Lung Cancer Flashcards
How common is Lung cancer in the UK?
It is the 3rd most common cancer in the UK behind breast and prostate.
What is the main cause of lung cancer?
Cigarette smoking - 80% of cancers preventable.
What is the histology of lung cancer?
Non-small cell lung cancer:
- squamous cell carcinoma (35%)
- Adenocarcinoma (25%)
Small cell lung cancer (20%)
How are small cell cancers responsible for paraneoplastic syndromes?
Small cell lung cancers contain neurosecretory granules that can release neuroendocrine hormones.
What is a paraneoplastic syndrome?
A syndrome that is the consequence of cancer in the body specifically due to the production of chemical signalling molecules (such as hormones or cytokines) by the tumour cells or by an immune response against the tumour.
What are the signs and symptoms of lung cancer?
- SOB
- Cough
- Haemoptysis
- Finger clubbing
- Recurrent pneumonia
- Weight loss
- Lymphadenopathy - often supraclavicular nodes are the first to be found on examination.
What investigations should be carried out to investigate lung cancer?
- CXR - 1st line.
- Staging CT scan - contrast enhanced
- PET-CT
- Bronchoscopy with endobronchial ultrasound (EBUS)
- Histological diagnosis
What findings on a CXR are suggestive of lung cancer?
- Hilar enlargement
- Peripheral opacity - a visible lesion in the lung field
- Pleural effusion - usually unilateral in cancer
- Collapse
Why is a staging CT scan useful in lung cancer?
- Helps to establish the stage and check for lymph node involvement and metastasis.
What is the benefit of using contrast enhanced staging CT scan in lung cancer?
This gives more detailed information about different tissues.
What is the rationale for using a PET-CT in lung cancer?
PET-CT injects a radioactive tracer - normally attached to glucose molecules. Therefore taking images using a combination of a CT scanner and a gamma ray detector help to visualise how metabolically active various tissues are. Therefore this is useful in identifying areas that the cancer has spread to by showing areas of increased metabolic activity suggestive of cancer.
What is the benefit of using EBUS with lung cancer?
Bronchoscopy with endobroncial ultrasound is endoscopy of the airways with ultrasound on the end of the scope. This allows for detailed assessment of the tumour and ultrasound guided biopsy.
What are the 2 methods for obtaining a histological sample of lung cancer?
- Bronchoscopy
2. Percutaneously
What is the treatment in non-small cell lung cancer?
- Surgery - in patients that have disease isolated to a single area with intention to cure the cancer.
- Lobectomy = first line.
- Segmentectomy or wedge resection is also an option. - Radiotherapy if early can be curative
- Chemotherapy in addition to surgery or radiotherapy to improve outcomes (adjuvant chemotherapy) or as palliative
What is the first line treatment for non-small cell cancer?
Surgery - Lobectomy/segmentectomy.
What is the treatment for small cell cancer?
- usually chemotherapy and radiotherapy. Prognosis is worse for small cell lung cancer than non-small cell cancer.
Endobrachial treatment with stents or debulking can be used as part of palliative treatment to relieve bronchial obstruction caused by lung cancer.
How is recurrent laryngeal nerve palsy related to lung cancer?
recurrent laryngeal nerve palsy presents with hoarse voice. It is cause by the cancer pressing on or affecting the recurrent laryngeal nerve as it passes through the mediastinum.
How is phrenic nerve palsy related to lung cancer?
Due to nerve compression causing the diaphragm to weaken and presents as shortness of breath.
How does superior vena cava obstruction result as a complication of lung cancer?
It is caused by direct compression of the tumour on the superior vena cava.
How does superior vena cava obstruction present?
Facial swelling
Difficulty breathing
Distended veins in the neck and upper chest
Pemberton’s sign - when raising the hands over the head causes facial congestion and cyanosis - Medical emergency
What is Horner’s syndrome?
Triad of - partial ptosis, miosis and anhidrosis.
Caused by Pancoast’s tumour - tumour in the pulmonary apex, pressing on the sympathetic ganglion
How is SIADH caused by small cell lung cancer?
SIADH is caused by ectopic ADH secretion by a small cell lung cancer and presents with hyponatraemia.
How can Cushing’s syndrome be caused by small cell lung cancer?
ectopic ACTH secretion by a small cell lung cancer.
How can hypercalcaemia be caused by a squamous cell carcinoma?
ectopic parathyroid hormone from a squamous cell carcinoma.
