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Respiratory > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

How common is lung cancer?

A

Third most common cancer in the UK behind breast and prostate

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2
Q

What are the histiological types of lung cancer?

A

Small Cell

Non Small Cell

  • Squamous
  • Adenocarcinoma
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3
Q

What are the two sub-types of non-small cell lung cancer?

A

Squamous

Adenocarcinoma

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4
Q

What is the most common sub-type of lung cancer?

A

Squamous

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5
Q

What are the causes of lung cancer?

A

Smoking

Asbestos

Air pollution

FH

Pulmonary fibrosis

Nickel

Radiotherapy

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6
Q

Which type of lung cancer has the strongest association with smoking?

A

Squamous

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7
Q

What type of lung cancer is the most common in non smokers?

A

Adenocarcinoma

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8
Q

Where are squamous lung tumours typically located?

A

Centrally

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9
Q

Where are adnocarcinoma lung tumours typically located?

A

Peripherally

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10
Q

Where are small cell lung cancers typically located?

A

Perihilar/central

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11
Q

Describe the presentation of lung cancer

A

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
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12
Q

What are the extrapulmonary manifestations of lung cancer?

A

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

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13
Q

What is Horner’s Syndrome and how does it present?

A

Cervical sympathetic nerve obstruction

< Sweating/Anhidrosis

Miosis/constricted pupil

Drooping eyelid/ptosis

Endophthalmos/posterior displacement of eye

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14
Q

What type of tumour causes Horner’s Syndrome

A

Upper lung pan coast tumour

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15
Q

What investigations are used in lung cancer diagnosis and management?

A

CT/PET

  • Staging

CXR

  • Shows pulmonary mass/opacity
  • Golden S Sign

Bronchoscopy/EBUS and biopsy

  • Histological diagnosis

>Ca2+/Hypercalcaemia

  • Squamous
  • Small cell

>TSH

  • Squamous
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16
Q

Why does hypercalcaemia occur in lung cancer?

A

Squamous lung cancer associated with PTH related peptide production

17
Q

What are complications of small cell lung cancer?

A

Inappropriate ACTH production, which causes Cushing’s

Inappropriate ADH production/hyponatremia

Lambert-Eaton myasthenia syndrome

18
Q

What are complications of non small cell lung cancer?

A

Hypercalcaemia

Hyperthyroidism

19
Q

Where can lung cancer metastasise to?

A

Kidney

Brain

Lymph nodes

Bone/Axial skeleton

Adrenal glands

Liver

20
Q

Describe the T classifications of TNM staging of lung cancer

A

T1: <3cm

T2: >3cm, 2cm from carina

T3: >7cm

21
Q

What is the management of lung cancer?

A

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
22
Q

What is first line management in non-small cell lung cancer?

A

Lobectomy

23
Q

What is first line management in small cell lung cancer?

A

Chemotherapy

24
Q

When is a Lobectomy appropriate lung cancer management?

A

FEV1>1.5l

25
Q

When is a Pneumonectomy appropriate lung cancer management?

A

FEV1>2l

26
Q

Give contraindications for lung cancer surgery

A

SVC obstruction

FEV<1.5

Malignant pleural effusion

Vocal cord paralysis

Tumour near hilum

27
Q

What is Mesothelioma?

A

Cancer of the mesothelial layer of the pleural cavity that is strongly associated with asbestos exposure

28
Q

What is the management of mesothelioma?

A

Treatment is palliative

Chemotherapy

Surgery

Pleural aspiration/chest drain

Pleurodhesis

29
Q

How long after asbestos exposure does mesothelioma develop?

A

20-40 years post exposure

30
Q

What is the prognosis of mesothelioma?

A

Poor, average survival 12 months

31
Q

What cancer is SVCO most commonly associated with?

A

Small cell lung cancer

32
Q

Give features of SVCO

A

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

Respiratory (14 decks)

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