Lung Cancer And Tobacco Flashcards
If lung cancer is suspected by a GP, what is the maximum wait time to see to lung clinic?
2 week wait
Which cancer has the highest number of deaths worldwide?
Lung cancer
Name the cancers that are the biggest killers
Lung Colorectal Breast Prostate Oesophagus Pancreas Stomach
Which 3 cancers have the worst 5 year survival rates?
Pancreas
Lung
Leukaemia
What is an MST?
Median survival time
Why has lung cancer got an increased incidence in poorer communities?
More likely to smoke
Less access to health care
Less likely to seek help
English may not be first language
What is the commonest age group to get lung cancer?
60 - 80 years old
Tobacco smoking is linked to what proportion of all cancer deaths?
1/3
Apart from smoking, name some other lung cancer risk factors
Radon
Asbestos
Occupational carcinogens (nickel)
Genetic factors
List the criteria needed for an effective screening
Disease with serious consequences High prevalence of detectable disease Test detects little pseudo-disease Test detects disease before critical point Test causes little morbidity Affordable and available Treatment exists Treatments is more effective when applied before symptom detection Treatment not too risk or toxic
What percentage of people presenting with lung cancer actually have a treatable disease?
20%
Describe the basis of TNM staging
T = tumour N = lymph nodes M = metastases
Where does lung cancer spread locally?
Draining lymph nodes
Pleura
Pericardium
Where does lung cancer commonly spread to distally?
Brain
Liver
Adrenals
Bone
When staging lung cancer, what imagining techniques do we use?
CXR
CT scan
PET scan
(Consider MRI, USS, bone scan, ECHO)
How does a PET scan work?
Shows areas of increased activity (metabolism) in a tissue
(Glows orange)
We can figure out if lymph nodes are enlarged due to cancer or another reason
Other than cancer, name 2 lung conditions which in cause tissue to be overactive
Pneumonia
Sarcoidosis
Name some techniques for getting a tissue sample from the lungs
Bronchoscopy USS guided CT guided Thoracoscopy Surgical
Give some symptoms of a primary lung tumour
Cough Dyspnoea Wheezing Haemoptysis Lung infection Chest/shoulder pain Weight loss Lethargy/malaise
What is the commonest presentation of lung cancer?
No symptoms
Give some symptoms that indicate regional metastases of lung cancer
Bloated face (SVC obstruction) Hoarseness of voice Dyspnoea Dysphagia Chest pain
Give some symptoms that indicate distant metastases of lung cancer
Bone pain or fracture CNS symptoms Hypercalcaemia Hyponatraemia Seizures Thirst and constipation
Give some clinical signs of lung cancer
Finger clubbing SVC obstruction Cachexia Pale conjunctiva Cervical lymphadenopathy Horner's syndrome Consolidation Signs of pleural effusion Muffled heart sounds Liver enlargement Skin metastases
What is Horner’s syndrome?
Pressing on the sympathetic trunk causing:
Miosis (constriction of pupil)
Ptosis (weak, droopy eyelids)
Anhidrosis (decreased sweating)
Name the endocrine paraneoplastic syndromes that can occur with lung cancer
Hypercalcaemia
Cushing’s
SIADH
Give some neurological paraneoplastic syndromes that can occur with lung cancer
Encephalopathy
Peripheral neuropathy
Eaton-lambert
Give some haematological paraneoplastic syndromes that can occur with lung cancer
Anaemia
Thrombocytosis
Where do we usually do a biopsy for lung cancer?
In a regional lymph node
Confirm if it is cancer and has it spread
What is the most common type of lung cancer?
Non-small cell carcinoma
What are the different types of non-small cell carcinoma?
Squamous cell carcinoma
Adenocarcinoma
Large cell carcinoma
What are the 2 most common specific lung cancers?
Squamous cell carcinoma (40%)
Adenocarcinoma (35%)
What are the main types of lung cancer?
Non-small cell
Small cell
What are molecular markers?
Genetic mutations in some tumours that we can target therapy at
Why does performance status in a cancer patient need to be assessed?
Decide whether they will be able to cope with the treatment
Treatment is very exhausting
Describe the performance status ranking
0 = no symptoms, normal activity 1 = symptomatic but able to carry out normal daily activities 2 = symptomatic, in bed or chair less than half the day. Needs some assistance with daily activities 3 = symptomatic, in bed or chair more than half the day 4 = bedridden 5 = dead
What performance status is required to consider cancer treatment?
< 2
What are the different treatment options for lung cancer?
Surgery Radiotherapy - radical (curative intentions) or palliative Chemotherapy Combined chemo and radio Targeted therapies Palliative care
What type of lung cancer are we most likely to attempt surgery on?
Non small cell
Chemotherapy can potentially be curative for which type of lung cancer?
Small cell
Has the general prevalence of smoking increased or decreased?
Decreased
In which groups of people have the prevalence of smoking remained the same?
Unemployed
Prisoners
People with mental health issues
Name some of the many tobacco related diseases
Lung cancer COPD Mouth cancer Atherosclerosis Stroke Aneurysm Claudication RA Dementia Cancers: throat, renal, bladder, pancreatic etc
What are markers of addiction?
Use despite knowledge of harmful consequences
Cravings during abstinence
Failure of attempts to stop
Withdrawal symptoms during abstinence
Why is nicotine addictive?
Acts on nicotinic acetylcholine receptors (nAChR)
Stimulates dopamine release
Gives satisfaction
What happens in chronic nicotine exposure?
Upregulated nAChRs
Therefore a decline in nicotine will cause withdrawal symptoms and cravings
What is the difference between patch and spray nicotine replacements?
Patch - constant nicotine source
Spray - hit of nicotine like when smoking
What are the 3 As of helping people to stop smoking?
Ask - about smoking status
Advise - health benefits of stopping
Act - build confidence, give into, refer, prescribe
What are Champix?
Nicotine gum
Partial nicotine agonist with high affinity
Reduces cravings and reduces withdrawal symptoms
Also reduces the satisfaction a smoker will get from smoking
