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Oncology > Lung Cancer > Flashcards

Lung Cancer Flashcards

-Pathology -Patterns of spread -Staging -Management

1
Q

What is the epidemiology of lung cancer?

A
  • 3rd most commone cancer in UK
  • 1 in 13 men
  • 1 in ever 15 women
  • Account for 22% or cancer related deaths
  • 10% of patients diagnosed with lung cancer live for 5 years or more
  • M 3x> F, however rates amognst men declining but women increasing
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2
Q

What are the risk factors for devloping lung cancer?

A
  • Genetic predisposition
  • Cigarette smoking
  • Increasing age
  • Hx of COPD
  • Industrial exposure to absbestos, chromium, arsenic and iron oxide
  • Coal tar/combustion production
  • Exposure to radiation
  • Smoking -90% of lung cancers is in smokers, passive smoking also increases risk by 1.5
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3
Q

What are the histology sub-types of lung cancer?

A
  • Small cell lung cancer (15%)
  • Non-small cell lung cancer (85%)
    • Squamous cell carcinoma
    • Adenocarcinoma
    • Large cell carcinoma
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4
Q

How can bronchial carcinoma be devided? Which is more common?

A
  • Small cell lung carcinoma 15%
  • Non-small cell lung carcinoma 85%
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5
Q

What are features of small cell lung carcinomas?

A
  • 15% of lung cancer
  • Arise from Kulchitsky cells -part of amine precursor uptake and decarboxylation (APUD) endocrine system
  • Highly malignant and highly aggressive
  • Usually inoperable at presentation
  • Poor prognosis
  • also associated with paraneoplastic syndromes causing:
    • cushings syndrome
    • lambert eaton myesthaenic syndrome
    • SIADH
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6
Q

What are the histological subtypes of non-small cell carcinomas? Which is the most common to least?

A
  • Adenocarcinoma 50%
  • Squamous Cell Carcinoma 30%
  • Large Cell Carcinoma 5%
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7
Q

What are the features of squamous cell lung carcinoma?

A
  • 42% of non-small cell lung cancers
  • Often obstructive lesions of the bronchus
  • Local spread common, widespread metastases occurs late
  • Most related to smoking
  • Found centrally, close to bronchi, and can present with bronchial obstruction
  • Can also secrete PTH relate peptide which can lead to malignancny-related hypercalcaemia
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8
Q

What are the features of lung adenocarcinoma?

A
  • 39% of non-small cell lung cancers
  • arises from mucous cells in bronchus epithelium
  • invasion of pleura and mediastinal lymph nodes common
  • often metastasises to brain and bones
  • 10% related to non-smokers
  • often peripheral
  • more frequent in women
  • commonly associate dwith activating mutations in EGFR and ALK
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9
Q

What are the features of large cell carcinoma?

A
  • Less differentiated forms of squamous cell and adenocarcinoma
  • Metastasises early
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10
Q

What are the symptoms a patient who has lung carcinoma would present with?

A
  • Chronic cough (80%)
  • Haemoptysis (70%)
  • Dyspnoea (60%)
  • Chest pain (40%)
  • Weight loss
  • Bone pain
  • Right upper quadrant pain
  • Headaches/Nausea/Neurological symptoms
  • Recurrent or slowly resolving pneumonia
  • Lethargy
  • Anorexia
  • Finger clubbing
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11
Q

What are some signs you might find on examination of a patient with lung carcinoma?

A
  • Cachexia
  • Anaemia
  • Clubbing
  • Hypertrophic pulmonary osteoarthropathy (NSCLCs)
  • Supraclavicular or axillary nodes
  • Bone tenderness -metastasis
  • Hepatomegaly -metastasis
  • Confusion/fits/focal CNS signs/cerebellar symptoms
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12
Q

What investigations should be done in suspected lung cancer?

A
  • CXR -more than 95% of lung tumours are visiable on a plain CXR at presentation
  • CT chest and upper abdo
  • PET scan
    • used in patients who are throught to have operable disease ot check for distant metastases
  • Bronchoscopy
    • tumour biopsy
  • Tumour markers
    • neurone specific enolase and lactate dehydrogenase
  • Pulmomnary function tests
  • Cardiopulmomnary exercise testing
    • important in patients being considered for surgical resection to ensure they are fit enough to undergo an operation
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13
Q

When do you offere an urgent chest X-Ray (2 weeks) to assess for lung cancer in people aged 40 and over?

A

2 or more of the following unexplained symptoms or if they have ever smoked, 1 or more of the following unexplained symptoms:

  • cough
  • fatigue
  • SOB
  • Chest pain
  • weight loss
  • appetite loss

Or if they have any of the following:

  • persistent or recurrent chest infection
  • finger clubbing
  • supraclavicular lymphadenopathy or persistent cervical lymphadenopathy
  • chest signs consistent with lung cancer
  • thrombocytosis
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14
Q

When to you make an urgent chest X-Ray referral to assess for mesothelioma in people age 40 or over?

A

2 or more of the following unexplained symptoms or

1 or more and have ever smoked or

1 or more and have been exposed to asbestos

  • cough
  • fatigue
  • SOB
  • chest pain
  • weight loss
  • appetite los
  • finger clubbing
  • chest signs compatible with pleural disease
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15
Q

A diagnosis of lung cancer is made from a CXR. Why and when is a CT scan used?

A
  • Contrast-enhances chest CT to further the diagnosis and stage the disease
  • Include the liver, adrenals and lower neck in the scan
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16
Q

Name some other investigations and when they would be appropriate in lung cancer?

A
  • Fibreoptic bronchoscopy
    • define anatomy, obtain biopsy and cytological samples
  • Sputum cytology in people who have centrally placed nodules or massess who decline or cannot tolerate bronchoscopy
  • Endobronchial USS or transbronchial needle aspiration for biopsy
    • for peripheral lesions that cannot be seen by bronchoscopy
  • PET-CT offered before treatment
  • Bloods
    • FBC (anaemia)
    • LFT (liver mets)
    • U&Es (hypercalcaemia, hyponatraemia)
17
Q

What is offered for people with clinical features of intracranial pathology, and lung cancer?

A
  • CT of head, followed by MRI if normal
  • Investigating for brain metastases
18
Q

What are the some of the different managements for lung cancer?

A
  • Smoking cessation
  • Surgical resection -stage I-II tumours or lobar resection treatment of choice
  • Radiotherapy -stage I-III unsuitable for surgery
  • Chemotherapy -stage III-IV
  • Multidrug regimes
  • Palliative care -opiates, symptomatic pleural drainage/pleurodesis,sterids, radiotherapy, bronchodilators
19
Q

What is the usual management of small cell lung cancer?

A

Chemo

  • generally considered a systemic disease at presentation so vast majority receive palliative chemotherapy
  • SCLC most chemo-sensitive solid tuour
  • Most relapse 12months after chemo

Radiotherapy

  • is disease apprearse ‘limited stage’ at diagnosis may try radical radiotherapy. Indications are:
    1. Treatment of primary tumours
    2. Prophylactic cranial irradiation (brain metastases are frequent in SCLC)
    3. Palliative for symptom relief

Surgery

  • considered inappropriate for majority due to it being systemic disease
20
Q

What is the prognosis of small cell lung cancer? Prognostic factors?

A
  • Poor
  • Without treatment, median survival 2-4months
  • Median survival with systemic chemo is 6-12months
  • Prognostic factors
    • extent of disease at presentation
    • number of metastatic sites
    • performance status
    • degree of weight loss
    • biochemical abnormalities
21
Q

What are the treatment options with curative intent for non-small-cell lung cancers?

A

Surgery

  • Stage 1 and 2 managed with surgical resention =good prognosis
  • Mediastinal involvement contraindication
  • 30% cases suitable
  • Hilar & mediastinal lymph node sampling
  • Lobectomy who are well enough
  • Offer more extensive surgery when needed to obtain clean margins

Radiotherapy

  • Early stage unsuitable for surgery, radical radiotherapy given
  • for people stage I-IIa, 20% 5 year survival
  • 55 Gy in 20 fractions over 4 wks of 60-66Gy in 30-33 fractions in 6wks
  • CHART: Contnuous Hyperfractionated Accerlerated Radiotherpy given2 times a day for 12 days
  • Or can use SABR for early peripheral tumours
  • Palliative therapy can be given

Chemoradiotherapy

  • Mainstay of treatment for patients with metastatic or locally advanced disease
  • Combination regimens are used: Carboplatin and Gemcitabine or Caboplatin/Cisplatin and Pemetrexed

Immunotherapy

  • recently approved for patients with advanced NSCLC with high PDL1 expression
  • used either before or after chemo and small percentage of patients have prolonged benefit
  • stage II or III
22
Q

What is the prognosis of non-small cell lung cancer?

A
  • without treatment, prognosis short 3-6months
  • with chemo extends life by months to possibly over a year
  • if suitable for targeted treatment or immunotherapy, substantially longer and prognosis may be around 2 years in some cases

Oncology (14 decks)

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