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Respiratory Medicine > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

What is the third most common cancer in the UK behind breast and prostate?

A
  • lung
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2
Q

What are the RF for lung cancer?

A
  • Cigarette smoking (90%)
  • Passive smoking
  • Age
  • COPD
  • Hx of H&N cancer
  • occupational exposure
    • asbestos, chromium, arsenic, iron oxides, radiation
  • EGFR-TK mutation
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3
Q

What are the different histology for lung cancer?

A
  • Non-small cell lung cancer (NSCLC)
    • Squamous cell carcinoma
    • Adenocarcinoma
    • Large cell
  • Small cell lung cancer (SCLC)
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4
Q

What are the features of SCLC?

A
  • arise from endocrine cells - Kulchitsky cells
  • secrete hormone (ectopic ADH, ectopic ACTH)
  • results in paraneoplastic syndrome
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5
Q

What are the sx of lung cancer?

A

Lungs

  • Cough
  • Haemoptysis
  • Dyspnoea
  • Chest pain
  • recurrent pneumonia

Systemic

  • weight loss
  • malaise
  • anorexia
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6
Q

What are the signs of lung cancer?

A

Lungs

  • Normal
  • Consolidation
  • collapse
  • pleural effusion

Systemic

  • Cachexia
  • Anaemia
  • clubbbing
  • lymphadenopathy

Metastases

  • bone tenderness
  • hepatomegaly
  • confusion, cerebellar syndrome, focal CNS sign
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7
Q

What are the differentials of coin lesion on CXR?

A
  • Secondary malignancy.
  • Arteriovenous malformation.
  • Pulmonary hamartoma
  • Bronchial adenoma
  • Abscesses
  • Granuloma - eg, tuberculosis.
  • Encysted effusion (fluid, blood, pus).
  • Cyst.
  • Foreign body.
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8
Q

When will you urgently refer a pt with suspected lung cancer?

A
  • 2 weeks urgent referral
  • CXR finding suggestive of lung cancer
  • >40
  • Unexplained haemoptysis
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9
Q

What ix would you order for lung cancer?

A
  • Bedside
    • sputum cytology
    • lung function test - assess suitability for lobectomy
  • Imaging
    • CXR - first line
    • Contrast enhanced CT CAP - staging
    • PET CT
  • Special
    • Fine needle aspiration or biopsy
    • Bronchoscopy c endobronchial ultrasound
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10
Q

What are the tx options for lung cancer?

A

NSCLC

  • Lobectomy - tx choice if medically fit
  • Segmentectomy
  • Radical radiotherapy - stage 1,2,3
  • Chemo + radio - advance disease
    • cetuximab

SCLC

  • Chemotherapy + radiotherapy
  • Endobrachial therapy
    • stents
    • debulking
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11
Q
A
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12
Q

What is the prognosis of NSCLC and SCLC?

A
  • NSCLC
    • 50% 2yr survival w/o spread
    • 10% c spread
  • SCLC
    • 3months survival if untreated
    • 1.5years if treated
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13
Q
A
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14
Q

What are the CXR features for lung cancer?

A
  • peripheral nodule
  • hilar enlargement
  • consolidation
  • lung collapse
  • pleural effusion
  • bony secondaries
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15
Q
A
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16
Q

What are the extrapulmonary manifestations of lung cancer?

A
  • Recurrent laryngeal nerve palsy - hoarse voice
  • Phrenic nerve palsy - shortness of breath
  • SVC obstruction - (SVC syndrome)
  • Horner’s syndrome
  • SIADH - ectopic ADH - sclc
  • Cushings - ectopic ACTH - sclc
  • Hypercalcaemia - ectopic PTH - squamous
  • Limbic encephalitis
  • Lambert-Eaton myasthenic syndrome
17
Q

How would a SVC obstruction present?

A
  • Facial swelling
  • Difficulty breathing
  • Distended veins in neck
  • pemberton’s sign
18
Q

What is pemberton’s sign?

A
  • raising the hands over the head causes facial congestion and cyanosis
19
Q

What is Lambert-Eaton Myasthenic Syndrome?

A
  • antibodies produced by the immune system against small cell lung cancer cells
20
Q

What is the Px of Lambert-Eaton Myasthenic Syndrome?

A
  1. antibodies target and damage VGCC on the presynaptic terminals in motor neurones
  2. weakness in the proximal muscles, intraocular muscle, pharyngeal muscles
21
Q

What is the presentation of Lambert-Eaton Myasthenic Syndrome?

A
  • Weakness in proximal muscle
  • Diplopia
  • Ptosis
  • Slurred speech
  • Dysphagia
  • Dry mouth
  • Blurred vision
  • Impotence
  • Dizziness
22
Q

What is asbestos inhalation linked to?

A

Mesothelioma

23
Q

What is the latent period between exposure to asbestos and the development of mesothelioma?

A
  • Up to 45 years

Respiratory Medicine (12 decks)

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