Lung Cancer Flashcards by Hannah Farquhar

What are the four major aspects of lung cancer presentation?

primary tumour
local invasion
metastases
paraneoplastic

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Describe the effects of a primary tumour

Haemoptysis (coughing up blood)
Recurrent pneumonia
Stridor (wheeze on inspiration)
Shortness of breath

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Why does the primary tumour cause haemoptysis?

It is very fragile and has a disordered blood supply so it bleeds easily

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Why does a primary tumour cause pneumonia?

Compressed airway is a good environment for bacteria

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Why does a primary tumour cause SOB?

The tumour reduces air getting into the lungs

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Describe presentation of local invasion

recurrent laryngeal nerve - hoarse voice
pericardium - SOB & atrial fibrillation
oesophagus - dysphagia
brachial plexus - muscle wasting
pleural effusion
superior vena cava - obstruction causes gorging blood vessels in the neck
lump on the chest

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Where can metastases be found?

cerebral
liver
bone
adrenal

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Describe cerebral metastases

insidious onset, weakness, visual disturbances, headache, fits

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Describe liver metastases

unusual particular capsule pain caused by stretching of the capsule

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Describe bone &adrenal metastases

Bone - can press against spinal cord but most likely asymptomatic
Adrenal - y shaped above the kidneys

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Describe paraneoplastic presentation

finger clubbing
hypertrophic pulmonary osteoarthropathy
thrombophlebitis (inflammation of superficial veins)
weight loss
hypercalcaemia
SIADH

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What is hypertrophic pulmonary osteoarthropathy?

Periosteum lifts & enlarges as a reaction to the lung cancer the patients presents with pain

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Where can hypercalcaemia be found?

stones (renal/biliary)
bones
groans (abdominal pain/constipation)
thrones (polyuria)
overtones (depression, anxiety)
cardiac arrhythmias

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What is the treatment for hypercalaemia?

Rehydration or IV bisphosphate treatment of cancer

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What does SIADH stand for?

Syndrome of inappropriate antidiuretic hormone

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What does SIADH result in?

Low sodium

Describe the treatment for SIADH

Treating the cancer, restricting fluid and sometimes use of democlocyline

State nine important features of lung cancer history

cough
haemopytsis
smoker
breathless
weight loss
chest wall pain
tiredness
recurrent infection
COPD or other lung related illness

State eleven features of a lung cancer examination

finger clubbing
resp rate
3 cough
weight loss
bloated face
hoarse voice
lymphadenopathy
tracheal deviation
dull percussion
stridor
enlarged liver

What investigation would you carry out to diagnose lung cancer?

blood count
coagulation
Na, K, Ca, Alk phos
Spirometry
CXR
CT of thorax
PET scan
Bronchoscopy
Endobronchial ultrasound

What is a PET scan?

Positron emission tomography - looks for metabolic activity by picking up labelled glucose

What are the four common smoking associated types of neoplasm?

adenocarcinoma
squamous cell carcinoma
small cell carcinoma
large cell carcinoma

Describe small cell carcinomas

They have the worst survival rate and almost always result in death within one year. They are rarely suitable for surgery but respond well to chemotherapy. Produced ACTH

Describe non-small cell carcinomas

Squamous & adenocarcinoma have curative options involving surgery or radiotherapy

What are the four treatments for lung cancer?

- Surgery - Radiotherapy - Chemotherapy - Palliative Care

State four questions asked before surgery

1. can we cut it out? 2. is the disease localised? 3. will the patient survive the operation? 4. what will the residual lung function be?

What are the two types of lung surgery?

Pneumonectomy - lung out | Lobectomy - lobe out

What tests must be done before surgery?

- bronchoscopy - mediastinoscopy - CT brain scan - CT thorax - PET scan

What tests must be done before chemotherapy?

- bronchoscopy - CT scan - Performance status - ECOG score

Describe cytotoxic chemotherapy

Rarely curative but longer survival, better response in small cell cancer but has major side effects. It is given as an IV infusion every 3/4 weeks as an outpatient visit. Whole body treatment targets rapidly dividing cells

State five side effects of chemotherapy

- nausea & vomitting - tiredness - bone marrow suppression - hair loss - pulmonary fibrosis

Describe radiotherapy

Ionising radiation can have curative or palliative intent. It is well tolerated but has a maximum cumulative dose. It can have collateral damage and only goes where you point the beam so no use for treating mets.

Explain SABR

Stereotactic ablative radiotherapy - alters the target while the patient breathes

Name two treatments during palliative care

Cryotherapy | Endobronchial therapy - infusion of a stent to help with stridor

What symptoms may be treated in palliative care?

- pain - breathlessness - cough - anxiety - poor mobility

Describe adenocarcinoma

Associated with mucous cells, TTF1, most common. Usually non-smokers, found in the peripheries

What is the significance of ACTH secretion?

It is produced in the pituitary gland to increase secretion of corticosteroids, therefore the cancer may present as Cushing's syndrome

Describe squamous cell carcinoma

Central, associated with smoking, produces parathyroid hormone. May present as pneumonia.

What is the significance of producing parathyroid hormone?

It causes calcium to leave the bone leading to hypercalcaemia