Lung cancer Flashcards
List some associations of lung cancer
- Smoking and passive smoking
- COPD, fibrosis, alveolitis, TB, chronic inflammation
- Environmental carcinogens: silica, chromium, iron oxide, nickel, asbestos (mesothelioma), radon gas, diesel engine exhaust fumes, air pollution
- Poor diet, lack of exercise
- Family history
List the local symptoms of lung cancer
- Cough
- SOB
- Coughing blood
- Pain
- Recurrent pneumonia
List the systemic symptoms of lung cancer
- Weight loss, anorexia
- Voice changes
- Paraneoplastic syndromes
- Metastases – brain and bone
- Dysphagia
Describe the examination for lung cancer
Colour Clubbing RR SpO2 Pleural fluid Collapse/consolidation SVCO
What investigations
CXR Bloods SaO2 EBUS CT PET CT MRI, pleural fluid cytology
What is radical treatment
Curative intent
What is palliative treatment
palliate symptoms and possibly prolong survival
What is neoadjuvant treatment
post surgery when no cancer present aiming to improve chance of cure
What is adjuvant treatment
chemo/radiotherapy before surgery aiming to downstage
What are the two main types of lung cancer
Small cell (15-20%) and non-small cell (75-85%)
What is EBUS
Endobronchial ultrasound
What are the treatment modalities for lung cancer
Chemo/radio/immunotherapy
Surgical resection
Palliative treatments - TK inhibitors, chemo, radiotherapy
What is the management for stage 1 lung cancer?
Surgery or SABR
What is the management for stage 2 lung cancer?
surgery +/- chemo or radical RT
What is the management for stage 3 lung cancer?
multimodality treatment
What is the 5 year survival for lung cancer?
50%
What is the management for stage 4 lung cancer?
palliative chemotherapy (+/- RT)
Name 3 oncological emergencies which may present to other specialities
Superior vena cava obstruction
Metastatic spinal cord compression
Bony metastasis - pathological fracture
What scan would you order for someone presenting with suspected metastatic spinal cord compression?
MRI of whole spine
How may orthopaedics help patients with bony metastasis
Prophylactic nailing
Or fixing/replacement of broken joints
How do you nurse patients with SVCO?
Upright with O2
How do patients with SVOC present?
Dyspnoea
Dilated neck veins
Sitting upright and forward - tripod position
List the types of non-small cell cancer?
o Adenocarcinoma
o Squamous cell
o Large cell, adenosquamous, carcinoma, carcinoid
Which type of non-small cell cancer presents with gyanecomastia?
Adenocarcinoma
Which type of non-small cell cancer presents with gynaecomastia?
Adenocarcinoma
What are some toxicities of chemo
Fatigue Nausea and vomiting Mouth ulcers/stomatitis Hair loss Myelosuppression Renal impairment Neuropathy Thromboembolic
What mutations do we test for in lung cancers
EGFR, ALK, ROS-1, KRAS
Which patients may be at increased risk of mutation
Females
Non-smokers
Asian/Indian people
Which type of cancer is more associated with genetic mutations?
Adenocarcinoma
Which lung cancer has strongest association with smoking?
Squamous cell carcinoma
What scale is used to measure a patients fitness?
Performance status - from PS0(asymptomatic) to PS4 (Bedridden)
