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Respiratory System > Lung cancer > Flashcards

Lung cancer Flashcards

1
Q

Summarise the epidemiology of lung cancer

A

third most common cause of death in the UK
accounts for over 40,000 deaths per annum in the UK
quarter of all cancer deaths
80% of patients die within one year of diagnosis
5 year survival is 5.5%
causative factor
tobacco
radon
asbestos

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2
Q

Describe the statistics associated with lung cancer

A

Fourth most common cause of cancer
Second highest death rate from a cancer.
20% of all cancers in men with a life time risk of 1 in 13
12% of all cancers in women with a life time risk of 1 in 23.

Worldwide lung cancer incidence 1.6 million
1,095,200 cases in men
513,600 in women
724,300 new diagnoses in the developed world
884,500 new patients diagnosed with lung cancer in the developing world

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3
Q

Describe mutational compensation

A

All cells want to be immportal
pRB, p53 and box prevent this
smoking damages p53 allowing oncogenes and viruses to propel cells towards immortality- leading to cancer
smoking damages p53 genes, preventing cells undergoing apoptosis and arrest to allow them to become cancerous

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4
Q

What is key to remember about smoking

A

Stopping smoking: at any age will reduce risk

Smoking prevalence is decreasing

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5
Q

Describe the recent trends associated with lung cancer

A

Age groups 35-55- prevalence is decreasing in both sexes

55+- decreasing in both- women started to decrease

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6
Q

Describe the risk associated with passive smoking

A

Risk is greater and increases with the number of years spent living with a smoking relative

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7
Q

Describe the clinical presentation of lung cancer

A 
Haemoptysis - coughing up blood 
unexplained or persistent (more than 3 weeks)
cough
chest/shoulder pain
chest signs
dyspnoea
hoarseness
finger clubbing- greater than 180 degree bend of the nails (nail becomes boggy and the angle between the nail and the nail bed becomes more obtuse)
Urgent referral for a CXR
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8
Q

What is the choice of treatment based on

A

The choice of treatment is based on 3 key factors:
§ Histological cell type.
§ Stage of the lung cancer.
§ Performance status of the patient.

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9
Q

What is the main distinction for treatment based on

A

Histological cell type
The main distinction for the purposes of treatment choice is between small cell lung cancer and non-small cell lung cancer. The latter accounts for about 75% of all lung cancers and consists of squamous cell carcinoma, large cell carcinoma, anaplastic carcinoma, adenocarcinoma, bronchiolo-alveolar cell carcinoma and other rare tumour groups.

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10
Q

Describe the different types of lung cancer

A

Small cell lung cancer: highly malignant form, with shorter doubling time and earlier metastases
Non small cell lung cancer: subdivided to adenocarcinomas, squamous cell cacner or large cell cancer

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11
Q

Describe the epidemiology of the different types of lung cancer

A

§ Small cell lung cancer – ~20-25% of lung cancers.
§ Non-small cell lung cancer – ~75% of lung cancers.
o Squamous cell carcinoma – 25-40%.
o Adenocarcinoma – 25-40%.
§ Incidence on the increase (common in females

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12
Q

Why do we have subtypes for non-small cell lung cancers

A

Variety of treatments available for different tumours- we want to know their phenotype (targeted therapies)

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13
Q

Describe the phenotype of non-small cell lung cancers

A

All;
PDL-1 Status
Over 50% consider immunotherapy

Adenocarcinoma
EGFR
ALK gene
ROS-1
kRAS
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14
Q

How do we determine the spread of the cancer

A

TMN

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15
Q

Describe the classifications of T

A

Size of tumour and where it is located
TX Primary tumor cannot be assessed, or tumor proven by presence of malignant cells in sputum or bronchial washings but not visualized by imaging or bronchoscopy
T0 No evidence of primary tumor
Tis Carcinoma in situ
T1 Tumor 3 cm or less in greatest dimension, surrounded by lung or visceral pleura, without bronchoscopic evidence of invasion more proximal than the lobar bronchus (i.e. not in main bronchus)
T2 Tumor with any of the following features of size or extent: More than 3 cm in greatest dimension. Involves main bronchus, 2 cm or more distal to the carina Invades the visceral pleura. Associated with atelectasis or obstructive pneumonitis which extends to the hilar region but does not involve the entire lung
T3 Tumor of any size that directly invades any of the following: chest wall (including superior sulcus tumors), diaphragm, mediastinal pleura, parietal pericardium; or tumor in the main bronchus less than 2 cm distal to the carina but without involvement of the carina; or associated atelectasis or obstructive pneumonitis of the entire lung
T4 Tumor of any size that invades any of the following: mediastinum, heart, great vessels, trachea, esophagus, vertebral body, carina; or tumor with a malignant pleural effusion

Regardless of size- if spread- gets upstaged

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16
Q

Describe the assessment of lymph spread

A

Consider hilar, mediastinal and contralateral lymph nodes (spread from one side to the other)
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Metastasis in ipsilateral peribronchial and/or ipsilateral hilar lymph nodes, including direct extension
N2 Metastasis in ipsilateral mediastinal and/or subcarinal lymph node(s)
N3 Metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene or supraclavicular lymph node(s)

17
Q

Describe metastases

A

MX Presence of distant metastasis cannot be assessed
M0 No distant metastasis
M1 Distant metastasis Note: M1 includes separate tumour nodule(s) in a different lobe (ipsilateral or contralateral)

18
Q

Describe the progression of the tumour

A

T1- earliest stage

can go to M1- where the tumour has metastatic spread0 local treatment inappropriate.

19
Q

Describe the relationship between diagnosis and staging

A

They are done together

20
Q

What do we do if there are glands in lymph nodes

A

Biopsy- for diagnosis and assess spread for staging

21
Q

What can we use for staging

A

radio-labelled glucose actively taken up by rapidly dividing cancer cells; lung and lymph node tissue should not take up, so if have, then cancer probably spread - activity seen on CT and can be used to see spread

FDG-PET-CT
Only imaging
No tissue diagnosis
Additional specimen collection procedure is required to confirm diagnosis

22
Q

Describe Bronchoscopy & Endobronchial Ultrasound (EBUS)

A

Ultrasound uses vascular land marks to identify lymph nodes effected- bronchoscopy- use needle to extract tissue from lymph node for biopsy

Pathologists analyse histology and run immunological tesSmall cell carcinoma

T2bN2M0
ts to identify the tumour

23
Q

Describe the use of trans-thoracic CT biopsy

A 
Advantage:
Real time
Sensitivity 70-100%
Disadvantage:
Risk of pneumothorax (25-30%)
Small sample size
In case of bleeding no immediate intrabronchial treatment possible

We are penetrating lung tissue from the outside and so we can let air in

24
Q

What are the use of lung function tests

A

Assess the fitness of the patient

25
Q

Why do we need to use MRI for assessing metastases to the brain

A

Brain is metabolically active tissue- will have hotspots already on FDG-PET-CT- therefore MRI is needed to assess for metastatic spread

26
Q

Describe small cell lung cancers

A

More rapidly dividing and spreading

Therefore- treatment is often chemotherapy

27
Q

Describe non-small cell lung cancers

A

More slow growing- will try surgery with adjuvant radiotherapy or chemotherapy
Adjuvant means after surgery

28
Q

What happens If the tumour has spread to the mediastinal lymph nodes

A

Chemotherapy and radiotherapy
If they are doing well- can try surgery
Highly advanced- can give immunotherapy

29
Q

Describe the non-metastatic symptoms of cancers

A

metastatic symptoms- bone pain due to bone metastases

non-metastatic- cancer may be releasing pro-inflammatory molecules or PTH- resulting in low calcium

30
Q

What is the issue with lung cancer

A

we find it quite late
prognosis is poor
tumours can spread before we see them and may have been malignant for years before we have detected them
e.g the patient may have had an adenocarcinoma for 13 years, we detect it at 15 but they die at 17- short survival time

31
Q

How can we solve this issue

A

Regular CT screening in heavy smokers over 55- reduce death by 20%
But stopping smoking (preventative measures)- more effective

32
Q

Summarise the treatment of lung cancer

A 
Treatment Based on:
Diagnosis
Cell Type
Subgroup
Molecular Phenotype
Staging
Disease extent
Fitness
33
Q

Describe the prognosis of lung cancer

A

Poor prognosis
80 % die within one year
5year survival or cure rate less than 6%

34
Q

Describe the survival of cancer according to stage

A

Survival related to suitability for surgery
considered in patients with Stage I, II & some with Stage IIIa disease

therefore, need to detect tumour early

5% overall surgical risk & 10% major complications

Respiratory System (23 decks)

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