Lung cancer Flashcards

1
Q

Classifications of lung cancer

A

Small cell carcinoma

  • Highly malignant
  • Associated with smoking
  • Accounts for around 15%

Non-small cell carcinoma

  • Adenocarcinoma (most common type)
  • Squamous cell (SCC)
  • Large cell carcinoma
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2
Q

Small cell carcinoma

- Epidemiology

A

Accounts for 15-20% of all lung cancers

Associated with smoking

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3
Q

Adenocarcinoma

  • Epidemiology
  • Associations
A

Most common type of lung cancer

  • Around 40%
  • F>M
  • Far east ethnicity have higher risk.

Most common type in non-smokers.

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4
Q

Squamous cell carcinoma

  • Epidemiology
  • Associations
A

Next most common type of cancer
(25%)
- Strongly associated with smoking

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5
Q

Large cell carcinoma

- Epidemiology

A

Accounts for 10% of NSCLC

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6
Q

Hamartoma

  • Definition
  • Epidemiology
  • Pathology
  • Treatment
A

Benign tumour, most common type is from the lung.
- Originates from connective tissues: fat, cartilage, CT.

Epidemiology
- F>M

Treatment
- Surgical resection, excellent prognosis.

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7
Q

Complications of lung cancer

A

Paraneoplastic syndromes
- Horner’s syndrome (Pancoast tumour)

Phrenic nerve palsy

Recurrent laryngeal n palsy

SVC obstruction

AF

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8
Q

Paraneoplastic presentations of lung cancer

- Endocrinology

A

Endocrinology
- SIADH ( SCLC producing ADH)= hypoNa+

  • Cushings (SCLC producing ACTH)
  • Serotonin syndrome–> carcinoid
  • SCC producing PTHrP= hyperCa2+
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9
Q

Paraneoplastic presentations of lung cancer

  • Rheumatology
  • Neurology
  • Dermatology
A

Rheumatology
- Dermatomyositis/ polymyositis

Neurology

  • Cerebellar degeneration
  • Peripheral neuropathy.

Dermatology

  • Acanthosis nigricans
  • Trousseau syndrome
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10
Q

Small cell carcinoma

- Pathology: location, histology, behaviour

A

Location
- Central, near bronchi

Histology

  • Small, poorly differentiated cells
  • “Oat cells” appearance, flat, low cytoplasm
  • Neuroendocrine origins= Feyrter cells

Behaviour

  • Highly malignancy, mainly present in later stage
  • Poor prognosis, but highly sensitive to chemo
  • Ectopic hormone secretion due to neuroendocrine origin.
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11
Q

Adenocarcinoma

- Pathology: location, histology, behaviour

A

Location
- Peripheral

Histology

  • Differentiated, glandular (poorly differentiated if advanced)
  • Mucin positive

Behaviour

  • Mets are extrathoracic
  • Most present with mets.
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12
Q

SCC

- Pathology: location, histology, behaviour

A

Location
- Central

Histology

  • Squamous cell differentiation
  • May show keratinisation

Behaviour

  • Locally invasive
  • Late mets, via lymph
  • HyperCa2+ due to PTHrP
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13
Q

Large cell carcinoma

- Pathology: location, histology, behaviour

A

Location
- Central/ peripheral

Histology
- large, undifferentiated cells

Behaviour
- Poor prognosis

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14
Q

Symptoms of lung cancer

A

General

  • Fatigue
  • Weight loss/ anorexia

Resp

  • Dyspnoea
  • Cough w/ haemoptysis
  • Chest pain
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15
Q

Signs of lung cancer

-

A

Peripheral

  • Clubbing
  • Lymphadenopathy: supraclavicular, axillary
  • Horner’s syndrome; miosis, ptosis, anhydrosis
  • Anaemia signs

Chest
- Dull percussion

Mets sign

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16
Q

Signs of mets in lung cancer

A
  • Bone pain
  • Confusion
  • Seizures
  • Cerebellar dysfunction
  • Peripheral neuropathy
17
Q

Blood tests for Lung Ca

A

FBC
- May show anaemia

U+E
- HypoNa+

Hypercalcaemia

LFT
- May show ALP if bone mets

18
Q

Imaging for lung Ca

A

CXR

  • Pleural effusion
  • Peripheral circular opacity
  • Hilar enlargement
  • Consolidation
  • Lung collapse

CT
- Lower neck, thorax, upper abdomen.

Bronchoscopy

19
Q

Special investigations for lung ca

A

Thoracentesis of pleural effusion/ pleural biopsy
- Shows malignant cells

Fine needle aspiration
- If lymphadenopathy present

Sputum cytology
- Malignant cells may be present

20
Q

SCLC

- treatment

A

Tends to present at late stage

If caught earlier:

  1. Chemotherapy
    - with radiotherapy
    - Prophylactic cranial irradiation

Surgery

If extensive, surgery not an option

Later stages= palliation

21
Q

Palliation for SCLC

A

Analgesia

Radiotherapy

  • Bronchial obstruction
  • Haemoptysis
  • Bone/ CNS mets

Stenting/ dexamathasone/ RT
- SVC obstruction

Endobronchial therapy

Pleural draining

22
Q

NSCLC treatment

A
  1. Stage 1, 2
    - Surgical resection, requires good cardioresp reserve
  • Preoperative chemo
  • Post-op radiotherapy/chemo
  1. Later stages
    - Radio/ Chemo