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Z - Cancer Care Old > Lung Cancer (AAG) > Flashcards

Lung Cancer (AAG) Flashcards

1
Q

How common is lung cancer worldwide, compared to other cases?

A

Most common cancer worldwide

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2
Q

How common is lung cancer in the UK compared to other cancers?

A

Second most common cancer

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3
Q

What % of cases of lung cancer are in people over 65?

A

87%

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4
Q

At what age is the highest incidence of lung cancer?

A

Between 80 and 84 years

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5
Q

What demographic shift has occurred with lung cancer?

A

The incidence and mortality rates are falling in males and rising in females

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6
Q

How does mortality from lung cancer compare to other cancers?

A

It is the biggest cause of cancer deaths in the UK and USA

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7
Q

What is the most significant risk factor for lung cancer?

A

Smoking, including passive smoking

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8
Q

What % of cases of lung cancer are associated with smoking?

A

80-90%

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9
Q

What is the risk of lung cancer from smoking proportional to?

A
  • The person’s pack years
  • Age they started smoking
  • Type of cigarettes smoked
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10
Q

How is pack years calculated?

A

Packs smoked per day x years smoked

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11
Q

What are the other risk factors for lung cancer?

A
  • Previous radiotherapy to the chest

- Occupational exposure to chemicals

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12
Q

Exposure to which chemicals increases the risk of lung cancer?

A
  • Asbestos
  • Acetaldehyde
  • Beryllium
  • Cadmium
  • Chromium
  • Formaldehyde
  • Polycyclic aromatic hydrocarbons
  • Nickel
  • Inorganic arsenic compounds
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13
Q

By how much does a significant family history increase the risk of lung cancer?

A

2.5x

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14
Q

What genetic mutation can increase the risk of lung cancer?

A

Germline mutations in genes such as Rb TP53

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15
Q

What are the main categories of lung cancer?

A
  • Small cell lung cancer

- Non-small cell lung cancer

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16
Q

What % of lung cancers are small cell lung cancers?

A

20%

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17
Q

Where does SCLC arise?

A

In the larger airways - tends to be a more central tumour

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18
Q

How do most patients with SCLC present?

A

Systemic disease

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19
Q

Does SCLC frequently metastasise?

A

Yes

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20
Q

How does SCLC metastasise?

A

Via haematogenous spread

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21
Q

Where does SCLC metastasise to?

A
  • Liver
  • Skeleton
  • Bone marrow
  • Brain
  • Adrenal glands
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22
Q

What do the small cells in SCLC contain?

A

Dense neurosecretory granules

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23
Q

What can the dense neurosecretory granules in SCLC produce?

A

Ectopic biological substances such as ACTH and ADH

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24
Q

What can ectopic production of ACTH by SCLC cause?

A

Cushing’s syndrome

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25
Q

What can ectopic production of ADH by SCLC cause?

A

SIAD

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26
Q

What genetic abnormalities are common in SCLC?

A
  • Mutations in RB1 and TP53

- Abnormal DNA methylation of the cyclin D2 gene

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27
Q

What % of cases of SCLC have mutations in RB1 and TP53?

A

80%

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28
Q

What % of lung cancers are non-small cell lung cancers?

A

80%

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29
Q

Where do NSCLC arise from?

A

The epithelial cells of the lung, from the central bronchi to the terminal alveoli

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30
Q

What types can NSCLC be divided into?

A
  • Squamous cell carcinoma
  • Adenocarcinoma
  • Large cell carcinoma
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31
Q

What % of lung cancers are squamous cell carcinomas?

A

50%

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32
Q

How do lung squamous cell carcinomas often present?

A

As an obstructive lesion of the bronchus, causing infection

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33
Q

How might lung squamous cell carcinomas appear on the CXR?

A

Cavitation

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34
Q

Describe the course of lung squamous cell carcinomas?

A

They tend to grow slowly, spread locally, and disseminate late

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35
Q

What % of lung cancers are adenocarcinomas?

A

15%

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36
Q

Where do lung adenocarcinomas arise from?

A

The bronchial mucosal glands - tend to arise in the periphery

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37
Q

What is the result of lung adenocarcinomas tending to occur at the periphery?

A

The presentation can represent a metastasis from a distant site, so careful patient assessment is required

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38
Q

How do the risk factors for lung adenocarcinomas differ from other lung tumours?

A

There is less of an association with smoking with adneocarcinomas

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39
Q

What can lung adenocarcinomas arise in?

A

Scar tissue

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40
Q

Do lung adenocarcinomas metastasise?

A

Yes, they have a high risk of metastatic spread

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41
Q

Where do lung adenocarcinomas often metastasise to?

A
  • Mediastinal lymph nodes

- Pleura

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42
Q

What does lung adenocarcinoma metastasising to the pleural produce?

A

Effusion

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43
Q

What % of lung cancers are large cell carcinomas?

44
Q

How do large cell carcinomas often present?

A

As a large peripheral mass on a chest radiograph

45
Q

How might large cell carcinomas produce paraneoplastic features?

A

They can have neurosecretory elements producing paraneoplastic features

46
Q

Describe the features of large cell carcinomas?

A
  • Tend to be poorly differentiated
  • Can grow rapidly
  • Metastasise early
47
Q

What is the most common presentation of lung cancer?

48
Q

What % of patients with lung cancer present with a cough?

49
Q

What are the other symptoms of lung cancer?

A
  • Chest pain
  • Haemoptysis
  • Breathlessness
  • Recurrent chest infections

Patients can be asymptomatic

50
Q

In which type of lung cancer is finger clubbing particularly common?

51
Q

What symptoms can local spread of lung cancer result in?

A
  • Lymphadenopathy
  • Dysphagia
  • Hoarseness of the voice
  • Shoulder pain
52
Q

How can local spread of lung cancer cause hoarseness of voice?

A

Recurrent laryngeal nerve involvement

53
Q

How can metastases from lung cancer present?

A
  • Bone pain
  • Liver discomfort
  • Neurological signs due to CNS involvement
54
Q

What are the extra-thoracic symptoms of lung cancer?

A
  • Anorexia
  • Weight loss
  • Malaise
  • Lethargy
55
Q

What paraneoplastic syndromes are associated with lung caner?

A
  • Dematomyositis
  • Acanthosis nigricans
  • Lambert-Eaton myasthenic syndrome (LEMS)
  • Ectopic production of ACTH, ADH, and PTHrP
56
Q

What should be looked for on facial examination in lung cancer?

A
  • Conjunctival pallor
  • Jaundice
  • Horner’s syndrome
  • Cushingoid features
57
Q

What lymph nodes should be examined in lung cancer?

A
  • Neck
  • Supraclavicular
  • Axillary
58
Q

What should be looked for on examination of the hand in lung cancer?

A
  • Clubbing
  • Signs of smoking
  • Pallor
  • Wasting of small muscles
59
Q

What causes wasting of small muscles in lung cancer?

A

T1 root compression

60
Q

What should be looked for on cardiovascular examination in lung cancer?

A
  • SVC obstruction
  • Atrial fibrillation
  • Pericardial effusion
61
Q

What should be looked for on respiratory examination in lung cancer?

A
  • Tachypnoea
  • Stridor
  • Consolidation
  • Pleural effusion
62
Q

What should be looked for on abdominal examination in lung cancer?

A
  • Abdominal distention
  • Ascites
  • Hepatomegaly
63
Q

What should be looked for on neurological examination in lung cancer?

A
  • Confusion
  • Focal neurological signs
  • Sensory deficit
  • Spinal cord compression
  • Memory deficit
  • Personality change
  • Hallucinations
64
Q

What should be looked for on skeletal survey for lung cancer?

A
  • Focal bone tenderness
  • Pathological fractures
  • Wrist tenderness and ankle tenderness
65
Q

What is wrist and ankle tenderness a sign of in lung cancer?

A

Hypertrophic osteopathy

66
Q

What is the aim of investigation in lung cancer?

A
  • Gain histological diagnosis

- Determine extent of spread (stage)

67
Q

What should investigation in lung cancer include?

A
  • Chest x-ray
  • FBC
  • Liver function tests
  • Serum calcium
68
Q

What is the problem with sputum cytology in lung cancer?

A

It can be unreliable

69
Q

What is CT imaging used for in lung cancer?

A
  • Assess tumour size and spread
  • Assess lymph node involvement
  • Identify chest wall invasion or metastasis to other sites
70
Q

How is tissue for diagnostic testing usually obtained in lung cancer?

A

During a bronchoscopy

71
Q

What other ways of obtaining tissue for diagnostic testing may be considered in lung cancer?

A
  • FNA of involved lymph nodes

- CT guided biopsy

72
Q

What fluid might be used for fluid cytology in lung cancer?

A

From any pleural effusion

73
Q

What investigations should be done if bone pain is present in lung cancer?

A
  • X rays

- Bone scan imaging

74
Q

What is PET/CT used for in lung cancer?

A

Increasingly used as an alternative to invasive mediastinoscopy to determine the operability of the patient

75
Q

What treatment is required in SCLC?

A

Chemotherapy

76
Q

What chemotherapy agent is used in SCLC?

A

Etoposide combined with carboplatin or cisplatin

77
Q

What chemotherapy regime is used in SCLC?

A

Chemotherapy delivered at 3 weekly-intervals for 4-6 cycles

78
Q

What is the response rate of SCLC to chemotherapy?

A

80-90% for limited stage, 60-90% for extensive stage

79
Q

What is the limitation of chemotherapy in SCLC?

A

Most patients relapse, and medial survival is only improved by about 14 months

80
Q

Describe the use of radiotherapy in SCLC?

A
  • Can be used as concurrent therapy with curative intent
  • Pallitation
  • Proprohylactic cranial irradiation
81
Q

Why is radiotherapy useful for pallitation in SCLC?

A

As 60% of relapses occur within the thorax

82
Q

Who might receive prophylactic cranial irradiation in SCLC?

A

Those being treated with curative intent

83
Q

What is the purpose of prophylactic cranial irradiation in SCLC?

A

Reduce risk of CNS metastasis

84
Q

What is NSCLC treatment dependant on?

A
  • Patient

- Type and stage of cancer

85
Q

What offers the best curative option for stage 1, 2, and some 3a NSCLC patients?

A

Complete surgical excision

86
Q

What is complete surgical excision often followed by in NSCLC?

A

Adjuvant chemotherapy

87
Q

What is the aim of surgery in NSCLC?

A

Remove the primary tumour with all locoregional lymph nodes

88
Q

What do patients require to be able to undergo surgery for NSCLC?

A

Sufficient fitness and respiratory function

89
Q

How is stage 3b or 4 NSCLC managed?

A

Chemotherapy

90
Q

What is the purpose of chemotherapy in stage 3b/4 NSCLC?

A

Improvement in symptoms and disease control

91
Q

What chemotherapy regime is used in NSCLC?

A

4-6 cycles using a combination carboplatin or cisplatin with gemcitabine or vinorelbine

92
Q

What % of patients with NSCLC respond to chemotherapy?

93
Q

What is the problem with chemotherapy in NSCLC?

A

There are limited survival gains of 6-7 weeks

94
Q

What is the second line chemotherapy agent in NSCLC?

95
Q

What therapy can be offered to patients with NSCLC with ECGFR mutations?

A

EGFR tyrosine kinase inhibitors

96
Q

What is the application of radiotherapy in NSCLC?

A

Can be used in a radical or palliative setting

97
Q

How can high-dose curative radiotherapy be given for NSCLC?

A

Using a schedule of continuous hyperfractionated accelerated radiotherapy (CHART)

98
Q

How is continuous hyperfractionated accelerated radiotherapy (CHART) delivered ?

A

3 fractions per day for 12 days

99
Q

Over what time period is palliative radiotherapy given for NSCLC?

100
Q

Which patients are suitable for palliative radiotherapy in NSCLC?

A
  • Symptomatic disease
  • No metastatic spread
  • Good performance status
101
Q

What can palliative radiotherapy be useful for in NSCLC?

A

Symptom control, in particular to improve pain, haemoptysis, breathlessness, and cough

102
Q

What intervention should patients with SVC obstruction be considered for?

A

Stent insertion or radiotherapy

103
Q

What % of patients with SVC obstruction will have SCLC?

104
Q

What is the result of 50% of patients with SVC obstruction having SCLC?

A

Prompt responses to chemotherapy are common

105
Q

How are paraneoplastic syndromes due to production of hormones managed?

A

The syndrome features will improve if treatment for the underlying cancer is successful

106
Q

What should be done if the features of paraneoplastic syndromes return after treatment of the underlying cancer?

A

It should be considered as a possible relapse, and investigated accordingly

Z - Cancer Care Old (28 decks)

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