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Year 3 - CR > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

What increases the risk of lung cancer

A
  • Smoking
  • Asbestos
  • Radiation (environmental radon)
  • Arsenic
  • Chromium
  • Coal tar and oils
  • Iron oxides
  • Recent study: pollution
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2
Q

What is the increase in passive smoking on lung cancer

A
  • passive smokers have a 1.5 fold increased risk

- but this depends on the quantity inhaled

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3
Q

how much lung cancers occurs in non-smokers

A

15% of lung cancers occurs in non-smokers

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4
Q

if you stop smoking what happens to the risk of lung cancer

A
  • stopping smoking does not lower the risk back down to non-smoking levels - but it does increase life expectancy
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5
Q

What are the genetic mechanisms of lung cancer

A
  • Activation of oncogenes e.g. KRAS, myc family of oncogenes. EGFR and ALK mutations
  • Inactivation of tumour suppressor genes e.g. p53
  • Autocrine growth factors e.g. derivatives of nicotine found in smoke
  • Inherited predisposition (details not fully known)
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6
Q

what are the types of lung cancer

A
  • Small cell (oat cell) lung cancer (SCLC) 10%

- Non small cell lung cancer (NSCLC)

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7
Q

Name the types of non small cell lung cancer

A
  • Squamous cell carcinoma 20-30%
  • Adenocarcinoma 40-50%
  • Large cell carcinoma 10-15%
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8
Q

What are the features of small cell carcinoma

A
  • Aggressive, early spread, usually inoperable as spreads easily
  • May respond to chemotherapy due to rapidly dividing cells
  • Endocrine cells: hormones produced
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9
Q

who is squamous cell carcinoma tend to be in

A

smokers

- often cavities

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10
Q

describe large cell carcinomas

A
  • Undifferentiated

- Early metastasis

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11
Q

Name an example of large cell carcinoma

A
  • bronchoalveolar cell (adenocarcinoma in situ)
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12
Q

what does a bronchoalveolar cell (adenocarcinoma in situ) resemble

A
  • may resemble a pneumonia
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13
Q

What are the indications that call for an urgent CXR if you suspect lung cell carcinoma

A
  • haemoptysis

Any of the following for greater than 3 weeks unexplained:

  • cough
  • chest/shoulder pain
  • dyspnoea
  • weight loss
  • chest signs

Other things

  • hoarseness - tumour in left side compressing recurrent laryngeal nerve
  • clubbing
  • features of mets
  • Supraclavicular / Cervical lymphadenopathy
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14
Q

What are chest signs of lung cancer

A
  • Visible swelling
  • Facial swelling
  • Distended veins - superior vena cava disrupted syndrome
  • Reduced expansion
  • Dullness, ↓TVF and VR
  • Wheeze – esp. unilateral
  • Reduced breath sounds
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15
Q

what paraneoplastic syndromes can be caused by small cell lung cancer

A
  • Cushing’s syndrome (ectopic ACTH)
  • SIADH
  • Lambert Eaton myasthenic syndrome
  • Limbic encephalitis
  • Cerebellar syndrome

Any – but more common in SCLC
- Dermatomyositis

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16
Q

What paraneoplastic syndrome is in squamous cell carcinoma

A
  • parathyroid hormone-related protein (PTH-rp) secretion causing hypercalcaemia
  • clubbing
  • hypertrophic pulmonary osteoarthropathy (HPOA)
    hyperthyroidism due to ectopic TSH
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17
Q

what should cause a 2 week wait referral for lung cancer

A

If the CXR or CT scan suggests lung cancer including:

  • pleural effusion
  • slowly resolving consolidation

If the CXR (or CT) is normal, but there is a high clinical suspicion of lung cancer, the patient should be referred

18
Q

When should patients be referred whilst having to wait for a CXR

A

Patients should be referred whilst awaiting a CXR in the presence of:

  • Persistent haemoptysis in smokers/ex-smokers older than 40 years
  • signs of superior vena caval obstruction (swelling of the face/neck with fixed elevation of jugular venous pressure)
  • Stridor

Emergency referral should be considered for patients with superior vena cava obstruction or stridor.

19
Q

What investigations do you use to stage and diagnose lung cancer

A
  • CT of chest
  • bronchoscopy
  • CT guided biopsy
  • PET scan
  • MRI scan for pancoast tumours not used so much for lung cancer
  • blood tests - urea and electrolytes for IV contrast which can be dangerous for people in renal impairment
20
Q

What does staging involved when using a CT scan

A

“Staging” CT of chest – includes upper abdomen to cover liver, adrenals and kidneys

21
Q

What are the other staging investigations can be used

A
  • Transbronchial “blind” FNA
  • EBUS guided FNA - can look at lymph nodes or tumours that are sitting near the bronchi, can put a fine needle and take samples
  • EUS guided FNA
  • Mediastinoscopy
  • Bone scan
  • Brain CT/MRI
22
Q

Describe the TNM staging for lung cancer

A

T – based on size and location of tumour.

  • T1 is a small peripheral tumour which may be removed surgically (Stage 1 or 2)
  • T4 is an advanced large tumour invading e.g. heart (Stage 3)

N – depends on which lymph nodes are involved

  • N1 – hilar (Stage 2),
  • N2 – mediastinal
  • N3 – contralateral (Stage 3)

M – if metastases are present: M1 (Stage 4)
- Common sites: liver, lungs, adrenals, brain, bones

23
Q

What is the only curative treatment for lung cancer

A
  • Surgery
24
Q

describe what lung cancers can be surgically treated

A
  • For localised tumours that are not invading other organs e.g. heart, bones
  • No signs of spread – have to perform a PET scan
  • It is the only chance of a “cure”
  • 5 – 10% are suitable
25
Q

What is the survival rate for lung cancer

A

70% 5 year survival with successful surgery and a small tumour

26
Q

name other treatments for lung cancer

A
  • Radical radiotherapy
  • palliative radiotherapy
  • chemotherapy
  • immunotherapy
  • adjuvant chemotherapy
  • Neo-adjuvant chemotherapy
27
Q

Describe radical radiotherapy

A

May be useful in squamous cell carcinoma where surgery not possible (lymph nodes involved, patient declines or not fit)

28
Q

What are the complications of radical radiotherapy

A
  • Pneumonitis (early)
  • fibrosis (late)
  • oespheogitis
29
Q

what is palliative radiotherapy used for

A

To relieve pain, haemoptysis, neurological problems (brain or spinal metastases

30
Q

describe chemotherapy use in lung cancer

A
  • Cisplatin, pemetrexed, gemcitabine
  • Oral therapy: EGFR antagonists like gefitinib, erlotinib
  • ALK (anaplastic lymphoma kinase) mutation: Crizotinib, ceritinib, alectinib
  • Newer agents: atezolizumab, durvalumab
  • T790M mutation: osimertinib
31
Q

what immunotherapy can be used

A

pembrolizumab (for PD-L1 positive tumours)

32
Q

when is adjuvant chemotherapy given

A

Chemotherapy given after surgery to try to reduce chance of recurrence – usually if disease is found in a hilar lymph node

33
Q

When is Neo-adjuvant chemotherapy given

A

Chemotherapy given before surgery to try to make sure that the cancer is as well controlled as possible

34
Q

Name some other palliative therapies

A
  • Endobronchial laser to relieve obstruction, breathlessness, haemoptysis
  • Stenting to relieve breathlessness
  • Endobronchial radiotherapy (brachytherapy)
35
Q

Name some general palliative treatments

A
  • Painkillers
  • Antitussives
  • Oxygen
  • Steroids
36
Q

Why is it important to have histopathology of lung cancer

A
  • To differentiate between small cell lung cancer and large cell lung cancer
37
Q

Where does small cell carcinoma differentiate from

A

Arise from endocrine cells (Kulchitsky cells), often secreting polypeptide hormones

38
Q

What tumours spread to the lungs

A
  • stomach
  • pancreas
  • breast
39
Q

Where does lung cancer metastasise to

A
  • the other lung
  • adrenal gland
  • bones
  • brain
  • liver
40
Q

What pareneoplastic syndrome is seen in adenocarcinoma

A
  • gynaecomastia

- hypertrophic pulmonary osteoarthropathy (HPOA)

Year 3 - CR (44 decks)

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