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Respiratory System > Lung Cancer And Tobacco > Flashcards

Lung Cancer And Tobacco Flashcards

1
Q

If lung cancer is suspected by a GP, what is the maximum wait time to see to lung clinic?

A

2 week wait

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2
Q

Which cancer has the highest number of deaths worldwide?

A

Lung cancer

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3
Q

Name the cancers that are the biggest killers

A 
Lung 
Colorectal 
Breast 
Prostate 
Oesophagus 
Pancreas
Stomach
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4
Q

Which 3 cancers have the worst 5 year survival rates?

A

Pancreas
Lung
Leukaemia

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5
Q

What is an MST?

A

Median survival time

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6
Q

Why has lung cancer got an increased incidence in poorer communities?

A

More likely to smoke
Less access to health care
Less likely to seek help
English may not be first language

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7
Q

What is the commonest age group to get lung cancer?

A

60 - 80 years old

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8
Q

Tobacco smoking is linked to what proportion of all cancer deaths?

A

1/3

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9
Q

Apart from smoking, name some other lung cancer risk factors

A

Radon
Asbestos
Occupational carcinogens (nickel)
Genetic factors

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10
Q

List the criteria needed for an effective screening

A 
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
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11
Q

What percentage of people presenting with lung cancer actually have a treatable disease?

A

20%

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12
Q

Describe the basis of TNM staging

A 
T = tumour
N = lymph nodes 
M = metastases
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13
Q

Where does lung cancer spread locally?

A

Draining lymph nodes
Pleura
Pericardium

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14
Q

Where does lung cancer commonly spread to distally?

A

Brain
Liver
Adrenals
Bone

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15
Q

When staging lung cancer, what imagining techniques do we use?

A

CXR
CT scan
PET scan
(Consider MRI, USS, bone scan, ECHO)

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16
Q

How does a PET scan work?

A

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

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17
Q

Other than cancer, name 2 lung conditions which in cause tissue to be overactive

A

Pneumonia

Sarcoidosis

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18
Q

Name some techniques for getting a tissue sample from the lungs

A 
Bronchoscopy 
USS guided 
CT guided 
Thoracoscopy
Surgical
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19
Q

Give some symptoms of a primary lung tumour

A 
Cough 
Dyspnoea 
Wheezing 
Haemoptysis 
Lung infection 
Chest/shoulder pain 
Weight loss
Lethargy/malaise
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20
Q

What is the commonest presentation of lung cancer?

A

No symptoms

21
Q

Give some symptoms that indicate regional metastases of lung cancer

A 
Bloated face (SVC obstruction)
Hoarseness of voice
Dyspnoea 
Dysphagia 
Chest pain
22
Q

Give some symptoms that indicate distant metastases of lung cancer

A 
Bone pain or fracture 
CNS symptoms 
Hypercalcaemia
Hyponatraemia 
Seizures 
Thirst and constipation
23
Q

Give some clinical signs of lung cancer

A 
Finger clubbing 
SVC obstruction 
Cachexia 
Pale conjunctiva
Cervical lymphadenopathy 
Horner's syndrome 
Consolidation 
Signs of pleural effusion 
Muffled heart sounds
Liver enlargement 
Skin metastases
24
Q

What is Horner’s syndrome?

A

Pressing on the sympathetic trunk causing:
Miosis (constriction of pupil)
Ptosis (weak, droopy eyelids)
Anhidrosis (decreased sweating)

25
Q

Name the endocrine paraneoplastic syndromes that can occur with lung cancer

A

Hypercalcaemia
Cushing’s
SIADH

26
Q

Give some neurological paraneoplastic syndromes that can occur with lung cancer

A

Encephalopathy
Peripheral neuropathy
Eaton-lambert

27
Q

Give some haematological paraneoplastic syndromes that can occur with lung cancer

A

Anaemia

Thrombocytosis

28
Q

Where do we usually do a biopsy for lung cancer?

A

In a regional lymph node

Confirm if it is cancer and has it spread

29
Q

What is the most common type of lung cancer?

A

Non-small cell carcinoma

30
Q

What are the different types of non-small cell carcinoma?

A

Squamous cell carcinoma
Adenocarcinoma
Large cell carcinoma

31
Q

What are the 2 most common specific lung cancers?

A

Squamous cell carcinoma (40%)

Adenocarcinoma (35%)

32
Q

What are the main types of lung cancer?

A

Non-small cell

Small cell

33
Q

What are molecular markers?

A

Genetic mutations in some tumours that we can target therapy at

34
Q

Why does performance status in a cancer patient need to be assessed?

A

Decide whether they will be able to cope with the treatment

Treatment is very exhausting

35
Q

Describe the performance status ranking

A 
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
36
Q

What performance status is required to consider cancer treatment?

A

< 2

37
Q

What are the different treatment options for lung cancer?

A 
Surgery 
Radiotherapy - radical (curative intentions) or palliative 
Chemotherapy 
Combined chemo and radio 
Targeted therapies 
Palliative care
38
Q

What type of lung cancer are we most likely to attempt surgery on?

A

Non small cell

39
Q

Chemotherapy can potentially be curative for which type of lung cancer?

A

Small cell

40
Q

Has the general prevalence of smoking increased or decreased?

A

Decreased

41
Q

In which groups of people have the prevalence of smoking remained the same?

A

Unemployed
Prisoners
People with mental health issues

42
Q

Name some of the many tobacco related diseases

A 
Lung cancer
COPD
Mouth cancer
Atherosclerosis 
Stroke 
Aneurysm 
Claudication 
RA
Dementia 
Cancers: throat, renal, bladder, pancreatic etc
43
Q

What are markers of addiction?

A

Use despite knowledge of harmful consequences
Cravings during abstinence
Failure of attempts to stop
Withdrawal symptoms during abstinence

44
Q

Why is nicotine addictive?

A

Acts on nicotinic acetylcholine receptors (nAChR)
Stimulates dopamine release
Gives satisfaction

45
Q

What happens in chronic nicotine exposure?

A

Upregulated nAChRs

Therefore a decline in nicotine will cause withdrawal symptoms and cravings

46
Q

What is the difference between patch and spray nicotine replacements?

A

Patch - constant nicotine source

Spray - hit of nicotine like when smoking

47
Q

What are the 3 As of helping people to stop smoking?

A

Ask - about smoking status
Advise - health benefits of stopping
Act - build confidence, give into, refer, prescribe

48
Q

What are Champix?

A

Nicotine gum
Partial nicotine agonist with high affinity
Reduces cravings and reduces withdrawal symptoms
Also reduces the satisfaction a smoker will get from smoking

Respiratory System (13 decks)

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