Lung Cancer Flashcards
Which cancer has the highest rates of mortality?
lung cancer
Which cancer is the most deadly?
pancreatic
How do patients with lung cancer present?
Incidentally (6%)/Screening
Symptoms/Signs of Primary Tumor
Symptoms/Signs of Metastases
Paraneoplastic Syndromes
What are the sign and symptoms of primary lung cancer?
Central tumours – cough, hemoptysis, SOB, SVC Obstruction
Peripheral tumours- usually asymptomatic, may present with chest wall pain or as a Pancoast tumor
- Pancoast syndrome – shoulder/arm pain, Horner’s syndrome, arm weakness/muscle atrophy
what is horner’s syndrome?
Horner’s- miosis (constriction of the pupils), anhidrosis (lack of sweating), ptosis (drooping of the eyelid), enophthalmos (recession of the eyeball within the orbit)
What usually happens with SVCO?
One of the signs sometimes seen with SVCO includes engorgement of superficial chest vascular, as collateralization of blood flow occurs.
What is a pancoast tumor?
Pancoast tumours, or superior sulcus tumours, present in the apex of the lung and involve the cervical sympathetic and brachial plexus, resulting in the aforementioned signs and symptoms.
What are usually sign/symptoms of metastatic lung cancer?
Nodal : neck mass
Bone : pain, pathological fracture, spinal cord compression
Liver : right upper quadrant pain, weight loss, fatigue anorexia
Brain : headache, neurological deficit, seizures, nausea
What is paraneoplastic syndrome?
Signs and symptoms caused by the cancer but not directly related to the primary or its metastases:
Endocrine
Hypercalcemia, hyponatremia (SIADH), Cushing’s syndrome
Neurologic
Immune-mediated with autoantibodies
Hematologic
Anemia, leukocytosis, thrombocytosis
Dermatologic
Hypertrophic pulmonary osteoarthropathy (clubbing)
T or F: it is common for solid tumors from other sites to metastasize to lungs
T: ie. Breast cancer GI cancers Renal cell carcinoma Melanoma
For a primary lung cancer, what is the most important pathological info ?
Non-small cell [surgical disease] versus small cell
Why cancer staging is important?
Vital for : treatment decisions prognosis comparing outcomes of different treatments communicating with other physicians
What characteristic does the NSCLC (non-small cell lung cancer) staging system use?
T ( tumour)
N (node)
M (metastases)
How does the SCLC stage work?
limited disease vs. extensive disease
What is limited disease according to SCLC?
confined to one hemithorax including mediastinal and supraclavicular nodes
can encompass all disease in a tolerable radiation volume
treated with curative intent (median survival still only 18 months, ~15% long term survivors)
What is extensive disease according to SCLC?
anything else
65%-70% present with extensive disease
palliative
What is the usual investigation for lung cancer suspicion?
Chest X-ray: central/peripheral, effusion, mediastinal nodes, other nodules, bone mets
CT Scan (chest/upper abd): mediastinal nodes, metastases
Bronchoscopy: tissue diagnosis and staging
Mediastinoscopy: tissue diagnosis and staging
- Surgical procedure
Percutaneous transthoracic biopsy
Pulmonary function tests
- Important to assess pulmonary reserve prior to treatment
Positron Emission Tomography (PET) Scan
What is the treatment for a patient with NSCLC at stage 1/2?
Treatment of choice is surgical resection of lung
Adjuvant chemotherapy after surgical resection in certain patients
What is the treatment for a patient with NSCLC at stage 3?
Selected patients who are not resectable are treated with chemotherapy and radiotherapy with curative intent
What is the treatment for a patient with NSCLC at stage 4?
85% of patients will either present with or develop metastatic disease
Treatment intent is palliation of symptoms and prolongation of survival
Patients with localized symptoms (cough, SOB, hemoptysis, bone pain, brain mets) usually receive palliative radiation therapy initially
What is the treatment for a patient with SCLC ?
Chemotherapy the mainstay of treatment and is the only treatment shown to alter the course of the disease
-In patients with limited stage disease, combined with thoracic radiation therapy
