Lung Cancer - Clinical Features and Staging Flashcards

1
Q

What are RFs for developing lung cancer?

A
Smoking
Passive smoking
Exposure to asbestos
Air pollution 
Diesel exhaust
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2
Q

What are signs and symptoms of lung cancer?

A
Chronic cough
Haemoptysis
Wheeze
SoB
Chest pain 
Wt loss, anorexia
Hoarseness 
SVC syndrome 
Lymphadenopathy (cervical/supraclavicular)
Clubbing
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3
Q

What patients with lung cancer will get hoarseness?

A

Pancoast tumours pressing the recurrent laryngeal nerve

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4
Q

What are symptoms of advanced/metastatic lung cancer?

A

Bone pain
Spinal cord compression –> limb weakness, paraesthesia, bladder/bowel dysfunction
Cerebral mets –> headache, vomiting, dizziness, ataxia, focal weakness
Thrombosis

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5
Q

What are symptoms someone with a paraneoplastic syndrome might get?

A
Hyponatraemia (SIADH)
Anaemia
Hypercalcaemia (PTHrP)
Dermatomyositis/polymyositis
Eaton-Lambert syndrome (proximal muscle weakness) 
Cerebellar ataxia
Sensorimotor neuropathy
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6
Q

What cancers is Lambert-Eaton syndrome associated with?

A

Mostly associated with small cell lung cancer
(Less so with breast + ovarian cancer)

May occur independently as an autoimmune condition

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7
Q

What causes Lambert-Eaton syndrome?

A

Antibodies directed against presynaptic voltage gated calcium channels in the peripheral nervous system

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8
Q

What are features of Lambert-Eaton syndrome?

A

Repeated muscle contractions leads to increased muscle strength
Limb girdle weakness (lower limbs first)
Hyporeflexia
Autonomic symptoms - dry mouth, impotence, difficulty micturating

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9
Q

What do you see on EMG in Lambert-Eaton syndrome?

A

Incremental response to repetitive electrical stimulation

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10
Q

How is Lambert-Eaton syndrome managed?

A

Treat underlying cancer
Immunosupression, e.g. prednisolone +/- azathioprine
3, 4-diaminopyridine
IV Ig therapy + plasma exchange

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11
Q

What is SIADH?

A

Syndrome of inappropriate ADH secretion is characterised by hyponatraemia secondary to dilutional effects of excessive water retention

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12
Q

What are causes of SIADH?

A

Small cell lung cancer, pancreatic + prostate cancer

Stroke, SAH, subdural haemorrhage, meningitis/encephalitis/abscess

TB, pneumonia

Drugs - SUs, SSRIs, TCAs, carbamazepine, vincristine, cyclophosphamide

Others - positive end expiratory pressure, porphyrias

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13
Q

How is SIADH managed?

A

Correct slowly
Fluid restrict
Demeclocycline
ADH receptor antagonists

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14
Q

Why must you correctly SIADH slowly?

A

To avoid precipitating central pontine myelinolysis

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15
Q

How does demeclocycline work?

A

Reduces responsiveness of collecting tubule cells to ADH

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16
Q

What initial investigations are useful to do in someone who has just been diagnosed with lung cancer?

A

CXR, FBC, LFTs, U&E, calcium, clotting screen, spirometry

17
Q

Which of NSCLC and SCLC carries a worse prognosis?

A

SCLC

18
Q

What kind of tumour do you usually get with bronchial adenoma?

A

Carcinoid

19
Q

What is important to remember about alveolar cell carcinomas?

A

++ sputum

NOT related to smoking

20
Q

How is lung cancer staged?

A

TNM

21
Q

What is T1 lung cancer?

A

<=3cm surrounded by lung/visceral pleura, not involving main bronchus
1a <=1cm
1b 1-2cm
1c 2-3cm

22
Q

What is T2 lung cancer?

A

3-5cm or involves main bronchus, visceral pleura or aletectasis or post-obstructive pneumonitis extending to hilum

23
Q

What is T3 lung cancer?

A

5-7cm or tumour involving chest wall, pericardium, phrenic nerve or satellite nodules in same lobe

24
Q

What is T4 lung cancer?

A

> 7cm or invades mediastinum, diaphragm, heart, great vessels, recurrent laryngeal nerve, carcina, trachea, esophagus, spine or separate tumour in different lobe of ipsilateral lung

25
Q

What is N0 in lung cancer staging?

A

No regional LN involvemetn

26
Q

What is N1 in lung cancer staging?

A

Involvement of ipsilateral hilar/ipsilateral peribronchial nodes

27
Q

What is N2 in lung cancer staging?

A

Involvement of mediastinal/subcarcinal nodes

28
Q

What is N3 in lung cancer staging?

A

Involvement of contralateral mediastinal/hilar or ipsilateral scalene/supraclavicular

29
Q

What is M0?

A

No distant mets

30
Q

What is M1?

A

Distant mets present

31
Q

What are the performance statuses?

A
0 = fully active
1 = symptoms but ambulatory 
2 = up and about >50% of time, unable to work 
3 = up and about <50% of the time, limited self care
4 = wheelchair/bed bound
32
Q

What surgeries may be offered for lung cancer?

A

Wedge resection
Lobectomy
Pneumonectomy

33
Q

What kind of radiotherapies may be offered for some patients with lung cancer?

A

Radical
Palliative
Stereotactic

34
Q

What targeted therapies may be used in treating lung cancer?

A

TKIs

Monoclonal antibodies, e.g. enotinib, getitinib

35
Q

What chemotherapies may be used in treating lung cancer?

A

Small cell, e.g. cisplatin/etoposide
Adenocarcinoma, e.g. cisplatin/pemetrexed
Squamous, e.g. cisplatin/gemcitabine

36
Q

What may be involved in managing palliative lung cancer?

A

Symptom control - chemo/radio, opiates, bisphosphonates, benzos
Treat hypercalcaema, dehydration, hyponatraemia