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RC-Respiratory illnesses > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

What are the histological types of lung cancer?

A 
Squamous Cell (40%)
Adenocarcinoma (41%)
Small cell (15%)
Large Cell (4%)
[So NSCLC 85%]
Adeno tends to be peripheral & squamous central
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2
Q

What other less common types of lung cancer are there?

A 
Sarcoma
Lymphoma
Carcinoid Tumour
Bronchial Tumour
Metasteses from elsewhere
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3
Q

What are the causes/risk factors for lung cancer?

A 
85% attributable to Smoking
Asbestos
Enviromental Radon
Other Radiation
Air Pollution
Pulm. Fibrosis
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4
Q

Where does Lung Cancer commonly metastasise to?

A 
Bones
Lymph tissue
Adrenals
Liver
Brain
Skin
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5
Q

What are the symptoms of Lung CanceR?

A 
Haemoptysis
Dyspnoea
Chest & Bone Pain
Wheezing
Dysphagia
Weight Loss
Chronic Cough
Recurrent Chest Infections
Shoulder Pain (Pancoast Tumour)
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6
Q

What are the clinical signs of Lung Cancer?

A

Hoarse Raspy Voice (L recurrent laryngeal nerve compression)
Clubbing (distinguishes LC from TB)
Lymphadenopathy
Horner’s Syndrome (Cervical Ganglion compression)
Hepatomegaly
Skin Nodules (Metastases)
SVC Obstruction (Face/neck swelling + pumped veins)

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7
Q

What are the possible complications of lung cancer? (warning: lots ahead)

A

Bronchial Obstruction:

  • Lobar Collapse
  • Bronchiectasis
  • Infection/Endogenous Lipid Pneumonia)
  • Abscess

Pleural:

  • Pleurisy
  • Malignant Invasion
  • Effusions/Empyema

Mediastinal:

  • SVC obstruction
  • Phrenic compression (diaphragm paralysis)
  • L recurrent Laryngeal Nerve (Hoarse voice & bovine cough)
  • Brachial Plexus (loss of sensation/function in limb)
  • Cervical Ganglion (Horner’s Syndrome)

Paraneoplastic Syndromes (Neuroendocrine)

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8
Q

Explain Neuroendocrine complications of Lung Cancer?

A

Some tumours can release hormones.
Squamous:
Parathyroid Hormone (PTH) -> Decrease in bone calcium & increase in blood calcium -> Fractures, hepatopathy (abdominal pain), constipation, confusion etc

Small Cell:
ADH (antidiuretic) -> Decrease Diuresis plus bodt loses more Na to cope -> Hypertension & diabetes insipidus
ACTH (Adrenocorticotropic) -> Excess CCS -> Immunesuppression -> Ectopic Cushings Syndrome

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9
Q

How is Lung cancer investigated?

A

Initial Investigations - GP:
CXR - FBC - Serum Calcium (Squamous paraneoplastic) - Bone profile - Clotting Screen - Spirometry - U&E + LFT

Tissue Diagnosis:
Bronchoscopy
EBUS
Lung & liver biopsy
FNA
Bone Biopsy
Explorative Thoracotamy
Mediastinoscopy/otomy (smaple mediastinal nodes)
Aspiration of pleural effusion

Cardiac Assessment:
CT - MRI - ECHO - ETT - ECG - Coronary Angiogram -

PET(metastases, normally pre-surgery)

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10
Q

What factors affect prognosis?

A

Stage
Class/Type
Biomarkers
Performance Status

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11
Q

What do we do to assess fitness for surgery?

A 
Spirometry
V/Q Scan
ABG
Diffusion studies
Cardiac Assessment
PET scan to check for metastases (using FDG glucose analogue)
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12
Q

What predictive biomarkers are there?

A

Adenocarcinoma - EGFR/KRAS/HER2/BRAF

Squamous - FGFR1/DDR2/FGFR2

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13
Q

What complications are there from surgery?

A 
Empyema
Pleural Effusion
Pneumothorax
Intra-thoracic Bleeding
Wound Pain & Infection
ARDS
Bronchopneumonia
MI
Pulmonary Thromboembolism
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14
Q

How is a cancer staged?

A

T = Size and degree of invasion
N = Lymph Node involvement
M = Metastases
Performance status & pulm function are also involved

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15
Q

What difficulties are there with staging?

A

Other nodules due to TB, abscess, granuloma, fibrosis, paraffinama, benign tumour
Lobar collapse can make the tumour hard to see

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16
Q

What factors influence treatment?

A 
Performance Status
Wishes
Stage & Type
Radical vs Palliative
Co-morbidities
17
Q

What is performance status?

A 
0 - No symptoms and fully mobile
1 - Symptomatic but mobile
2 - Up an about >50% of day -- cant work
3 - Up an about <50% of day -- Limited self care
4 - Bed or chair bound
18
Q

What are the possible treatments for lung cancer?

A

Surgery
Radiotherapy
Chemotherapy
Best Supportive & palliative

19
Q

What types of radiotherapy are there?

A

Radical (curative)
Palliative (control spread & symptoms)
Stereotactic (targeted brain radiotherapy)

20
Q

What types of chemo are there?

A

Different for different cancer:
Adeno- and Small cell = cisplatin/pemetrexed
Squamous = cisplatin/gemcitabine

Targeted Agents:
EGFR (adenocarcinoma mutation) inhibitors:
Monoclonal Antibodies e.g. Cetuximab
Tyrosine Kinase Inhibitors e.g. Erlotinib

ALK translocation inhibitor (Adenocarcinoma):
Crizotinib

21
Q

Whats involved in palliative care?

A

Suppressive Chemo & radiotherapy
Treatment of complications e.g. hypercalcaemia & hyponatramia
Community Support
Planning for end of life

22
Q

What are the levels of N and T?

A

N1- Hilar/intrapulmonary/contralateral mediastinal
N2- ipsilateral mediastinal/subcarinal
N3- supraclavicular/contralateral hilar or mediastinal/scalene

Tis - abnormal cells 
Tx - Primary tumour cant be assessed
T0 - No primary tumour
T1 - <3cm 
T2 - <5cm 
T3 - <7cm
T4 - 7cm
23
Q

How is NSCLC treated in stage 1-3?

A
  • Neo-Adjuvant chemo or radiotherapy to shrink the tumour pre-op
  • Adjuvant chemo or RT as a insurance policy against any tumour cells that might have been left behind
  • Radical RT, can cause fibrosis & inflammation so need good Pulm Function Results to do it
  • Chemo, usually + RT gives better survival rate
24
Q

How is stage 4 NSCLC treated?

A

Incurable
Palliative RT - Reduces symtpoms & complications from primary tumour. Useful for bone metastasis too.
Palliative Chemo - Does same thing, ideally give pemetrexed and RT if the pateint is healthy enough
Surgery - remove metastasis pressing on spinal cord and prevent paraplegia
Targeted treatment - Certain mutations can be targeted specifically e.g. EGFR = Erlotinib and ALK translocation = crizotinib
Immunotherapy

25
Q

How is small cell lung cancer treated?

A

With combination chemo as palliative care

RC-Respiratory illnesses (15 decks)

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