Lung Cancer Flashcards
How common is lung cancer?
Third most common cancer in the UK behind breast and prostate
What are the histiological types of lung cancer?
Small Cell
Non Small Cell
- Squamous
- Adenocarcinoma
What are the two sub-types of non-small cell lung cancer?
Squamous
Adenocarcinoma
What is the most common sub-type of lung cancer?
Squamous
What are the causes of lung cancer?
Smoking
Asbestos
Air pollution
FH
Pulmonary fibrosis
Nickel
Radiotherapy
Which type of lung cancer has the strongest association with smoking?
Squamous
What type of lung cancer is the most common in non smokers?
Adenocarcinoma
Where are squamous lung tumours typically located?
Centrally
Where are adnocarcinoma lung tumours typically located?
Peripherally
Where are small cell lung cancers typically located?
Perihilar/central
Describe the presentation of lung cancer
Weight loss
Tracheal deviation
Lymphadenopathy
Cough
- Earliest symptom due to tumour irritating airways
Dyspnoea
- Tumour obstructing airways or fluid in lungs
Hoarse voice
- Compression of laryngeal nerve
Haemoptysis
- Tumour is in major airways
Horner’s Syndrome
Clubbing
- Squamous
Acanthosis Nigrins
Anaemia
Hepatomegaly
Superior vena cava obstruction
- Dilated veins
- Progressive facial and upper limb swelling
Brachial plexus obstruction
Gynaecomastia
- Adenocarcinoma
What are the extrapulmonary manifestations of lung cancer?
Recurrent laryngeal nerve palsy
Phrenic nerve palsy
SVC obstruction
Horner’s syndrome
Syndrome of inappropriate ADH/hyponatraemia
Cushing’s syndrome
Hypercalcaemia/ectopic PTH
Limbic encephalitis
Lambert-Eaton myasthenic syndrome
What is Horner’s Syndrome and how does it present?
Cervical sympathetic nerve obstruction
< Sweating/Anhidrosis
Miosis/constricted pupil
Drooping eyelid/ptosis
Endophthalmos/posterior displacement of eye
What type of tumour causes Horner’s Syndrome
Upper lung pan coast tumour
What investigations are used in lung cancer diagnosis and management?
CT/PET
- Staging
CXR
- Shows pulmonary mass/opacity
- Golden S Sign
Bronchoscopy/EBUS and biopsy
- Histological diagnosis
>Ca2+/Hypercalcaemia
- Squamous
- Small cell
>TSH
- Squamous
Why does hypercalcaemia occur in lung cancer?
Squamous lung cancer associated with PTH related peptide production
What are complications of small cell lung cancer?
Inappropriate ACTH production, which causes Cushing’s
Inappropriate ADH production/hyponatremia
Lambert-Eaton myasthenia syndrome
What are complications of non small cell lung cancer?
Hypercalcaemia
Hyperthyroidism
Where can lung cancer metastasise to?
Kidney
Brain
Lymph nodes
Bone/Axial skeleton
Adrenal glands
Liver
Describe the T classifications of TNM staging of lung cancer
T1: <3cm
T2: >3cm, 2cm from carina
T3: >7cm
What is the management of lung cancer?
Surgery
- Lobectomy
- Pneumonectomy
Chemotherapy
- First line for small cell
Radiotherapy
- For non-operable non-small cell
Endobronchial treatment for palliative care
- Stents
- Debulking
- PD-1 and PD-L1
What is first line management in non-small cell lung cancer?
Lobectomy
What is first line management in small cell lung cancer?
Chemotherapy
When is a Lobectomy appropriate lung cancer management?
FEV1>1.5l
When is a Pneumonectomy appropriate lung cancer management?
FEV1>2l
Give contraindications for lung cancer surgery
SVC obstruction
FEV<1.5
Malignant pleural effusion
Vocal cord paralysis
Tumour near hilum
What is Mesothelioma?
Cancer of the mesothelial layer of the pleural cavity that is strongly associated with asbestos exposure
What is the management of mesothelioma?
Treatment is palliative
Chemotherapy
Surgery
Pleural aspiration/chest drain
Pleurodhesis
How long after asbestos exposure does mesothelioma develop?
20-40 years post exposure
What is the prognosis of mesothelioma?
Poor, average survival 12 months
What cancer is SVCO most commonly associated with?
Small cell lung cancer
Give features of SVCO
Dyspnoea, most common presenting symptom
Swelling of the face, neck and arms
Headache, often worse in the morning
Visual disturbance
Pulseless jugular venous distention
Pemberton sign positive, diagnostic
