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Yr 2 - EMS > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

What does survival depend on?

A
  • How big the tumour is
  • What it has invaded locally
  • Distant spread to other nodes and tissues
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2
Q

What system is used to stage lung cancer?

A

TNM system

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3
Q

Survival rate of stage 1 lung cancer?

A

More than 55% will survive their cancer for 5 years or more after diagnosis

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4
Q

Survival rate of stage 2 lung cancer?

A

Around 35% will survive their cancer for 5 years or more after

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5
Q

What % of lung cancers are operable?

A

Unfortunately, only a small percentage of patients with lung cancer are operable by the time they are diagnosed.

This is approximately 20%.

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6
Q

Why does lung cancer have such a poor prognosis?

A

Presents late

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7
Q

What is the respiratory epithelium?

A

A type of ciliated columnar epithelium

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8
Q

What can happy if the bronchial epithelium are irritated e.g. cigarette smoke?

A

To adapt, they change into a stronger epithelium e.g. squamous –> this is called squamous metaplasia

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9
Q

What is squamous metaplasia?

A

Squamous metaplasia is a benign non-cancerous change (metaplasia) of surfacing lining cells (epithelium) to a squamous morphology.

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10
Q

If the irritation of the respiratory epithelium continues, what can occur?

A
  • Damage to genetic materials within cells (body can deal with this via apoptosis or immune surveillence)
  • Sometimes a neoplastic cell will develop (can avoid body checks)
    • This can independently proliferate –> dysplasia
      • ​N.B. still above basement membrane
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11
Q

If the dysplasia of respiratory epithelium continues, what can occur?

A
  • Part/whole of epithelium can be replaced by neoplastic cells
    • Part: low grade dysplasia
    • Whole: high grade dysplasia or carcinoma in situ
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12
Q

What is ‘intraeptihelial neoplasia’?

A

Neoplastic cells on the epithelium but still above basement membrane

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13
Q

When can intraepithelial neoplasia become invasive?

A

When they develop the ability to invade through the basement membrane

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14
Q

What are the 2 main types of lung cancers?

A
  1. Non-small cell lung cancer (NSCLC): 80-85% of lung cancers
  2. Small cell lung cancer (SCLC) - 10-15% of lung cancers

N.B. mixed types are not unlikely

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15
Q

What are the 3 main types of NSCLC?

A
  1. Adenocarcinoma
  2. Squamous cell carcinoma
  3. Large cell carcinoma
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16
Q

Where do adenocarcinomas start?

A

Start in the cells that would normally secrete substances such as mucus (glandular)

17
Q

Who do adenocarcinomas typically occur in?

A
  • This type of lung cancer occurs mainly in current or former smokers, but it is also the most common type of lung cancer seen in non-smokers
  • More common in women than in men
  • More likely to occur in younger people than other types of lung cancer.
18
Q

Where do squamous cell carcinomas start?

A

In squamous cells, which are flat cells that line the inside of the airways in the lungs.

19
Q

Is SCLC or NSCLC more aggressive?

A

SCLC - This type of lung cancer tends to grow and spread faster than NSCLC

20
Q

Clinical Case 1:

  • Man in 60s
  • Cough, haemoptysis, weight loss, increasing shortness of breath
  • Smoker 20 a day for 45 years
  • Ventolin (salbutamol) –> evidence of COPD
  • Otherwise fit and well

Examinations:

  • Clubbed, no lymphadenopathy (enlarged lymph nodes)
  • Respiratory:
    • Dull to percussion on left
    • Decreased air entry left base

Investigations:

  • Bloods - normal
  • CXR - pleural effusion
  • Bronchoscopy - tumour left main bronchus
  • CT - tumour and mediastinal lymphadenopathy
  • Biopsy result - NSCLC

Treatment?

A
  • Pleural fluid drainage and pleurodesis
  • Palliative care (tumour not treatable)

(look at year 1 lung cancer cases)

21
Q

Clincal Case 2:

  • 80 year old man
  • Weight loss, R chest/shoulder pain, back pain
  • Heaky smoker
  • COPD

Examination:

  • Dehydrated
  • Fullness between ribs R upper chest
  • No neurology R arm
  • Respiratory:
    • Decreased air entry R apex
    • Dull R apex
  • Liver large and knobbly

Investigations:

  • Bloods - calcium 3.5 (raised)
  • CXR
  • CT
  • Bronchoscopy normal
  • CT guided biopsy - SCLC

Treatment and progress?

A
  • IV fluids and pamidronate
  • Palliative radiotherapy to chest wall
  • Pain control (not curative)
22
Q

What can presentation of lung cancer be linked to?

A
  • Effects of primary tumour
  • Effects of metastatic deposits
  • Systemic effects
23
Q

How can:

  1. Cough
  2. Haemoptysis
  3. Shortness of breath
  4. Chest pain

be caused by primary tumour?

A
  1. Cough: e.g. tumour irritating airways triggering cough reflex
  2. Haemoptysis: if invasive tumour damages vessels it can lead to coughing up blood
  3. Shortness of breath: e.g. tumour blocks a proximal airway, tumour causes distal infection
  4. Chest pain: tumour grows into parietal pleura/chest wall
24
Q

How can

  1. Shortness of breath
  2. Lumps
  3. Neurological signs
  4. SVCO

be caused by metastatic deposits?

A
  1. Shortness of breath: tumour in pleural cavity/ies causes an effusion which restricts lung expansion
  2. Lumps: e.g. in nodes, skin, bones - may also cause bone pain)
  3. Neurological signs: e.g. destruction or squashing of brain tissue by brain deposits
  4. SVCO (Superior Vena Cava Obstruction)
25
What can cause these systemic effects of lung cancer: 1. Weight loss 2. Hypercalcaemia 3. Paraneoplasic syndromes
1. Weight loss: loss of appetite, changes in metabolism, etc due to circulating tumour products like cytokines 2. Hypercalcaemia: eg from osteolytic metastases, and/ or parathyroid hormone related protein secretion by the tumour cells 3. Paraneoplasic syndromes: other circulating tumour products
26
Hypercalcaemia is present in an estimated 10-20 per cent of all patients with cancer. What causes this?
* Increased osteoclastic activity induced bone resorption * Decreased renal excretion of calcium * Increased gut absorption of calcium
27
Typical symptoms of lung cancer?
* **Unexplained cough** for at least 3 weeks (with or without haemoptysis) * **Unintended weight loss** (\>5% in 6 months) * New-onset **dyspnoea** * **Pleuritic chest pain** (due to the tumour invading the pleura or the chest wall) * **Bone pain** (due to metastases – commonly the spine, pelvis and long bones) * **Fatigue** (due to anaemia of chronic disease) Note that up to 20% of patients present with non-respiratory symptoms (such as fatigue).
28
How can cancer cause anaemia?
* Cancers cause inflammation that decrease red blood cell production * Many chemotherapies are myelosuppressive, meaning they slow down the production of new blood cells by the bone marrow.
29
Other important areas to cover in the history of lung cancer?
* Family history * Smoking history * Occupation
30
A full respiratory examination should be performed in suspected cases of lung cancer. What are typical clinical findings?
* Cachexia * Cancer can cause increased resting energy expenditure and lipolysis * Finger clubbing * Dullness to percussion * Due to tumour (solids are less resonant than gases) * Lymphadenopathy * Due to metastasis to the lymphatic system * Wheeze on auscultation * Due to the tumour obstructing an airway
31
In laboratory investigations of lung cancer, what may be shown in: * FBCs * LFTs * U&Es * Serum calcium
* FBCs: anaemia * LFTs: * raised ALP and GGT may indicate hepatic metastases * raised ALP may indicate bone metastases * U&Es: Hyponatraemia may be due to syndrome of inappropriate antidiuretic hormone secretion (SIADH), which is more common in small cell carcinoma * Serum calcium: elevated with the secretion of PTH-related protein (PTHrP)
32
What is first line investigation in lung cancer?
Chest x-ray
33
What investigation is then used to confirm chest x-ray findings?
CT
34
What is a bronchoscopy?
Bronchoscopy involves the insertion of a small camera into the airways to directly visualise the tumour. A biopsy of the tumour is taken.
35
What is essential for making the diagnosis of lung cancer?
A biopsy
36
From a cellular point of view, what may cause a late presentation of lung cancer?
* The process of gaining malignant genetic mutations is a stepwise process that takes years * There are a large number of pneumocytes that have to be invaded before the lung function is significantly hampered * Intraepithelial changes will almost always be asymptomatic * Early invasive phases will almost always be asymptomatic
37
From an anatomical view point, what may cause a late presentation of lung cancer?
* Lack of pain fibres within the lung parenchyma means that a lung tumour within the centre of the lung may be asymptomatic * Symptoms can be vague and non-specific * There is reserve capacity in the lungs so loss of function of one small area does not necessarily cause symptoms

Yr 2 - EMS (60 decks)

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