Lung Cancer Flashcards
What is the primary cause of lung cancer? What are some other causes?
Smoking is primary cause
Occupational exposure, radiation, genetic factors
Name 3 general presentations of lung cancer
Weight loss, appetite loss, lethargy
Name 4 symptoms related to having a primary lesion in the lung
- cough
- dyspnoea
- wheezing
- hemoptysis
What 3 main things can occur as a result of lung cancer spreading locally in the thorax?
- Pleural/pericardial effusion
- Mediastinal structures; dysphagia, SVC obstruction - facial plethora
- Various nerve damage: a) Recurrent laryngeal nerve - hoarseness
b) phrenic nerve - breathlessness
c) sympathetic chain: can lead to horner’s syndrome
d) Tumours can impact the brachial plexus
What are 4 symptoms of distant metastasis
- Bone pain/fractures
- CNS signs: seizures, personality changes, headache
- Liver pain
- Lymphadenopathy; palpable lymph nodes in neck
Name the most common paraneoplastic syndrome that can result from lung cancer
Endocrine: hormone substances released from the tumour; hypercalcemia can result as PTH is released from squamous cell carcinomas, cushing’s syndrome releases ACTH and inappropriate ADH may be released from small cell carcinomas
What are the other 3 paraneoplastic syndromes that can occur?
- Hematological: anemia caused by factors released by the tumour
- Cutaneous: dermatomyositis: inflammation of the skin and underlying muscle tissue
- Skeletal: finger clubbing
Name 3 investigations for lung cancer
- X-ray
- CT scan
- bronchoscopy; visualize and for biopsy
Are there blood tests specific for lung cancer?
No, can do serum biochemistry instead: Na+: identifies inappropriate ADH Calcium: identifies hypercalcemia Liver function test: if there is liver metastasis FBC: identifies anemia
How would you assess the patient’s ability to undergo surgery?
ECHO cardiogram and respiratory function test (as many lung cancer patients will be smokers and have some degree of disease in the lungs)
Compare the 3 radiological investigations that can be done
MRI: better to visualize tumours and soft tissue contrasts
PET CT: good to identify metastasis after staging a patient
Isotope Bone scan: if you suspect bone metastasis
What might you be able to observe from a cytology sample in lung cancer?
Where could you obtain a biopsy from?
Atypical cells and nucleoli may be enlarged and variable sizes
Biopsy: transthoracic, transbronchial, biopsy of the metastasis
How would you need to make a pathological diagnosis?
Using histology; need cytology material and can also do a tissue biopsy sample
What are the main 2 things you need to know about the tumour?
- Bronchial or metastasized
2. Tumour primary or secondary
Name 6 cancers that commonly spread to the lungs
Breast, prostate, colonic carcinomas, endometrial carcinomas, melanomas and sarcomas
What is the main age group of patients diagnosed with lung cancer? Which gender is it more common in?
65-80, men
What 5 investigations would you do to obtain a tissue diagnosis?
- transthoracic biopsy
- mediastinal biopsy
- transbronchial biopsy
- EBUS fine aspiration of lymph nodes
- pleural tap and pleural biopsy
What are the main types of primary lung cancer?
- Small cell carcinoma
- Non small cell carcinoma: squamous, adenocarcinoma and large cell carcinoma
- Unusual tumours
What are the characteristics of squamous cell carcinoma?
- often central tumours
- angulate cells
- keratinization: keratin pearls
- eosinophilic cytoplasm
- intercellular bridges
What are the characteristics of adenocarcinoma?
- often peripheral
- columnar/cuboidal
- form glands
- papillary structure
- some produce mucin
- can line the alveoli
List some characteristics of small cell carcinoma
“Oat cell carcinoma”
- small nuclei and little cytoplasm
- very cellular
- nuclear moulding
- often necrosis and lots of mitosis
Name 4 things that can result from the spread of lung cancer locally into the lung?
- Necrosis
- Ulceration: hemoptysis
- Infection: abscess formation
- bronchial obstruction; consolidation
Which patients are deemed able to undergo surgery?
Fit enough (passed ECHO and/or resp function test) and have tumour is confined to the lungs with limited nodal involvement
What is the prognosis of lung cancer? What factors does the prognosis depend on?
10-15% live 5 years.
Overall prognosis depends on: cell type (small cell worst), stage of disease, level of patient fitness, biochemical markers and co-morbidities
What is the key to improving lung cancer prognosis?
Early diagnosis, as many cases present as emergencies
What are the treatment options for lung cancer?
Involves multi-disciplinary team
- Surgery
- radiotherapy
- chemo
- palliative care
List 4 things you could do as part of management of non small cell cancer
- Palliative radiotherapy
- chemo
- Combination chemo-radio therapy
- targeted agents
Which targeting agents could you use in non small cell cancer?
- EGFR antagonists
- ALK inhibitors (patients with ALK mutated tumours)
- Immunotherapy to allow the patient’s immune system to mount a response against the tumour
How would could you manage small cell carcinoma? What is the prognosis without treatment and where does the cancer frequently metastasize?
Death in 3 months with no treatment, good responsiveness to chemo - often cerebral metastasis
What are some grounds for optimism for future lung cancer prognosis?
- Developing personalized treatment
- New biological targeted agents
- better surgical techniques
- more effective radiotherapy
- Better screening and early diagnosis
