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Respiratory > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

What are the two types of lung cancer

A

Small cell

Non-small cell

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2
Q

What can non-small cell be further differentiated into

A

SCC
Adenocarcinoma
Large cell undifferentiated

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3
Q

What are the RF for lung Ca
What is specific to SCC
What is specific to adenocarcinoma

What is smoking most related too
What is least related to smoking

A 
Smoking - most related to SCC (least to adenocarcinoma)
Asbestos
Environmental radon 
Air pollution
Pulmonary fibrosis 
SCC - polycyclic aromatic carbons
Adeno - N-nitroxamines
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4
Q

What are the symptoms of lung cancer

A 
If central = tend to get chest symptoms
If peripheral e.g. adenocarcinoma = present late (may not see on bronchoscopy) 
SOB 
Chronic cough
Haemoptysis
B symptoms 
Wheezing
Chest + bone pain
Chest infection - slow resolving + recurrent 
Abscess 
Hoarse voice - pancoast compressing laryngeal nerve
Lymphadenopathy - often supraclavicular
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5
Q

What are the signs of lung cancer

A 
Anaemia - haemolytic
Weight loss 
Clubbing 
Dysphagia + stridor if compress 
Trachea deviation
Horner's 
Hypercalcaemia 
Vena cava obstruction 
HSM
Skin nodules 
Thromboplebitis migrans
DIC
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6
Q

What is Horner’s and what causes

A 
Pancoast tumour - in apex pressing on sympathetic ganglion 
Miosis
Ptosis 
Anhidrosis 
Enopathalmus
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7
Q

What are signs of hypercalacameia

A

Constipation
Abdominal pain
Confusion
Renal

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8
Q

What are local complications of lung C

A

Lung collapse
Pneumothorax
Bronchial obstruction - lung collapse, pneumonia, bronchiectasis
Direct invasion of chest wall + nerves
Phrenic = diaphragm paralysis = SOB
L recurrent palsy = bovine cough / hoarse voice
Brachial plexus + ribs
Superior vena cava obstruction - distended veins and swelling
Rib erosion
Pericarditis

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9
Q

What is squamous associated with

A

Clubbing
PTH increased = high Ca
Ectopic TSH = hyperthyroid
Osteoarthropathy

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10
Q

What is adenocarcinoma associated with

A

Clubbing
Gynaecomastia due to HCG
Pulmonary osteoarhtropathy

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11
Q

What is suggestive of mets

A

Bone pain
Anaemia
Hepatomegaly
Adrenal = Addison’s
CNS - Confusion / fits / cerebellar / encephalopathy
Peripheral neuropathy
Lambert eaton - autoimmune attack on own tissues

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12
Q

Urgent cancer pathway

A

If >40 + haemoptysis

>40 and CXR suggest cancer

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13
Q

When do you do CXR

A 
>40 + 2 of or smoker +1 of
Cough
Fatigue
SOB
Chest pain
Weight loss
Anorexia
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14
Q

What symptoms = immediate CXR

A 
Recurrent chest infection
Clubbing
Cervical LN
Thrombocytosis
Chest signs
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15
Q

What are initial investigation by GP and when do you admit straight away

A 
CXR
FBC, U+E - if contast, LFT, Ca 
Clotting screen in case biopsy 
Spirometry
Sputum cytology
Blood culture

Admit if

  • Stridor
  • SVC obstruction
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16
Q

What does FBC / LFT / Ca show

A

Anaemia (cancer in bone marrow)
Thrombocytosis
Abnormal LFT if liver mets
High Ca suggest bone mets

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17
Q

What does CXR show

A 
Pleural effusion - usually unilateral 
Peripheral opacity 
Invasion
Collapsed lung
Hilar enlarged
Consolidation
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18
Q

What do you do after CXR

A

Staging CT CAP contrast enhanced

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19
Q

Depending what CT shows what are options

A

Bronchoscopy + biopsy = most common
EUS aspiration
Trans thoracic FNA / biopsy
Surgical excision biopsy

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20
Q

What is advanced imaging options

A 
CT
ECHO - pericardial effusion
MRI
PET CT - if curative intent
Biomarkers
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21
Q

What biomarkers have drugs to target

A

EGFR

ALK

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22
Q

How do you do T staging

A

CT
PET
Bronchoscopy

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23
Q

N staging

A

PET
CT
EBUS
Mediastinoscopy - always do before surgery to look for LN

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24
Q

M staging

A

PET CT

Bone scan

25
Q

Differential of cancer / consolidation

A 
TB
Abscess
Carcinoid
Hamartoma
AV malformation
Foreign body
Skin tumoru
Fibrosis
26
Q

Where does lung metastasis too

A 
Liver
Adrenal
Renal - cannon ball
Bone
Brain
Skin
LN
27
Q

When is surgery CI

A 
Not fit
Stage IIIb or IV
FEV1 <1.5l
Pleural effusion
Tumour near hilum
Vocal cord affected
SVC obstruction
28
Q

What is palliation options

A 
Control symptoms - analgesia + anti-emetic 
Chemo 
RT
- Obstruction
- Bone + brain mets 
SVC stent 
Analgesia 
Biphosphonates – treat hypercalcaemia
Fluids 
DNACPR
END OF LIFE CARE
29
Q

What does Novulumab do

A

Attack check points
Switch on immune system to attack
Cancer switches of immune by binding to PD1 / PDL1 / CTLA4

30
Q

When is surgery possible

A

Stage 1 and 2 onl

Only 10% of people

31
Q

What is best chance of cure in NSC

A

Surgery
RT can be curative if early enough
Adjuvant chemo to improve chance of survival or for palliation
Nivolumab

32
Q

Where does small cell cancer arise and what is prognosis

A

Fast growing so usually have mets by the time Dx

Arise from neuroendocrine cells

33
Q

Sx Small cell

A 
Same as above
Ectopic hormone production common
ACTH
SIADH
Lambert Eaten common
Limbic encephalitis - short term memory, hallucination, seizure
34
Q

What does SIADH cause

A

Hyponatraemia

35
Q

What does ACTH cause

A

Cushing’s
High BP
High blood glucose
Hypokalaemic acidosis due to high cortisol

36
Q

How do you treat

A

Chemo + RT = Rx of choice

No surgery in most cases

37
Q

Prognosis

A

Poor

38
Q

What is adenocarcinoma associated with

A

KRAS

39
Q

What is SCC associated with

A

FGFR1
DDR2
FGFR2

40
Q

What mutations have no relation to smoking

A

EGFR – target drug
BRAF
HER2
ALK rearrangement – target drug

41
Q

What can RT be used for

A 
Palliation
Obstruction
Haemoptysis
Lobe collapse
Chest pain
42
Q

What does staging for RT require

A

PT test

43
Q

Radcical RT Stages

A 
0 = asymptomatic
1 = symptomatic with light work
2 = rest for <50% day
3 = rest for >50%
4 = bed bound (incurable)
44
Q

What are options for nicotine replacement therapy

A

Varencline

Bupropion

45
Q

When do you prescribe NRT

A

2 weeks before target stop date

If high dependence prescribe patch + another form

46
Q

SE of NRT

A

N+V
Headache
Flu
Insomnia

47
Q

What is Varencline

A

Nicotine partial agonist

12 week coarse

48
Q

Common SE

A

N+V
Headache
Insomnia

49
Q

When is it CI

A

Pregnancy
Breast feed
Depression

50
Q

What is Bupropion

A

Norenephrine and dopamine reuptake inhibitor

51
Q

When is it CI

A

Pregnancy

Epilepsy as small risk of seizure

52
Q

What do you do if smoking during pregnancy

A 
Refer to services
CO to test
CBT / motivation interview
Nicotine replacement Patch = 1st Line  
NRT if all else fails
53
Q

What is Lambert and what are Sx

A

Ab from SCLC targeted against Ca gated channels
Weakness - worse in legs / proximal muscles
Diplopia if extra-ocular
Ptosis if LPS
Slurred speech / dysphagia if pharyngeal muscles
Like myasthenia gravis
Improves muscle use

54
Q

What should you consider in cancer patient with weakness

A

Spinal cord compression
Cauda equina - back pain / saddle
Lambert Eaton

55
Q

What is large cell associated with

A

Poor prognosis as poor differentiated

Secrete b-HCG

56
Q

Rx NSCLC

A

Surgery

57
Q

RX SCLC

A

RT

CANT operate

58
Q

What can cause breathlessness in lung cancer

A

Pleural effusion
Pneumothorax
Lymphangitis carcinomatosa

Respiratory (23 decks)

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