Lung Cancer Flashcards
How common is lung caner.
It is the most common cause of death from cancer worldwide.
How many deaths occur per year due to lung cancer. (2)
1.4million worldwide.
27% of cancer deaths.
What percentage of deaths due to malignant disease are due to lung cancer.
18%.
How many deaths due to lung cancer occur in the UK per annum.
40,000.
What are the risk factors for lung cancer. (6)
Smoking is the biggest risk factor. Asbestos. Chromium. Arsenic. Iron oxides. Radiation (radon gas).
How many lung cancer cases are estimated to be due to smoking.
90% of lung carcinomas.
What are the histological types of lung cancer. (5)
Squamous cell (35%). Adenocarcinoma (27%). Small (oat) cell (20%). Large cell (10%). Alveolar cell carcinoma (rare,
What is the most important clinical distinction when it comes to lung cancer. (2)
Between small cell and non-small cell.
What are the most common blood-borne sites of metastasis in lung cancer. (5)
Liver. Bone. Brain. Adrenals. Skin.
What subset of lung cancer is prone to distant metastases.
Small cell lung cancers.
What local structures tend to be invaded by lung cancers. (6)
May involve the pleura directly or by lymphatic spread.
It may extend into: the chest wall, invading the intercostal nerves or the brachial plexus and causing pain.
There may be lymphatic spread to mediastinal and supraclavicular lymph nodes (often before diagnosis).
What are the symptoms of lung cancer. (9)
Cough (80%). Haemoptysis (70%). Dyspnoea (60%). Chest pain (40%). Recurrent or slowly resolving pneumonia. Lethargy. Anorexia. Weight loss. Pain and nerve entrapment (eg pleuritic pain usually indicated malignant pleural invasion).
What are the clinical signs of lung cancer.
Cachexia.
Anaemia.
Finger clubbing.
Hypertrophic pulmonary ostearthropathy (HPOA) causing wrist pain (painful periostitis of the distal tibia, fibula, radius, and ulne, with local tenderness and sometimes pitting oedema over the anterior shin).
Supraclavicular or axilliary node enlargement.
Chest: none, colsolidation, collapse, pleural effusion.
Metastatic: bone tenderness, hepatomegaly, confusion, fits, focal CNS signs, cerebellar syndrome, proximal myopathy, peripheral neuropathy.
What may a carcinoma in the lung apex cause.
Horner’s syndrome.
What is Horner’s syndrome characterised by. (4)
Ipsilateral partial ptosis.
Enophthalmos.
Miosis.
Hypohidrosis of the face.
What is Pancoast’s syndrome.
Pain in the inner aspect of the arm, sometimes with small muscle wasting in the hand.
What does Pancoast’s syndrome indicate.
Indicates malignant destruction of the T1 and C8 roots in the lower part of the brachial plexus by an apical lung tumour.
What occurs in SVC obstruction by a malignant node. (4)
Causes suffusion and swelling of the neck and face.
Conjunctival oedema.
Headache.
Dilated veins on the chest wall.
What is the most common cause of a SVC obstruction (in lung cancer).
Bronchial carcinoma.
What are some common non-metastatic extrapulmonary effects of lung cancer. (4)
Syndrome of inappropriate ADH secretion and ectopic adrenocorticotrophic hormone secretion are associated with small cell lung cancer.
Hypercalcaemia may indicate malignant bone destruction or production of hormone-like peptides by a tumour.
Associated neurological syndromes may occur with any type of bronchial carcinoma.
What causes the typical ‘bovine’ cough (lacking the normal explosive character) often seen in lung cancer.
Involvement of the left recurrent laryngeal nerve by tumours at the left hilum.
What are the local complications of lung tumours. (8)
Recurrent laryngeal nerve palsy. Phrenic nerve palsy. SVC obstruction. Horner's syndrome (Pancoast's tumour). Rib erosion. Pericarditis. AF.
What are the metastatic complications of lung cancer. (4)
Brain.
Bone (bone pain, anaemia, raised calcium).
Liver.
Adrenals (Addison’s).
What are the endocrine complications of lung cancer. (2)
Ectopic hormone secretion (eg SIADH = low sodium, raised ADH; ACTH = Cushing's) by small cell tumours. Raised PTH (raised serum calcium) by squamous cell tumours.
