Lung cancer Flashcards
What percentage of lung cancers are caused by smoking
85%
What percentage of smokers get lung cancer
10%
What are the causative agents of lung cancer
Asbestos
Radon
Air Pollution
Diesel Exhaust
Is there more lung cancer in males or females
Males but females are more succepitable
What are the presenting symptoms of lung cancer (x9)
Chronic cough (>3 weeks) Haemoptosis Wheeze Chest and Bone pain Difficulty swallowing Raspy hoarse voice S.O.B Nail Clubbing Unexplained weight loss
What are the clinical signs of lung cancer (x6)
Clubbing of fingers Lymphadenopathy Horners syndrome Pancoast tumour Superior Vena Cava obstruction from lymph glands Hepatomegaly and skin nodules
What is Horners syndrome
Horner’s syndrome is a rare condition characterized by miosis (constriction of the pupil), ptosis (drooping of the upper eyelid), and anhidrosis (absence of sweating of the face). It is caused by damage to the sympathetic nerves of the face.
What are the three indicators of finger nail clubbing
- The base of the nail (nail bed) becomes soft and the skin next to the nail bed becomes shiny. 2. The nails then curve more than normal when looked at from the side (this is called Scarmouth’s sign)
- The ends of the fingers may then get larger (when they are called drumstick fingers)
What is a Pancoast tumour?
A tumour of the pulmonary apex
If you suspect lung cancer then whats the first investigation you should carry out
Chest X-ray
After chest X-ray what further investigations can the GP perform when suspecting lung cancer
Full Blood count Renal and liver functions Calcium Clotting screening Pulmonary function (Spirometry)
What techniques can be used to diagnose a piece of tissue suspected to be lung cancer or metastasis.
Bronchoscopy (just looks)
EBUS (common) - bronchoscopy but sample is taken
Image guided lung biopsy
Image guided liver biopsy (for metastasis)
Fine needle aspiration of neck node or skin metastasis
What do you look for on a chest Xray when diagnosing lung cancer
No widening of the mediastinum The hilar vascular structures are crisply defined (left should be higher) The trachea should be central Pleural effusion phrenic nerve palsy Collapsed lobe/lung Shadowed local opacity Metastatic disease
If a lesion is found by the Xray, what investigations should be done next?
CT scan and tissue sample
How do you stage a lung neoplasm?
TNM staging
What is TNM staging
T - the size of the cancer tumor and whether or not it has grown into nearby tissue (T1–T4)
N - whether cancer is in the lymph nodes N0-N3)
M - if the cancer has metastasised to other organs (Mx-M1)
If the lesion is not Lung cancer, what else could it be?
Pulmonary mass - an opacity in the lung over 3cm with no mediastinal adenopathy or atelectosis
Pulmonary Nodule - less than 3cm with no mediastinal adenopathy or atelectosis
What is a PET scan and what area of the body can you not use it on
A positron emission tomography (PET) scan is an imaging test that helps reveal how your tissues and organs are functioning. A PET scan uses a radioactive drug (tracer) to show this activity. This scan can sometimes detect disease before it shows up on other imaging tests.
Cant use for brain metastasis
What are the 4 main types of lung carcinoma and how common are they (%)
Adenocarcinoma 41%
Squamous cell carcinoma 40%
Small cell carcinoma 15%
Large cell carcinoma 4%
What are the two categories of lung cancers and how common is each (in %)
Small Cell lung Cancer (SCLC) 15%
None small cell lung cancer (NSCLC) 85%
What the survival rate for a NSCLC
10-25%
What the survival rate for a SCLC
4%
What lung cancer is most commonly caused by smoking
Squamous cell carcinoma
Why are Squamous cell carcinomas difficult to treat
Very few addictive Oncogenes
What mechanism is used to attempt to treat Squamous cell carcinomas
inactivating mutations in tumour suppressor genes.
What is the name for genes that mutate and cause adenocarcinomas
Addictive oncogenes
What is the adenocarcinoma oncogene that is induced by smoking
Kras
What are the adenocarcinoma oncogenes that are not induced by smoking
EGRF BRAF HER2 ALK rearrangements ROS 1
A tumour in the lung might not be lung cancer. What else could it be
Carcinoid tumour
Tumour in bronchial glands (v rare)
lymphoma
sarcoma
What are the local effects of lung cancer
Bronchial obstruction
- —Lung collapse
- –Infection or abcess in lung
- –Endogenous lipid pneumonia
- –Bronchiectasis
Plural inflammation
Direct invasion of chest well, nerves and mediastinum
What nerves can be damaged in lung cancer and what are the effects
Phrenic - diaphragm paralysis
L-reccurant laryngeal - Bovine cough
Brachial Plexus - Pancoast T1 damage
Cervical sympathetic - Horner’s syndrome
What are the distant effects of lung cancer
Distant metastasis
pretty much everything gets affected
What is a common endocrine effect of SCLC and NSCLC
SCLC - ACTH and to much antidiuretic hormone
NSCLC - increased parathyroid hormone production
What treatments are available for lung cancer?
Surgery
Radiotherapy
Chemotherapy
Palliative management
Why would you use an MRI in lung cancer investigations
to assess the degree of vascular and neurological involvement in pancoast tumours
Why would you use an echocardiograph in lung cancer investigations
To look for pericardial effusion
What tests need to be done to decide if the patient is fit for surgery
Cardiovascular tests (is heart working ok) Respiratory tests (post operative FEV1) Psychological tests (mental illness)
What is the name of the gold standard lung surgery procedure
Lobectomy
What is the doubling time for NSCLC
129 days
What is the doubling time for SCLC
29 days
Why is the patient at higher risk of MI after lobectomy
More resistance as the same amount of blood has to go through less lung.
In NSCLC what is the 5 year survival rate after surgery
40%
Define adjuvent and Neo-adjuvent therapy
Adjuvent - after surgery
Neo-Adjuvent - delivered before main treatment.
In NSCLC should use use chemo adjuvently
Yes
In NSCLC should you use chemo neoadjuvently
Yes if stage 3 (locally advanced) but not if stage 1 or 2
What is the staging of SCLC
Limited disease
Extensive disease
What treatment is best for SCLC limited disease
Chemotherapy
What treatment is best for SCLC extensive disease
Radiotherapy
What are side effects with chemo therapy
Marrow supression
nausea
Neuropathy
Hairloss
What are side effects with radio therapy
Lethargy
Pneumonitis
What is immunotherapy for lung cancers
Immunotherapy, or immune-oncology (IO) as it is sometimes referred, is a type of treatment for non-small cell lung cancer (NSCLC). It works by helping the body’s immune system to recognise and destroy cancer cells.
What therapy do you give to stage 4 lung cancer patients
Radiotherapy to reduce negative symptoms
Chemo to help survive longer
BUT ITS INCURABLE AND PALLIATIVE
