

A
  • nausea and vomiting
  • tiredness
  • bone marrow suppression
  • anaemia
  • hair loss
  • pulmonary fibrosis
44
Q

how can radiotherapy be used?

A
  • ionising radiation = xrays, external beams
  • radical = curative intent
  • palliative = delaying tactic, useful for mestastases
  • well tolerated
45
Q

what are the disadvantages of radiotherapy?

A
  • maximum cumulative dose
  • collateral damage = spinal cord, oesophagus, adjacent lung tissue
  • only goes where you point the beam = not good for metastases
46
Q

what is SABR?

A
  • 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
Q

what is endobronchial therapy?

A
  • stent insertion for stridor
  • phtotodynamic therapy
  • other laser therapy
48
Q

what is the treatment of lung cancer determined by?

A
  • the cell type
  • the extent of the disease
  • co-morbidity
  • the patient’s wishes
49
Q

what are the causes of lung cancer?

A
  • smoking
  • asbestos
  • radon

Resp (30 decks)

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