Lung Cancer Flashcards
What is small cell lung cancer?
- malignant tumour
- generally affects small cells
generally begins in bronchi or trachea
- branch off spreading into smaller structures
Is small cell cancer more aggressive than non small cell carcinoma?
- yes
- faster doubling time, ⬆️ growth fraction ⬆️ risk of metastases
What is non small cell carcinoma?
- malignant tumour
- can form anywhere in the lungs
What are the 3 different types of non small cell carcinoma?
1 - Adenocarcinoma (most common)
2 - Squamous Cell Carcinoma
3 - Large Cell Carcinoma (least common)
What are common benign tumours that can be found in the lungs?
- hamartoma
- arterio-venous maliformations
- granuloma
What are common malignant tumours that can be found in the lungs. This relates to if it starts in the lungs or comes from somwhere else?
- primary lung cancer
- carcinoid tumour (account for only 1%)
- secondary metastasis
Is it easy distinguishing between benign and malignant tumours?
- no
What are the most common places secondary cancers can metastasise and spread to the lungs from?
- breast
- colon
- kidney
- ovaries
- prostate
- thyroid
What does bronchogenic mean?
- relates to bronchi in conducting airways
- mucosa epithelial cells affected
What is the most common place in the lungs where cancer is found?
- bronchogenic means cancer originating in the bronchus or the bronchioles
- accounts for 90% of all lung cancer
Non-small cell lung cancer, a form of bronchogenic lung cancer, which essentially relates to the primary and secondary bronchi, originates in which cells?
- epithelial and glandular cells (mucous)
Small cell lung cancer, a form of bronchogenic lung cancer originates in which cells?
- small neuroendocrine cells
- they secrete hormones directly into the lungs
Where does adenocarcinoma in situ originate from?
- adeno = glandular cells
- alveolar cells
- accounts for 5% of lung cancers
What is mesothelioma?
- tumour of myoepithelial cells of pleural walls
- associated with asbestos
Is lung cancer the most common fatal malignancy in the UK?
- yes - 34,000 deaths/year
Where does lung cancer rate in the causes of death in the UK?
- 3rd
How many deaths worldwide are caused by lung cancer?
- 1 million
What is the incidence of lung cancer in the UK?
- 40,000/year
Are men or women more at risk of lung cancer?
- men, mainly due to smoking - but women are catching up
What organs in the body does cancer affect that is the leading cause of deaths in the UK?
- lung cancer
What is the median age people are diagnosed with lung cancer?
- 40-70 years
Is the incidence of lung cancer affected by socioeconomic status?
- yes - ⬆️ rates in north of England
What is the main risk factor for lung cancer?
- smoking
What are some other common risk factors for lung cancer?
- passive smoking
- asbestos
- asbestos exposure
- genetic predisposition
- idiopathic pulmonary fibrosis - scar carcinoma (chronic fibrosis) - ionising radiation (radon gas) - polycyclic aromatic hydrocarbons - vinyl chloride - arsenic - nickel
How much does passive smoking increase the risk of lung cancer?
- 1.5 fold
How many years do people who quit smoking gain generally in later life?
- 6-10 years
What is the latency period for bronchogenic lung cancer in those exposed to asbestos?
- 30-40 years
Cigarette smoking and asbestos exposure combined are the biggest risk factors for developing lung cancer. What is the fold increase of the risk of developing lung cancer with if someone smokes and is exposed to asbestos?
- 100 fold increased risk
Asbestos exposure increases the risk of lung, but what is the main type of lung cancer is causes?
- mesothelioma
Carcinogens present in pollutants and toxins contribute to lung cancer by doing what to cells in the body?
- ⬆️ risk of DNA mutations
- mutations lead to cancer
In bronchogenic lung cancer DNA mutations are caused by pollutants and toxins, specifically which cells are affected?
- squamous = epithelial
- goblet cells = glandular
- metaplasia follows (switching from one cell type to another)
What is metaplasia?
- differentiation of one cell type to another
- reversible
- bodies response to stimulus
- in lung cancer inflammation/damage
Is squamous and goblet cells metaplasia caused by pollutants and toxins always dangerous?
- no
- can be benign
- but inflammation and irritation are present
What happens if the stimulus causing metaplasia continues?
- causes dysplasia
- dysplasia is an early marker for tumour development
- if it continues, this can become neoplasia
What is dysplasia?
- abnormal growth of cells - random cell shape and sizes
Dysplasia can develop to abnormal cells in the bronchial mucosa, which can be classified as mild, moderate and severe. What can dysplasia go on to develop?
- malignant tumour
If a patient develops a malignant tumour, and the primary site is in the lungs, where is it likely to spread locally?
- anything cloase to the lungs
- ipsilateral contralateral
- pleura
- pericardium
- nerves (pharyngeal nerve (horse voice), phrenic nerve, sympathetic chain or brachial plexus)
- ribs
- muscles
- lymph nodes
If a patient develops a malignant tumour, and the primary site is in the lungs, how will it travel through metastasis and where is it most likely to spread distally?
- through haematogenous
- liver, adrenals, bones, brain and skin
If a lung cancer has spread from the primary site in the lungs, will it be curable?
- generally no
What are the 4 most common symptoms of lung cancer?
1 - persistent cough (80%)
2 - breathlessness (60%)
3 - chest pain (50%)
4 - haemoptysis (30%)
What sounds might you hear from someone with lung cancer?
- monophonic sound
- sound is isolotated to one (mono) part of the lungs
Why might a patient with lung cancer experience shoulder pain?
- tumour may press on brachial plexus
- brachila plexus is in neck and shoulder
Why might a patient with lung cancer develop a hoarse voice?
- develop vocal cord palsy
- laryngeal nerve palsy causes this
- most common in left due to course it follows
Why might the superior vena cava have an obstructed blood flow in a patient with lung cancer?
- tumour may press on the vena cava
Why might a patient with lung cancer have swollen lymph nodes?
- tumour may spread through lymph nodes
- metastasise
In addition to symptoms affecting the lungs, what are some general symptoms patients with lung cancer may present with?
- weight loss (cachexia)
- lethargy
- bone pain
- neurological pain
- spinal cord compression
- paraneoplastic symptoms (immune response)
Patients with a non small cell carcinoma may present with swollen fingers, what is this called?
- clubbing
Where does Horners syndrome affect?
- eyes
- due to nervous affects
Why might there be tracheal deviation in a patient with lung cancer?
- due to pleural effusion
- cancer may press on trachea
When looking and listening to the lungs in a patient with lung cancer, what might we expect?
- ⬇️ chest expansion
- ⬇️ breathe sounds
- ⬇️ dullness on percussion
When listening to patients lungs we can ask them to say 99 to listen to tactile vocal resonance. In a patient with lung cancer what might we expect to hear?
- ⬇️ tactile vocal resonance
What is the WHO performance status?
- measure to determine how much cancer affects patients activities of daily living
How many levels of the WHO performance status are there?
- from 0 to 4
In a patient with lung cancer, what does a WHO performance status score of 0 mean?
- normal day to day activities
In a patient with lung cancer, what does a WHO performance status score of 2 mean?
- in bed 50% of day - unable to work or self care
In a patient with lung cancer, what does a WHO performance status score of 4 mean?
- bedridden - unable to self care
In a patient with suspected lung disease, what is the first test a doctor will do?
- X-ray
In addition to an X-ray, what is the best imaging modalities that can be used to diagnosis lung cancer?
- CT san with contrast - PET scan
In addition to an X-ray, CT and PET scan what are some other imaging tests that can be used in patients with suspected lung cancer?
- bone scan (assess metastases, pathological fractures) - CT brain scan (changes prior to surgery) - MRI of thorax (look for metastases)
What is the main findings on an X-ray in patients with suspected lung cancer?
- mass
What is the test most commonly used method to provide an initial staging of the lung cancer?
- CT scan with contrast
What size nodules are modern scanners able to detect?
- 3-4mm size nodules
Iodine is used to CT contrast scans. What are 2 contradictions to using iodine?
- renal failure - allergy to iodine
Once an initial staging of cancer has been made, what imaging modality is used to provide accurate staging of the lung cancer?
- positron emission tomography/CT hybrid
In a PET scan 18 Fluro-2-deoxy-glucose (FDG) is used top identify tumours, why is this?
- tumours have a high metabolism - FDG will be drawn to the cancer cells - FDG emits gamma rays that can be detected
What hybrid imaging is used to effectively stage lung cancer?
- CT / PET scans
Why might a full blood count be useful in patients with suspected lung cancer?
- anaemia
- platelet count
- clotting
- all important if surgery needed and ⬆️ the risk of cancer
Why are urea and electrolytes measured in patients with suspected lung cancer?
- ⬇️ Na+ (Na+ <139mmol/L) - called hyponatraemia
- due to ADH secretion and H20 retention
Why can lung cancer cause hyponatraemia?
- small cell lung cancer secrete anti-diuretic hormone
- ⬆️ H2O retention dilutes Na+ (hypoosmolality
- tumour retains Na+ and H2O
- blood levels will therefore be ⬇️
Why might liver tests be conducted in patients with suspected lung cancer?
- metastases may spread to liver - alter liver enzymes
Why might a patients with lung cancer have hypercalcaemia?
- metastases may spread to bone
Where do small cell carcinomas generally originate from in lung cancer?
- neuroendocrine cells (small cells)
- secrete hormones, called ectopic secretion
Ectopic secretions are due to abnormal hormone secretion due to small cell lung cancer, what does the inappropriate secretion of anti-diuretic hormones do to the body?
- hyponatraemia - ⬇️ Na+
Ectopic secretions are due to abnormal hormone secretion due to small cell lung cancer, what does the inappropriate secretion of parathyroid hormones (important in Ca2+ levels) do to the body?
- hypercalcaemia - ⬆️ Ca2+
Ectopic secretions are due to abnormal hormone secretion due to small cell lung cancer, what does the inappropriate secretion of adrenocorticotrophic hormones do to the body?
- raised cortisol levels - Cushings syndrome
In patients with suspected lung cancer, what other lung disease are they likely to have if they have smoked?
- COPD
- obstructive lung disease
In patients with suspected lung cancer, what lung function measures may be assessed?
- spirometry provides FEV1, FVC and FEV1/FVC ratio
- TLCO
In patients with suspected lung cancer, why should lung function measures may be assessed prior to any type of surgery?
- assess fitness for surgery and radiotherapy
If a patient has lung disease and previous cardiac history, what cardiac assessments would be performed?
- ECG = electrical activity
- Echocardiogram = valve structure and function
What % of lung cancers are small cell carcinomas and non small cell carcinomas?
- non small cell carcinomas = 80% - small cell carcinomas = 20%
Does small cell carcinomas or non small cell carcinomas have a better prognosis?
- non small cell carcinomas
Once a biopsy has been taken from a patient with lung cancer, what can be done with the biopsy that may help with the patients treatment?
- WGS
- treatments can then be personalised
What system is used to stage lung cancer?
- TNM - T = Tumour size (T0-T4) - N = Nodal metastases (N0-N3) - M = distant metastases (M0-M1)
When patients have been confirmed with a diagnosis of lung cancer, what is generlaly the first thing that will be done to identify if it is a primary or secondary cancer?
- biopsy is taken
- histology of lung cancer
- histology identifies origin
Generally what are the first 2 treatment options when treating lung cancer?
- surgery (if no metastasis) - radiotherapy
If a patient cannot be cured, palliative care will be given. What are the treatment options when a patient is undertaking palliative care?
- chemotherapy - immunotherapy - radiotherapy - symptom control
What is a lobectomy that may be performed as a treatment for patients with non small cell lung cancer?
- removal of a lobe of the lung
What is a pneumonectomy that may be performed as a treatment for patients with non small cell lung cancer?
- removal of a whole lung
What is a segmentoctomy that may be performed as a treatment for patients with non small cell lung cancer?
- removal of part of a lobe
Surgery is rarely offered to patients with small cell carcinoma due to the aggressive nature and spreading of the cancer. What are the common treatments for patients with small cell caricinoma?
- chemotherapy - immunotherapy - palliative radiotherapy - palliative chemotherapy
Immunotherapy had been developed to treat patients with lung cancer. What are the 2 growth factors and 1 inhibitor that are targeted with treatment?
1 - epithelial growth factor receptor mutation (EGFR)
- controls cell proliferation, differentiation and survival
2 - vascular endothelial growth factor (VEGF)
- important for angiogenesis (no blood flow = no tumour)
3 - checkpoint inhibitors
- PD-L1
In patients with lung cancer what are the main aims of palliative care?
- improve quality of life - improve symptoms - physical and psychological support
What is the 1 and 5 years survival rate in patients with lung cancer?
- 1 year = 30% men and 35% women - 5 year = 9.5%
What are some simple control measures that can reduce the risk of developing lung cancer?
- smoking cessation - ⬇️ passive smoke exposure - ⬇️ radon exposure - ⬇️ occupational exposure - ⬆️ nutrition
How might lung cancer be detected earlier in the future?
- ⬆️ education about symptoms - ⬆️ education about risk factors - educate healthcare staff about signs - earlier chest X-rays
What is the difference between adenocarcinoma in situ and adenocarcinoma?
- adenocarcinoma in situ = tumour isolated and not spread
- adenocarcinoma = tumour has spread and invades
Cavitating lesions can be seen on an X-ray in patients with suspected lung cancer, what are they?
- tumour destorys part of lung
- appear as holes in lungs
Unilateral perfusion can sometimes be seen on an X-ray in patients with suspected lung cancer, what is uilateral perfusion?
- perfusion is gas exchange
- only one side of lungs is perfusing
Pneumonia can sometimes be seen on an X-ray in patients with suspected lung cancer, what is uilateral perfusion?
- repeated respiratory infections are common in lung cancer
- pneumonia could therefore be present
Solitary pulmonary nodules can sometimes be seen on an X-ray in patients with suspected lung cancer, what are these?
- can be malignant or benign
When a patient with lung cancer has been diagnosed and a histological test has confirmed it is a primary tumour, what is the next step of the diagnosis pathway?
- staging of lung cancer (TNM)
When a patient with lung cancer has been diagnosed, a histological test has confirmed it is a primary tumour, and it has been staged using the TNM method, what is the next step of the diagnosis pathway?
- WHO Performance Status
- assess how much activities of daily life are affected by cancer
When a patient with lung cancer has been diagnosed, a histological test has confirmed it is a primary tumour, and it has been staged using the TNM method, and the WHO performance status has been performed, what is the next step of the diagnosis pathway?
- lung function tests to assess severity
- co-morbidities that may affect treatment or outcomes
What is potentially the most important part of lung cancer and treatment plans?
- wishes of the patient
