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Respiratory > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

what are early signs of lung cancer?

A
  • a cough for more than 3 weeks
  • feeling breathless for no reason
  • a chest infection that doesn’t clear up
  • coughing up blood
  • unexplained weight loss
  • chest or shoulder pains
  • unexplained tiredness or lack of energy
  • a hoarse voice
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2
Q

what is haemoptysis?

A

coughing up blood

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3
Q

why might recurrent pneumonia suggest lung cancer?

A

A tumour may cause a partial obstruction of the upper lobe bronchus causing recurrent episodes of pneumonia which obscure the tumour on an X-ray

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4
Q

what is stridor?

A

difficulty breathing in leading to a coarse audible wheeze (unique as other diseases cause distress when breathing out)

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5
Q

where is likely to be affected by local invasion in lung cancers?

A
  • recurrent laryngeal nerve (causing hoarse voice)
  • pericardium
  • oesophagus
  • pleural cavity
  • superior vena cava
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6
Q

what can local invasion of the pericardium cause?

A
  • breathlessness
  • atrial fibrillation
  • pericardial effusion
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7
Q

what can pancoast tumour cause?

A

(brachial plexus invasion)
The tumour has eroded through the ribs and into the lower part of the brachial plexus (T1root infiltration) which leads to the wasting of small muscles of the hand

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8
Q

how is pleural effusion often dealt with?

A

when the primary tumour invades the pleural space it generates a large volume of pleural fluid and so this must be drained.

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9
Q

what symptoms may be shown when the superior vena cava is invaded?

A

blood drainage from the arms and head is obstructed so the patient may present with puffy eyelids and a headache. there may be distension of the superficial veins especially on the abdomen and normal pulsation is lost. There is also a raised JVN

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10
Q

what symptoms will lung cancer with chest wall invasion have?

A

localised chest wall pain, worse with movement and at night.

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11
Q

what are common sites for metastases in lung cancer?

A

liver, brain, bone, adrenal glands, skin, other areas of lungs

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12
Q

Describe cerebral metastases

A
  • insidious onset (slow and progressive)
  • weakness, visual disturbances, headaches which are worse in the morning but not photophobic (light sensitive)
  • can have fits
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13
Q

what are the symptoms of bone metastases?

A

localised pain which is worse at night or pathological fractures

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14
Q

what are non-metastatic consequences of lung cancer?

A

finger clubbing, hypertrophic pulmonary osteoarthropathy (HPOA), weight loss, thrombophlebitis, hypercalcaemia, hyponatraemia (SIADH), weakness

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15
Q

what is HPOA?

A

(hypertrophic pulmonary osteoarthropathy)
symptoms of pain and tenderness of the long bones near adjacent joints are due to the elevation of the periosteum away from the bone surface.

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16
Q

what are the features of hypercalaemia?

A

(too much calcium in the blood)
stones = in the renal, gal stones
bones = bone pain
groans = abdominal pain, constipation, thirst
thrones = polyuria
psychiatric overtones (depression, anxiety, reduced GCS, coma)
cardiac arrhythmias

17
Q

what is the treatment for hypercalcaemia?

A
  • initially rehydration
  • if calcium is >4 or does not correct with fluid then IV bisphosphonate should also be given
  • treat underlying cancer
18
Q

what is SIADH?

A

(symptom of inappropriate antidiuretic hormone)

  • usually small cell lung cancer
  • complex
  • results in low sodium concentration
  • nausea, myoclonus (muscle twitching), lethargy/confusion, seizures, coma
19
Q

what is the treatment for SIADH?

A
  • treat underlying cause
  • fluid restriction (<1.5L a day)
  • sometimes need demeclocycline
20
Q

what investigations would you always do for suspected lung cancer?

A
  • full blood count
  • coagulation screen
  • Na, K,Ca, Alk Phos
  • spirometry, FEV1
21
Q

what investigations would you only do sometimes for lung cancers?

A

chest X-ray, CT of thorax, PET scan, bronchoscopy, endobronchial ultrasound, Not sputum cytology

22
Q

what is a PET scan?

A
  • scan to asses function rather than structure
  • analysis of tissue uptake of radiolabelled glucose
  • tissues with high metabolic activity ‘light up’
23
Q

how can we make diagnosis of lung cancer?

A
  • bronchoscopy
  • CT guided biopsy
  • lymph node aspirate
  • aspiration of pleural fluid
  • endobroncial ultrasound
  • thoracoscopy
24
Q

what things should you do when giving a cancer diagnosis?

A
  • prepare the ground
  • bring a relative
  • make sure they understand
  • prepare for obvious questions
  • tell their GP
  • arrange follow up
25
Q

Describe the treatment of small cell lung cancer.

A
  • rapidly progressive disease
  • early metastases
  • rarely suitable for surgery
  • good initial response to chemotherapy (often backed up with radiotherapy)
26
Q

Describe the treatment of non small cell cancer.

A
  • includes squamous and adeno carcinomas
  • curative options are surgery or radical radiotherapy
  • palliative chemotherapy and new targeted treatment
  • majority of lung cancers
27
Q

what tests will be done before surgery to remove a lung cancer?

A
  • bronchoscopy
  • mediastinoscopy
  • CT scan of brain
  • CT of thorax
  • PET scan
28
Q

what surgery would be done for lung cancer?

A

-pneumonectomy or lobectomy

29
Q

how are lung cancers staged for chemotherapy?

A
  • bronchoscopy or other tissue sampling (small cell or non-small cell)
  • CT scan (assesses tumour size, local invasion, nodes and metastases)
  • performance status ECOG score
30
Q

Describe cytotoxic chemotherapy.

A
  • rarely curative but longer survival
  • better response in small cell cancer
  • major side effects
  • IV infusions every 3-4 weeks
  • outpatients visits
31
Q

what are side effects of chemotherapy?

A
  • nausea and vomiting
  • tiredness
  • bone marrow suppression (opportunistic infection and anaemia)
  • hair loss
  • pulmonary fibrosis
32
Q

Describe radiotherapy.

A
  • ionising radiation
  • can be radical = curative intent
  • can be palliative = delaying tactic, useful for metastases
  • well tolerated
33
Q

what are the downsides to radiotherapy?

A
  • maximum curative dose
  • collateral damage spinal cord oesophagus, adjacent lung tissue)
  • only goes where u point the beam (difficult for some metastases)
34
Q

what are the types of endobronchial therapy?

A
  • stent insertion
  • photodynamic therapy
  • other laser therapy
35
Q

what sort of things does palliative care manage in lung cancer?

A
  • pain
  • breathlessness
  • cough
  • anxiety
  • poor mobility
36
Q

what is the prognosis for lung cancer?

A
  • half dead in 6 months

- 1 in 20 survive for 5 years

Respiratory (17 decks)

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