Lung Cancer Flashcards
Describe the general features of cancer?
- malignant growth
- uncontrolled replication
- local invasion
- metastasis
- non metastatic systemic effects
what does invasion of the recurrent laryngeal nerve cause?
Hoarse voice
what does invasion of the oesophagus cause?
Dysphagia
What does invasion of the pericardium cause?
- Breathless
- Atrial fibrillation
- pericardial effusion
What can be a consequence of a pancoast tumour?
- invasion of the brachial plexus
- can cause wasting of the small muscles in the hand
What happens when a tumour invades the superior vena cava?
- blood drainage is obstructed from the head and neck
- causes rubor and visible distended veins
Where are common sites for lung metastases to occur?
- liver
- brain
- bone
- adrenal
- skin
- other sites on lung
describe symptoms of cerebral metastases?
- insidious onset
- weakness
- visual disturbance
- headaches
- worse in the morning
- not photophobic - fits
describe paraneoplastic symptoms of lung cancer?
- finger clubbing
- HPOA
- weight loss
- hypercalcaemia
Describe the treatment of hypercalcaemia
- initial treatment is rehydration
- IV bisphosphonate
- treat underlying cancer
Describe the treatment of syndrome of inappropriate antidiuretic hormone?
- treat underlying cause
- restrict fluid to 1.5L per day
- demeclocycline
What are the 4 lung cancers commonly associated with smoking?
- Adenocarcinoma
- squamous carcinoma
- small cell carcinoma
- large cell carcinoma
- (neuroendocrine and bronchial gland tumours)
Which cancer type has the worst prognosis?
small cell (then large cell)
which type of lung cancer is sensitive to chemotherapy?
small cell
what is the treatment of choice for non small cell lung cancers?
surgery
what do adenocarcinomas express?
Thyroid transcription factor 1
what do squamous carcinomas express?
nuclear antigen p63 and high molecular weight cytokines
How can the immune response be targeted in lung cancer?
- cancer expresses PD - L1
- PD -L1 binds to the PD receptor on T lymphocytes inactivating the cytotoxic immune response
- targeted therapy can inhibit this effect and enhance immune killing of the tumour
describe the characteristics of small cell lung cancer?
- rapidly progressive disease
- early metastases
- rarely suitable for surgery
- good initial response to chemotherapy
Describe the characteristics of non small cell lung cancer?
- includes squamous and Adeno carcinomas
- curative options are surgery or radical chemo
- palliative chemo and new targeted treatment
- accounts for the majority of lung cancers
what should the doctor consider when considering surgery as a treatment option?
- can we cut it out?
- is the disease localised?
- will the patient survive the operation?
- what will the residual lung function be?
What are the surgery options for lung cancer?
- Pneumonectomy or lobectomy
describe cytotoxic chemotherapy?
- rarely curative but longer survival
- better response in small cell cancer
- major side effects
- IV injections every 3-4 weeks
- outpatient visits
What is the target of cytotoxic chemotherapy?
- rapidly dividing cells
