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Respiratory > Lung Cancer > Flashcards

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
Q

what are the clinical signs of superior vena cava obstruction

A

Facial swelling, headache, migranes, edema, venous distension in veins of upper chest and arms, pembertons sign, orthopnoea

26
Q

what are the symptoms of pancoast tumours syndrome

A

horners syndrome - miosis, ptosis, anhidrosis, ipsilateral with leision

27
Q

what are the organs and symptoms of extrathroacic metastases

A 
Liver - pain
Bone - pain and cord compression
adrenal
asymptomatic
brain - mass effect
weight loss and confusion
28
Q

what are the various paraneoplastic phenomenon’s that can occur due to lung cancer (7)

A

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
Q

what are some features present on examination in someone with lung cancer

A 
Pale conjunctiva
Cachexia
Supra-claviclar lymph node
Clubbing
Reduced air entry
Afebrile
30
Q

what investigations should be used in suspected lung cancer?

A 
history + examination
Blood tests
CXR
Referral
Further Imaging - CT chest, PET, PET/CT, CT/MRI head
Tissue Biopsy
31
Q

what are the indications for a CXR in suspected lung cancer?

A

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
Q

What features may eb present on a chest CXR in someone with lung cancer?

A 
Mass lesions
Consolidation
Collapse
Pleural effusion
Pulmonary metastases
Erosion of ribs
33
Q

what are the various indications and timeframes for referral in lung cancer

A

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
Q

what are the various methods for tissue biopsy in lung cancer

A

bronchoscopy, mediastinoscopy, VATs, sputum cytology, EBUS/EUS, CT guided biopsy

35
Q

what are the types of bronchoscopy?

A

Flexible Bronchoscopy – if centrally located

Percutaneous FNA/biopsy – peripheral lesions, done with CT and anaesthia, pneumothorax complication

36
Q

when is a mediastinoscopy used?

A

Performed in patients with hilar and mediastinal masses

37
Q

when is sputum cytology used?

A

only be used in patients with large central lesions, where

 bronchoscopy or other diagnostic tests are deemed unsafe

38
Q

when is EBUS/EUS used?

A

for mediastinal masses in lung cancer, to obtain histological diagnosis if other biopsies have been inclusive, if nodal status will affect management

39
Q

which tumour classification is used for non small cell lung cancer

A

TNM
Tumour
Nodes
Mediastinal

40
Q

What are the different staging criteria for T

A

T1/2 tumours – resectable
T3 tumours – occasionally may be resectable
T4 tumours – invade vital structures; not resectable

41
Q

What are the different staging criteria for N

A

N1 – ipsilateral hilar tumour spread
N2 – ipsilateral mediastinal tumour spread; not resectable
N3 – contralateral mediastinal tumour/ supraclavicular tumour spread; not resectable

42
Q

What are the different staging criteria for M

A

M0 – no metastases

M1 – metatstatic disease

43
Q

What performance status score allows for radical surgery

A

0-1

44
Q

what performance status score allows for chemotherapy - palliative or radical

A

0-2

45
Q

What are the different treatment methods

A

Surgery, radiotherapy, chemotherapy, targeted therapies, immunotherapy, pain control

46
Q

What is the pulmonary function required for surgery

A

pulmonary function - FEV1 needs to be >2.0L for pneumonectomy and FEV1 needs to be >1.5L for lobectomy, assess with spirometry

47
Q

what are the side effects of radiotherapy?

A

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
Q

when should radiotherapy be offered?

A

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
Q

Chemotherapy use in NSCLC

A

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
Q

Chemotherapy use is SCLC

A

A platinum agent and etoposide should be the choice of treatment for SCLC
Duration of 3-6 cycles of chemotherapy in SCLC

51
Q

side effects of chemotherapy

A

nausea, vomiting, mucositis, diarrhoea, lassitude, infertility, alopecia, anaemia, neutropenia, thrombocytopenia, kidney and nerve toxicity, neutropenic sepsis

52
Q

What are the 3 mutations that can be targeted by therapies

A

EGFR mutations
ALK translocations
ROS1 translocations

53
Q

what targeted therapies can be used in EGFR mutations

A

Erlotinbib, Afatanib, Osmiertinib

54
Q

what targeted therapies can be used in ALK translocations

A

Crizotinib, Ceritinib

55
Q

what targeted therapies can be used in ROS1 translocations

A

Crizotinib

56
Q

what is the mechanism of immunotherapy agents used in lung cancer?

A

Checkpoint inhibitors targeting Programmed Cell Death 1 (PD-1)

57
Q

what immunotherapy agenst are used?

A

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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