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Respiratory > Lung cancer: clinical and treatment > Flashcards

Lung cancer: clinical and treatment Flashcards

1
Q

Is lung cancer common? is it curable? How commonly does it cause cancer death?

A
  • Third most common cancer in the UK
  • 90 % incurable at time of diagnosis
  • Most common cause of cancer death in men and women in Scotland
  • Rates of lung cancer in Scotland are among the highest in the world
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2
Q

What 9 clinical symptoms may cause suspicion of lung cancer?

A

A cough for 3 weeks or more.

SOB - the tumour can cause a pleural effusion

Recurrent pneumonia/treatment resistant pneuomonia.

haemoptysis - due ulceration of mucosa

Unexplained weight loss.

Chest or shoulder pains - invasion of the chest wall/bony erosion

Unexplained tiredness or lack of energy.

A hoarse voice

stridor

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3
Q

Where are the 6 areas of local invasion for lung cancer?

A 
Recurrent laryngeal nerve - hoarse voice
Pericardium - breathless/Atrial fibrillation/pericardial effusion
Oesophagus - dysphagia
Brachial plexus
Pleural cavity
Superior vena cava
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4
Q

What is a pancoast tumour? what is pancoast syndrome?

A

an apical (superior pulmonary sulcus) malignant neoplasm of the lung

Pancoast syndrome results from involvement of brachial plexus and sympathetic chain by a Pancoast tumour, or less commonly from other tumours involving the superior pulmonary sulcus. The syndrome consists of:

shoulder pain
C8-T2 radicular pain
Horner syndrome
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5
Q

What clinical symptoms/signs can local invasion of a tumour into the superior vena cava cause? why is this?

A
  • obstructs drainage of blood from the arms/head
  • puffy eyes/headache
  • may see distended veins on abdomen as the blood flow is bypassing the obstructed SVC by opening up anastomoses with the IVC tributaries
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6
Q

What are the common sites for metastases from primary lung cancer? (6)

A
  • liver
  • brain
  • bone
  • adrenal
  • skin
  • lung
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7
Q

What signs/symptoms may be seen with cerebral metastases of primary lung cancer? what is the nature of onset?

A

Insidious onset

  • Weakness
  • Visual disturbance
  • Headaches: Worse in the morning, Not photophobic
  • Fits
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8
Q

What treatment can be used to relieve symptoms of cerebral metastases?

A

high dose corticosteroid therapy

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9
Q

Where do tumours have to be located in the liver to produce pain?

A

-adjacent to liver capsule

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10
Q

What are the two common presentations of bony metastases? What scan can be used to detect these?

A
  • localised pain which is worse at night
  • pathological fracture

Isotope bone scan

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11
Q

What is paraneoplastic syndrome? what are the 7 clinical features?

A 
Clinical features which arise from the effects of biochemically active products from the primary tumour:
Finger clubbing
Hypertrophic pulmonary osteoarthropathy - HPOA (elevation of the periosteum away from the bone surface = pain/tenderness of long bones near the adjacent joints)
Weight loss
Thrombophlebitis
Hypercalcaemia
Hyponatraemia - SIADH
Weakness - Eaton Lambert syndrome
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12
Q

What investigations are important for suspected lung cancer? (9)

A

-Full blood count
-Coagulation screen
-Na, K, Ca, Alk Phos
-Spirometry, FEV1
-Chest X-ray
-CT scan of thorax
-PET scan (radiolabelled glucose is taken up by tissues with high metabolic activity = light up)
-Bronchoscopy
-Endobronchial Ultrasound (EBUS)
(NOT sputum cytology)

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13
Q

What is needed to make a diagnosis of lung cancer? what are 6 examples of how this can be done?

A 
A tissue diagnosis:
Bronchoscopy
CT guided biopsy
Lymph node aspirate
Aspiration of pleural fluid
Endobronchial Ultrasound
Thoracoscopy (bronchoscope with US tip, can target and sample lymph nodes)
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14
Q

What is horners syndrome and how is it caused?

A

Compression of the cervical parts of the sympathetic trunk:
- ipsilateral ptosis: drooping of the upper eyelid due to lack of sympathetic innervation of the smooth muscle within levator palpebrae superioris

  • ipsilateral miosis (pinpoint pupil) due to lack of sympathetic innervation of the dilator pupillae
  • reduced sweating of the ipsilateral facial skin due to lack of sympathetic innervation of skin sweat glands
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15
Q

For small cell lung cancer:

  • what is the progression of disease?
  • does it metastasise?
  • is it suitable for surgery?
  • is it suitable for chemo?
A
  • Rapidly progressive disease
  • Early metastases
  • Rarely suitable for surgery
  • Good initial response to chemotherapy (as it is fast growing this makes it more susceptable) This is often backed up by radiotherapy
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16
Q

For non-small cell lung cancer:

  • what are the treatment options?
  • sensitive to radiotherapy?
A

Curative options are surgery or radical radiotherapy

Less responsive to chemotherapy

17
Q

Is small cell lung cancer or non-small small cell cancers more common in the lung?

A

non-small cell cancer accounts for the majority of lung cancers

18
Q

How is staging carried out in lung cancer (5)? Why is this important to do before surgery?

A

Bronchoscopy:

  • Vocal cord palsy
  • Proximity to carina (as can’t remove if too close to the carina as there will be a hole in the trachea)
  • Cell type

Mediastinoscopy/EBUS:
-Lymph nodes

CT scan of brain:
Metastases

CT scan of thorax:
Tumour size
Lymph nodes
Metastases
Local invasion

PET scan:
Positron Emission Tomography
Metastases

It is important to do this before surgery because the surgeon needs to be certain they can remove the entire tumour via operation

19
Q

What types of surgery are available for lung cancer? what is the main objective? is it common for patients to be suitable for surgery?

A
  • pneumonectomy or lobectomy: requires a thoracotomy or minimal access VATS
  • curative objective
  • 1 in 20 are fit for surgery
20
Q

What staging needs to be done for lung cancer before chemotherapy commences?

A

Bronchoscopy or other tissue sampling:
Small cell / non-small cell (to determine choice of drugs)

CT scan:

  • Tumour size
  • Local invasion
  • Nodes
  • Metastases

Performance status ECOG score:
-patient needs to be fairly fit to cope with chemo.

21
Q

What endobronchial therapy is available for lung cancer?

A

Stent insertion for stridor
Photodynamic therapy
Other laser therapy
Radioactive pellets

22
Q

Overall: the treatment of lung cancer is determined by? (4)

A
  • cell type
  • extent of disease
  • co-morbidity
  • patient wishes

Respiratory (17 decks)

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