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Yr 3 resp > lung cancer > Flashcards

lung cancer Flashcards

1
Q

definition of non-small cell lung cancer

A

primary malignant neoplasm of lung

WHO classification of bronchocarcinoma: small cell 20%, non-small cell 80%

Histological types of non-small cell lung cancer include: Squamous cell carcinoma, adeno-carcinoma, large cell carcinoma and adenosquamous carcinoma, adenocarcinoma in situ

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2
Q

definition of small cell carcinoma

A

Malignant neoplasm of neuroendocrine Kulchitsky cells of the lung with early dissemination. Also known as oat cell carcinoma.

often secrete polypeptide hormones = paraneoplastic syndromes eg production of ACTH, Cushing’s syndrome

most SCLC are disseminated at presentation

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3
Q

definition of rarer lung cancer

A

bronchial adenoma - rare, slow growing. 90% are carcinoid tumours, 10% cylindromas

hamartoma - rare, benign. CT = lobulated mass +- flecks of calcification

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4
Q

aetiology of lung cancer

A

smoking = genetic alterations = neoplastic transformation

RF:

  • smoking
  • passive smoking
  • occupational exposures - polycystic hydrocarbons, asbestos, nickle, chromium, cadmium, radon, arsenic, iron oxides
  • atmospheric pollution

tumours generally in main or lobar bronchi

adenocarcinomas more peripheral

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5
Q

epidemiology of non-small lung cancer

A

Most common fatal malignancy in the West (18% of cancer mortality worldwide), 35000 deaths per year (UK), 3x more common in men (but increasing in women).

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6
Q

epidemiology of small cell lung cancer

A

20% of the lung cancers

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7
Q

epidemiology of carcinoma of the bronchus

A

2nd most common cancer in UK, 13% of all new cancer cases and 27% of cancer deaths (40000 cases/yr in UK)

incidence increasing in women

only 5% cured

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8
Q

sx of non-small cell lung cancer

A

may be asymptomatic with radiographic abnormality found - 5%

due to primary: cough, haemoptysis, chest pain, recurrent pneumonia

due to local invasion:

  • brachial plexus (pancoast tumour) - shoulder/arm pain
  • L recurrent laryngeal nerve - hoarseness and bovine cough
  • oesophagus - dysphagia
  • heart - palpitations/arrhythmias

due to metastatic disease or paraneoplastic phenomonia: weight loss, fatigue, fits, bone pain or fractures, neuromyopathies

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9
Q

sx of small cell lung cancer

A

may be asymptomatic with radiographic abnormality found

due to primary - cough, haemoptysis, dyspnoea, chest pain

due to metasatic disease - anorexia,m weight loss, fatigue, bone pain

due to paraneoplastic syndrome - weakness, lethargy, seizures, muscle fatiguability

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10
Q

Non-metastatic extrapulmonary manifestations of bronchial cancer

A

endocrine - ectopic secretion: ACTH (Cushing’s), ADH (dilutional hyponatraemia), PTH(hypercalcaemia), HCG (gynaecomastia)

neurological - Cerebellar degeneration, myopathy, polyneuropathy, myasthenic syndrome

vascular - thrombophlebitis migrans, anaemia, DIC

cutaneous - dermatomyositis, herpes zoster, acanthosis nigricans

skeletal - clubbing, HPOA

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11
Q

signs of non-small cell lung cancer

A

may be no signs

fixed monophonic wheeze

signs of collapse, consolidation or pleural effusion

due to local invasion

due to paraneoplastic phenomena

due to met

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12
Q

signs of non-small cell lung cancer due to local invasion

A

superior vena cava compression - facial congestion, distension of neck veins, upper limb oedema

brachial plexus - wasting of small muscles of the hand

sympathetic chain - Horner’s (pupillary miosis, ptosis, facial anhydrosis)

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13
Q

signs of non-small cell lung cancer due to paraneoplastic phenomena

A

hypertrophic osteoarthropathy: clubbing, painful swollen wrists/ankles (periosteal new bone formation)

dematological signs

  • Acanthosis nigricans(pigmented thickened skin in axilla or neck),
  • herpes zoster,
  • dermatomyositis,
  • thrombophlebitis migrans.
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14
Q

signs of non-small lung cancer due to metastasis

A

Supraclavicular lymphadenopathy,

hepatomegaly.

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15
Q

signs of small cell lung cancer

A

May be no signs or a fixed wheeze on auscultation of the chest.

signs of lobar collapse/pleural effusion

signs of met eg supraclavicular lymphadenopathy or hepatomegaly

signs of paraneoplastic syndrome

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16
Q

signs of lung cancer

A

cachexia

anaemia

clubbing

hypertrophic pulmonary osteoarthropathy = wrist pain

supraclavicular or axillary lymph nodes

chest signs: none, consolidation, collapse, pleural effusion

met: bone tenderness, hepatomegaly, confusion, fits, focal CNS signs, cerebellar syndrome, prox myopathy, peripheral neuropathy

17
Q

Ix for non-small cell lung cancer

A

CXR - coin lesions, lobar collapse, pleural effusion, features of lymphangitis, carcinomatosis

sputum cytology

bronchoscopy with brushings or biopsy

CT or US guided percutaneous biopsy

lymph node biopsy

18
Q

TNM staging for non-small lung cell cancer

A

based on tumour size, nodal involvement and metastatic spread

using CT chest, CT or MRI head and abdomen (or ultrasound), bone scan, PET scan.

can use invasive methods eg mediastinoscopy or video-assisted thoracoscopy

19
Q

bloods for non-small cell lung cancer

A

FBC

UE

Ca2+ hypercalcaemia is common

AlkPhos - increased bone met

LFT

20
Q

pre-op Ix for non-small cell lung cancer

A

ABG

pul function tests (FEV1>80% predicted to tolerate a pneumectomy, lung resection is contraindicated if FEV1 <30% predicted)

V/Q scan

ECG

echo

general anaesthetic assessment

21
Q

Ix for small cell lung cancer

A

diagnosis

  • sputum cytology
  • bronchoscopy with brushings and biopsy or percutaneous biopsy
  • thoracoscopy

staging

  • CT of chest, abdo, head
  • isotope bone scan

other

lung funct tests

  • FBC
  • UE
  • Ca
  • AlkPhos
  • LFT
22
Q

Ix for carcinoma of the bronchus

A

CXR

cytology - sputum and peripheral fluid (send at least 20mL)

FNAC or biopsy - peripheral lesions/lymph nodes

CT to stage and guide bronchoscopy

bronchoscopy

radionucleotide bone scan if suspected met

Lung function test - help assess suitability for lobectomy

23
Q

CXR for carcinoma of the bronchus

A

peripheral nodule

hilar enlargement

consolidation

lung collapse

pleural effusion

bony secondaries

24
Q

bronchoscopy for carcinoma of the bronchus

A

give histology and assess operability +- endobronchial US for assessment and biopsy

18F-deoxyglucose PET or PET/CTEBUS scan to help in staging.

25
Q

mx of small cell lung cancer

A
  1. chemo
  2. radio
  3. prophylactic cranial irradiation
  4. consider surgery
  5. if extensive disease - immunotherapy

chemo or radio if relapse

26
Q

complications of small cell lung cancer

A
27
Q

mx for non-small cell lung ca

A

Surgical resection:
Lobectomy (with hilar and mediastinal lymph node resection/sampling) - stage I or II cancer who are medically fit for surgery. This surgery is done with curative intent.

Radiotherapy:
stage I-III disease who are not suitable for surgery.
This treatment is given with curative intent.

Chemotherapy:
Is offered to those with stage III or IV disease to improve survival and quality of life.
First line regimes use a combination of:
Third-generation chemotherapy agent: e.g. docetaxel, paclitaxel or gemcitabine
Platinum agent: e.g. carboplatin or cisplatin

  • Adjuvant chemotherapy should be offered to patients who have undergone a complete resection
  • Adjuvant radiotherapy is offered to patients who have had a incomplete resection of their tumour
28
Q

complications of non-small cell lung cancer

A
29
Q
A

Yr 3 resp (19 decks)

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