Lung cancer Flashcards
3 causative factors of lung cancer
tobacco
radon
asbestos
Clinical features of lung cancer leads to?
Urgent referral for a CXR
What are clubbing of fingers?
In late clubbing the angle is greater than 180 degrees and the proximal edge of the nail elevates.
All Non Small Cell Lung Cancers
Molecular phenotype
PDL-1 Status
Over 50% consider immunotherapy
Adenocarcinoma
Molecular phenotype
EGFR
ALK gene
ROS-1
kRAS
What is FDG-PET-CT? Cons?
A FDG PET/CT Scan is a diagnostic procedure which uses a small amount of a tracer (FDG) to help physicians identify abnormal from normal functioning organs and tissues.
Only imaging
No tissue diagnosis
Additional specimen collection procedure is required to confirm diagnosis
Bronchoscopy & Endobronchial Ultrasound (EBUS) used for?
Small cell carcinoma
Trans-thoracic CT biopsy
Pros and cons
Advantage:
Real time
Sensitivity 70-100%
Disadvantage:
Risk of pneumothorax (25-30%)
Small sample size
In case of bleeding no immediate intrabronchial treatment possible
Treatment of lung cancer is based on?
Treatment Based on: Diagnosis Cell Type Subgroup Molecular Phenotype
Staging
Disease extent
Fitness
What is the airway conductive system?
Asymmetrical dichotomous branching tubular system
(up to) 24 divisions
Bronchi > ~ 1mm
Bronchioli < 1mm
“Small airways” < 2mm
Development of carcinoma
Multistep accumulation of mutations resulting in:
Disordered growth
Loss of cell adhesion
Invasion of tissue by tumour
Stimulation of new vessel formation around tumours
Mutations occur in epithelial cells and stem cells.
Pathways different for different tumour types
Reflected in histology of tumours
Lung tumour types
Tumours arise from a variety of cell types: Epithelial, mesenchymal (soft tissue), lymphoid.
What are Benign lung tumours
Do not metastasise
Can cause local complications
Airway obstruction
E.g. chondroma
What are Malignant lung tumours
Potential to metastasise, but variable clinical behaviour from relatively indolent to aggressive
Commonest are epithelial tumours : “carcinomas”
What is squamous cell carcinoma?
25-40% pulmonary carcinoma
Closely associated with smoking
Traditionally central arising from bronchial epithelium, but recently increase in peripheral SqCC
Local spread, metastasise late.
Adeocarcinoma development
Atypical adenomatous hyperplasia - proliferation of atypical cells
Lining the alveolar walls. Increases in size and eventually can become
Invasive.
Progression of AAH
acquires invasive phenotype
Small cell Ca vs Non small cell Ca
Small cell lung carcinoma
Survival 2-4 months untreated
10-20 months with current therapy
chemoradiotherapy (surgery very rarely undertaken as most have spread at time of diagnosis)
Non small cell lung carcinoma Early Stage 1: 60% 5 yr survival Late Stage 4: 5% 5 yr survival 20-30% have early stage tumours suitable for surgical resection. Less chemosensitive
TNM staging- define what it does and each section
TUMOUR (T1-4)
Size, Invasion pleura, invasion other structures e.g. pericardium
N LYMPH NODE METASTASIS (N0-3)
N0 – lymph node not involved by tumour
N1 or N2 or N3 - lymph nodes involved by tumour
M DISTANT METASTASIS (M0 or 1)
M1 – tumour has spread to distant sites
E.g. tumour in liver, bones, brain (includes separate tumour nodule in different lobe of lung)
It is a measure of how advanced a tumour is:
Each patient given T N and M stage and together these give information about prognosis and operability.
Can be clinical, radiological or pathological (the latter is most accurate)
Local effects of lung cancer
bronchial obstruction
invasion of local structures
inflammation/irritation/invasion of pleura or pericardium
Bronchial obstruction is ?
Collapse of distal lung
Shortness of breath
Impaired drainage of bronchus
Chest infection
Pneumonia, abscess
Invasion of local structures is?
Invasion of local airways and vessels Haemoptysis, cough Invasion around large vessels Superior vena cava syndrome- venous congestion of head and arm oedema and ultimately circulatory collapse Oesophagus Dysphagia Chest wall Pain Nerves Horners syndrome
Inflammation/irritation/ invasion of pleura or pericardium is?
Pleuritis or pericarditis, with effusions
Breathlessness
Cardiac compromise
Systemic Effects of Bronchogenic Carcinoma
Physical effects of distant spread brain (fits) skin (lumps) liver (liver pain, deranged LFTs) bones (bone pain, fracture)
Paraneoplastic Syndromes: Systemic effect of tumour due to abnormal expression by tumour cells of factors (e.g. hormones and other factors) not normally expressed by the tissue from which the tumour arose
Endocrine e.g. “Syndrome of inappropriate antidiuretic hormone” causing hyponatremia (especially small cell carcinoma)
Non-endocrine e.g. Haematologic/coagulation defects
