Lung Cancer Flashcards
What accounts for 90% of lung cancer?
Cigarette smoking
What are some risk factors for lung cancer apart from smoking?
Radon exposure Asbestos Older age Male sex Family history Pre-existing lung disease HIV infection
What are the 4 main types of lung cancer
Small cell
Large cell
Squamous cell
Adenocarcinoma
Which lung cancer is the most common among smokers?
Squamous cell
How does squamous cell lung cancer spread, and where to?
Local spread common, metastases later Pleura Ribs Lymph nodes Oesophagus
What conditions are associated with squamous cell lung cancer?
Parathyroid hormone (PTH) related protein secretion, causing hypercalcaemia Hypertrophic pulmonary osteoarthropathy
Where in the lung do all the types of cancer most commonly appear?
Squamous and small cell -central
Adenocarcinoma and large cell - periphery
What is the most common lung cancer overall?
Adenocarcinoma
Adenocarcinomas do not commonly metastasise, true or false?
False - metastases are common
What is the least common lung cancer?
Large cell
What may large cell lung cancer secrete?
Beta-hCG
Large cell lung cancer metastasises early but has good prognosis, true or false?
False - metastasises early but bad prognosis
Small cell lung cancer is rapidly progressive and metastasises early, true or false?
True
What can small cell lung cancer produce, and what does this cause?
ACTH
- Cushing’s syndrome
- Bilateral adrenal hyperplasia
- Hypokalaemic alkalosis
What syndrome can be caused by lung cancer, and which type causes it?
Lambert-Eaton syndrome
Caused by small cell
What are the common metastases from primary lung cancer?
Brain
Bone
Liver
Adrenal
What are the signs of brain metastases?
Weakness like a stroke Visual disturbance Headache due to increased cranial pressure No photophobia Fits
Which cancers metastasise TO the lungs?
Breast Colorectal Renal Prostate Bladder Melanoma
What are symptoms of lung cancer?
Cough Haemoptysis Breathlessness Chest wall pain Recurrent infection Weight loss Tiredness
What syndrome do Pancoast tumours cause?
Horner’s syndrome - disturbance of sympathetic chain
What are signs of lung cancer?
Clubbing Cachexia Lymphadenopathy Cushing's syndrome Dull percussion
It is common for lung cancer to be asymptomatic until late stages, true or false?
True
What are some investigations that can diagnose lung cancer?
CXR
CT thorax
Bronchoscopy + biopsy
FNA for peripheral lesions and lymph nodes
What is the treatment for small cell lung cancer?
Chemotherapy +/- radiotherapy
Rarely appropriate for surgery as it metastasises early
What is the treatment for non-small cell lung cancer?
Excision in peripheral tumours with no metastases
Chemotherapy +/- radiotherapy
What are the options for palliative care in lung cancer?
Palliative chemotherapy and radiotherapy
Stenting of the trachea or oesophagus
Analgesia
Antiemetics
What can cause hoarse voice in lung cancer?
Local invasion into the recurrent laryngeal nerve
What can cause localised chest pain, worse with movement in lung cancer?
Chest wall invasion
What can cause pleural effusion in lung cancer?
Local invasion into the pleural cavity
What is mesothelioma?
Malignancy of the pleura (mesothelial cells)
What is the chief causative agent for mesothelioma?
Asbestos
What are risk factors for mesothelioma?
Asbestos
Age 60-85
Male
Radiation exposure
Mesothelioma usually presents about 5 years after exposure to asbestos, true or false?
False - usually about 40 years after exposure
What are the symptoms of mesothelioma?
Chest pain Shortness of breath Diminished breath sounds Dullness to percussion Cough Recurrent pleural effusion Non-specific features
What are the investigations for mesothelioma?
CT (can do CXR too but CT better)
Pleurocentesis
Thoracoscopy and biopsy
What are some features of mesothelioma found on imaging?
Pleural thickening
Pleural effusion
What is the treatment for mesothelioma?
No curative options
Palliative chemotherapy or radiotherapy
Instillation of sclerosant substances to prevent re-accumulation of pleural effusions
What are common metastasis sites for mesotheliomas?
The other pleural cavity
Lung
Hilar lymph nodes
