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Lung Cancer Flashcards

1
Q

what are the modifiable risk factors associated with lung cancer

A

age and genetics

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2
Q

what are the unmodifiable risk factors associated with lung cancer

A 
Smoking
Environmental tobacco smoke
Occupational exposures
Air pollution
Ionising radiation
Diet (low fruit and veg intake)
Other medical conditions
Social deprivation
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3
Q

what type of cells do lung cancers grow from?

A

epithelial cells

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4
Q

which risk factors are small cell lung cancer especially associated with

A

smoking, radon, asbestos, ionising radiation, air pollution, genes

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5
Q

lung cancers types can be split into…

A

small cell and non small cell

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6
Q

non small cell cancers can be split into

A

adenocarcinomas, squamous, carcinoid, large cell

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7
Q

what type of cell do small cell carcinomas originate from?

A

small immature neuroendocrine cells

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8
Q

where do small cell cancers develop from?

A

main bronchus

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9
Q

what speed to small cell cancers grow at?

A

grow fast and rapidly metastasize

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10
Q

what do small cell cancers secrete

A

ADH hormone, antidiuretic hormone, autoantibodies

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11
Q

what is the histological features of adenocarcinomas?

A

form glandular structures, generate mucins

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12
Q

where do adenocarcinomas grow

A

develop peripherally in bronchiole or alveoli wall

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13
Q

what are the histological features of squamous cell carcinomas?

A

square shaped cells, produce keratin

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14
Q

where do sqaumous cell develop?

A

centrally

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15
Q

what risk factor is espeically associated with squamous celled carcinomas

A

SMOKING

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16
Q

what substance do squamous celled carcinomas release?

A

PTH

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17
Q

what are the histological features of carcinoid tumours?

A

mature neuroendocrine cells

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18
Q

where do carcinoid tumours develop

A

thorughout

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19
Q

what substance do carcinoid tumours secrete

A

hormones

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20
Q

histological features of large cell carcinoma

A

lack glandular and squamous differentiation

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21
Q

where do large cell carcinomas develop

A

found throughout

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22
Q

what do large cell carcinomas secrete

A

B-hCG

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23
Q

cell process to become cancerous

A

cells mutate, multiply uncontrollably and develop angiogenesis

24
Q

what are the intrathoracic effects of lung tumours (9)

A

cough, dyspnoea, chest pain, haemoptysis, chest infection, hoarseness, pleural effusion, superior vena cava obstruction, horners syndrome

25
what are the clinical signs of superior vena cava obstruction
Facial swelling, headache, migranes, edema, venous distension in veins of upper chest and arms, pembertons sign, orthopnoea
26
what are the symptoms of pancoast tumours syndrome
horners syndrome - miosis, ptosis, anhidrosis, ipsilateral with leision
27
what are the organs and symptoms of extrathroacic metastases
``` Liver - pain Bone - pain and cord compression adrenal asymptomatic brain - mass effect weight loss and confusion ```
28
what are the various paraneoplastic phenomenon's that can occur due to lung cancer (7)
Hypercalcaemia – parathyroid hormone-related protein, TGF-a, TNF, IL-1 SIADH secretion – antidiuretic hormone Neurologic manifestations – autoimmune reaction, inflammation Haematological manifestations – erythropoietin, mucins, hypercoagulability Hypertrophic osteoarthropathy Dermatomyositis, polymyositis - immunologic Cushing’s syndrome – ectopic ACTH and ACTH-like substance
29
what are some features present on examination in someone with lung cancer
``` Pale conjunctiva Cachexia Supra-claviclar lymph node Clubbing Reduced air entry Afebrile ```
30
what investigations should be used in suspected lung cancer?
``` history + examination Blood tests CXR Referral Further Imaging - CT chest, PET, PET/CT, CT/MRI head Tissue Biopsy ```
31
what are the indications for a CXR in suspected lung cancer?
Unexplained/persistent haemoptysis (urgent) 3 week history of the following unexplained: • Cough • Chest or shoulder pain • Dyspnoea • Weight loss • Hoarseness • Chest signs or finger clubbing • Persistent lymphadenopathy (cervical/supraclavicular) Features suggestive of metastases
32
What features may eb present on a chest CXR in someone with lung cancer?
``` Mass lesions Consolidation Collapse Pleural effusion Pulmonary metastases Erosion of ribs ```
33
what are the various indications and timeframes for referral in lung cancer
Urgent referral to a respiratory physician is necessary in the following cases:  Persistent haemopytsis if a smoker or ex-smoker and over 40 years old  If chest x-ray is suspicious of lung cancer  If there are signs of superior vena cava obstruction  Stridor (emergency referral needed) Urgent referral of patients with unexplained non-specific symptoms suggestive of lung cancer if present >6 weeks
34
what are the various methods for tissue biopsy in lung cancer
bronchoscopy, mediastinoscopy, VATs, sputum cytology, EBUS/EUS, CT guided biopsy
35
what are the types of bronchoscopy?
Flexible Bronchoscopy – if centrally located | Percutaneous FNA/biopsy – peripheral lesions, done with CT and anaesthia, pneumothorax complication
36
when is a mediastinoscopy used?
Performed in patients with hilar and mediastinal masses
37
when is sputum cytology used?
only be used in patients with large central lesions, where |  bronchoscopy or other diagnostic tests are deemed unsafe
38
when is EBUS/EUS used?
for mediastinal masses in lung cancer, to obtain histological diagnosis if other biopsies have been inclusive, if nodal status will affect management
39
which tumour classification is used for non small cell lung cancer
TNM Tumour Nodes Mediastinal
40
What are the different staging criteria for T
T1/2 tumours – resectable T3 tumours – occasionally may be resectable T4 tumours – invade vital structures; not resectable
41
What are the different staging criteria for N
N1 – ipsilateral hilar tumour spread N2 – ipsilateral mediastinal tumour spread; not resectable N3 – contralateral mediastinal tumour/ supraclavicular tumour spread; not resectable
42
What are the different staging criteria for M
M0 – no metastases | M1 – metatstatic disease
43
What performance status score allows for radical surgery
0-1
44
what performance status score allows for chemotherapy - palliative or radical
0-2
45
What are the different treatment methods
Surgery, radiotherapy, chemotherapy, targeted therapies, immunotherapy, pain control
46
What is the pulmonary function required for surgery
pulmonary function - FEV1 needs to be >2.0L for pneumonectomy and FEV1 needs to be >1.5L for lobectomy, assess with spirometry
47
what are the side effects of radiotherapy?
dependent on areas irradiated, erythema, telanectasia, tiredness (radical), nausea/vomiting (stomach/liver/brain), diarrhoea/cystitis (abdo/pelvic), mucositis (head/neck), pneumonitis (acute/chronic), cardiac damage, bone marrow suppression
48
when should radiotherapy be offered?
Patients with NSCLC stage 1 or 2 who are medically inoperable or not consenting to surgery Patients with IIIA or IIIB disease, if the tumour can be encompassed within a radical radiotherapy volume, who have WHO PS 0 or 1, and have less than 10% weight loss
49
Chemotherapy use in NSCLC
Platinum-based combination chemotherapy is recommended for patients with stage IIIb and IV NSCLC Not recommended for NSCLC performance status 3 or 4 Maximum of 4 cycles in patients with advanced NSCLC
50
Chemotherapy use is SCLC
A platinum agent and etoposide should be the choice of treatment for SCLC Duration of 3-6 cycles of chemotherapy in SCLC
51
side effects of chemotherapy
nausea, vomiting, mucositis, diarrhoea, lassitude, infertility, alopecia, anaemia, neutropenia, thrombocytopenia, kidney and nerve toxicity, neutropenic sepsis
52
What are the 3 mutations that can be targeted by therapies
EGFR mutations ALK translocations ROS1 translocations
53
what targeted therapies can be used in EGFR mutations
Erlotinbib, Afatanib, Osmiertinib
54
what targeted therapies can be used in ALK translocations
Crizotinib, Ceritinib
55
what targeted therapies can be used in ROS1 translocations
Crizotinib
56
what is the mechanism of immunotherapy agents used in lung cancer?
Checkpoint inhibitors targeting Programmed Cell Death 1 (PD-1)
57
what immunotherapy agenst are used?
Pembroluzimab - Can be used 1st line if PD-L1 expression > 50%, Otherwise 2nd line if PD-L1 >1% Nivolumab - Can be used 2nd line regardless of PD-L1

Respiratory (12 decks)

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