Lung Cancer Flashcards
What is stage III lung cancer?
When it is locally advanced i.e. lymph nodes or contralateral lung
What are the risk factors for lung cancer?
- 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
What scan would be a good screening tool for lung cancer?
CT
What types of pulmonary nodules identified on CT are more likely to be lung cancer?
- Solid (ground glass soft abnormality less likely)
- > 4mm
What is a type of benign lung nodule?
Benign non-calcified pulmonary nodules
What are possible presenting features of lung cancer (local)?
- Cough
- Dyspnoea
- Chest pain
- Haemoptysis
- Hoarseness
- Dysphagia
What are possible presenting features of lung cancer (systemic)?
- Anorexia and weight loss
- Bone pain
- Clubbing
- Supraclavicular lymph nodes
- Neurological manifestions
When should you suspect lung cancer in a pt?
- 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
Why do people with lung cancer often present late?
- 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
What investigations are required for optimum management of lung cancer?
1) Histological diagnosis
2) Accurate staging (CT/PET-CT/pathological staging)
3) Biomarker analysis
What are the two main histological subtypes of lung cancer?
1) Small cell lung cancer (10-15%)
2) Non-small cell lung cancer (80-85%)
Describe small cell lung cancer
- Smokers
- Neuroendocrine
- Lethal - poor prognosis
- Treatment effective in the short term
What are the 4 types of NSCLC?
1) Adenocarcinoma
2) Squamous cell carcinoma (more closely linked to smoking)
3) Large cell carcinoma
4) NSLC-NOS (not otherwise specified)
Describe the typical patient with adenocarcinoma NSCLC
- Most common type in long-term non smokers or never-smokers
- Esp. women
- Delayed diagnosis bc never smoked
- Early 40s/50s
What type of lung cancer does the EGFR mutation cause?
NSCLC lung adenocarcinoma
In ~2% of NSCLC adenocarcinomas what is the cause and why is this important?
- Driver/stem mutations that drive the phenotype
- Treatment is available that is specific to these mutations and highly effective esp. EGFR
Why would you biopsy an enlarged node or other lesion in preference to the primary lesion?
If determination of stage affects treatment - gives staging and tissue diagnosis at the same time
What investigations can be done to confirm diagnosis of lung cancer?
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)
How are most patients assessed?
By sampling of their primary tumour - mostly by bronchoscopy and CT guided needle biopsy
In which patients would you do surgery?
Early disease
- Stage I
- Stage II
- Some patients with stage IIIa
- Patient needs to have adequate lung function and fit for surgery
What is stage I lung cancer?
Disease localised to the chest with only involvement of regional lymph nodes
What are the types of surgery for lung cancer?
1) Pneumonectomy
2) lobectomy
3) Segmentectomy
4) Lung-conserving procedures e.g. wedge resection
What is the preferred type of surgery for lung cancer?
Lobectomy - risk of local recurrence lower even if just a small tumour (unless patient’s lung function would be severely affected)
What is surgery for lung cancer often done in combination with?
Radiotherapy
How do you treat small cell lung cancer?
- 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
How is NSCLC treated?
Chemotherapy
What drug is used to treat patients with EGFR mutation?
Erlotinib (EGFR tyrosine kinase inhibitor)
Where does lung cancer typically metastasise?
- Brain
- Breast
- Adrenals
- Bone
What are some signs of lung cancer?
- Pleural effusion
- Bony tenderness
- Hepatomegaly
What are two complications of lung cancers?
- SVCO
- Paraneoplastic syndromes
What paraneoplastic syndromes occur in SCLC?
- SIADH
- ACTH (Cushing’s)
- LEMS (Lambert Eaton Myasthenic syndrome)
What paraneoplastic syndromes occur in NSCLC?
- PTHrP - hypercalcaemia, brittle bones (squamous cell)
- HPOA (hypertrophic pulmonary osteoarthropathy)
In which type of lung cancer can Horner’s syndrome occur?
NSCLC (Pancoast tumour) - adenocarcinoma + squamous cell carcinoma
What investigations do you do for lung cancer?
- CXR
- CT
- ± PET (NSCLC)
- Bronchoscopy
What is curative treatment for lung cancer?
Surgery + radio ± erlotinib
What is palliative treatment for lung cancer?
Chemo ± radio
What is Horner’s syndrome?
Ptosis, miosis, anhidrosis (same side of the body as the damaged nerve)
What is the most common lung cancer?
Adenocarcinoma
Describe adenocarcinoma?
- Affects young asian women
- Peripherally located
Which lung cancer is most associated with paraneoplastic syndromes?
Small cell
In which lung cancer do you get hypercalcaemia?
Squamous cell
In which lung cancer can you get b-HCG production?
Large cell (giant cell)
