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Stage 2: Cancer and Clinical Genetics > Lung Cancer > Flashcards

Lung Cancer Flashcards

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1
Q

What is stage III lung cancer?

A

When it is locally advanced i.e. lymph nodes or contralateral lung

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2
Q

What are the risk factors for lung cancer?

A
  • Cigarette smoking
  • Passive smoking
  • Occupational carcinogens - asbestos, radon
  • Pre-existing lung disease esp. fibrotic/scarring lung disease
  • Air pollution
  • HPV infection
  • Genetics e.g. EGFR
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3
Q

What scan would be a good screening tool for lung cancer?

A

CT

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4
Q

What types of pulmonary nodules identified on CT are more likely to be lung cancer?

A
  • Solid (ground glass soft abnormality less likely)

- > 4mm

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5
Q

What is a type of benign lung nodule?

A

Benign non-calcified pulmonary nodules

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6
Q

What are possible presenting features of lung cancer (local)?

A
  • Cough
  • Dyspnoea
  • Chest pain
  • Haemoptysis
  • Hoarseness
  • Dysphagia
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7
Q

What are possible presenting features of lung cancer (systemic)?

A
  • Anorexia and weight loss
  • Bone pain
  • Clubbing
  • Supraclavicular lymph nodes
  • Neurological manifestions
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8
Q

When should you suspect lung cancer in a pt?

A
  • Present with change in respiratory symptoms and no alternative explanation
  • Esp. if they are at risk
  • Second course of abx more expensive than CXR so should do CXR
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9
Q

Why do people with lung cancer often present late?

A
  • Bc pt may have had symptoms suggestive of lung cancer before
  • e.g. if have LRTI on a frequent basis or have COPD
  • Ignore symptoms until become quite troublesome
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10
Q

What investigations are required for optimum management of lung cancer?

A

1) Histological diagnosis
2) Accurate staging (CT/PET-CT/pathological staging)
3) Biomarker analysis

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11
Q

What are the two main histological subtypes of lung cancer?

A

1) Small cell lung cancer (10-15%)

2) Non-small cell lung cancer (80-85%)

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12
Q

Describe small cell lung cancer

A
  • Smokers
  • Neuroendocrine
  • Lethal - poor prognosis
  • Treatment effective in the short term
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13
Q

What are the 4 types of NSCLC?

A

1) Adenocarcinoma
2) Squamous cell carcinoma (more closely linked to smoking)
3) Large cell carcinoma
4) NSLC-NOS (not otherwise specified)

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14
Q

Describe the typical patient with adenocarcinoma NSCLC

A
  • Most common type in long-term non smokers or never-smokers
  • Esp. women
  • Delayed diagnosis bc never smoked
  • Early 40s/50s
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15
Q

What type of lung cancer does the EGFR mutation cause?

A

NSCLC lung adenocarcinoma

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16
Q

In ~2% of NSCLC adenocarcinomas what is the cause and why is this important?

A
  • Driver/stem mutations that drive the phenotype

- Treatment is available that is specific to these mutations and highly effective esp. EGFR

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17
Q

Why would you biopsy an enlarged node or other lesion in preference to the primary lesion?

A

If determination of stage affects treatment - gives staging and tissue diagnosis at the same time

18
Q

What investigations can be done to confirm diagnosis of lung cancer?

A

1) Bronchoscopy - for centrally located tumours
2) Transthoracic needle aspiration (US/CT) - for peripheral lesions, complications = PTX, bleeding
3) Endobronchial ultrasound for mediastinal/endobronchial disease and lymph nodes
4) FNA/biopsy of accessible metastatic site(s)

19
Q

How are most patients assessed?

A

By sampling of their primary tumour - mostly by bronchoscopy and CT guided needle biopsy

20
Q

In which patients would you do surgery?

A

Early disease

  • Stage I
  • Stage II
  • Some patients with stage IIIa
  • Patient needs to have adequate lung function and fit for surgery
21
Q

What is stage I lung cancer?

A

Disease localised to the chest with only involvement of regional lymph nodes

22
Q

What are the types of surgery for lung cancer?

A

1) Pneumonectomy
2) lobectomy
3) Segmentectomy
4) Lung-conserving procedures e.g. wedge resection

23
Q

What is the preferred type of surgery for lung cancer?

A

Lobectomy - risk of local recurrence lower even if just a small tumour (unless patient’s lung function would be severely affected)

24
Q

What is surgery for lung cancer often done in combination with?

A

Radiotherapy

25
Q

How do you treat small cell lung cancer?

A
  • Limited disease = treat radically with combination of chemotherapy, radiotherapy and prophylactic radiotherapy to the brain to prevent metastases
  • Advanced disease = chemotherapy + symptomatic treatment
  • Resistance to chemotherapy common
  • Rarely resectable
26
Q

How is NSCLC treated?

A

Chemotherapy

27
Q

What drug is used to treat patients with EGFR mutation?

A

Erlotinib (EGFR tyrosine kinase inhibitor)

28
Q

Where does lung cancer typically metastasise?

A
  • Brain
  • Breast
  • Adrenals
  • Bone
29
Q

What are some signs of lung cancer?

A
  • Pleural effusion
  • Bony tenderness
  • Hepatomegaly
30
Q

What are two complications of lung cancers?

A
  • SVCO

- Paraneoplastic syndromes

31
Q

What paraneoplastic syndromes occur in SCLC?

A
  • SIADH
  • ACTH (Cushing’s)
  • LEMS (Lambert Eaton Myasthenic syndrome)
32
Q

What paraneoplastic syndromes occur in NSCLC?

A
  • PTHrP - hypercalcaemia, brittle bones (squamous cell)

- HPOA (hypertrophic pulmonary osteoarthropathy)

33
Q

In which type of lung cancer can Horner’s syndrome occur?

A

NSCLC (Pancoast tumour) - adenocarcinoma + squamous cell carcinoma

34
Q

What investigations do you do for lung cancer?

A
  • CXR
  • CT
  • ± PET (NSCLC)
  • Bronchoscopy
35
Q

What is curative treatment for lung cancer?

A

Surgery + radio ± erlotinib

36
Q

What is palliative treatment for lung cancer?

A

Chemo ± radio

37
Q

What is Horner’s syndrome?

A

Ptosis, miosis, anhidrosis (same side of the body as the damaged nerve)

38
Q

What is the most common lung cancer?

A

Adenocarcinoma

39
Q

Describe adenocarcinoma?

A
  • Affects young asian women

- Peripherally located

40
Q

Which lung cancer is most associated with paraneoplastic syndromes?

A

Small cell

41
Q

In which lung cancer do you get hypercalcaemia?

A

Squamous cell

42
Q

In which lung cancer can you get b-HCG production?

A

Large cell (giant cell)

Stage 2: Cancer and Clinical Genetics (18 decks)

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