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2B week 8 - lung cancers > lung cancer - diagnosis and staging > Flashcards

lung cancer - diagnosis and staging Flashcards

1
Q

what are the 3 subtypes of lung cancer

A

small cell, non-small cell and carcinoids

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2
Q

what are the 5 sub types of NSC lung cancer

A

adeno; squaemous; large cell; mixed; undifferentiated

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3
Q

7 risk factors for lung cancer

A

cigarette smoking; occupational exposure; genetics; low level radiation; smoking/low intake of beta carotene; lung disease history; FH of lung cancer

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4
Q

common signs/symptoms of lung cancer (10)

A

fever without a known reason; recurring infections (bronchitis, pneumonia etc.); cough that does not go away; change on cough that one has had for a long time; SOB; coughing up phlegm with blood in it; ache/pain in chest/shoulder; loss of appetite; tiredness

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5
Q

less common signs of lung cancer (7)

A

hoarse voice (compression of recurrent laryngeal nerve); difficulty swallowing; changes in fingernails (clubbing; swollen face (SVC obstruciton); swollen lymphnodes in neck; change in blood tests (raises platelets); pain under ribcgae (swollen liver); fluid in lungs causing SOB

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6
Q

why is early diagnosis needed (3)

A
  1. in early stages treatment is most successful
  2. earlier diagnosis can increase the survival
  3. to detect the disease at a stage when it is not causing symptoms
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7
Q

why is lung cancer not screened for routinely (4)

A

high number of pts needed to screen; cost effectivness uncertain; risk over diagnosis and invasive tests for benign disease; smoking cessation and tobacco control are likley to be more cost effective

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8
Q

who should be referred urgently for CXR (suspicion of cancer)

A

unexplained haemoptysis
or
any of the following unexplained, persisitant (>3wks) symptoms:
chest/shoulder pain
SOB
weight loss
abnormal chest signs
hoarseness
clubbing
cerviacle/supraclavicular lymphadenopathy
cough
features suggestive of a metastasis from a lung cancer

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9
Q

who should be urgently referred to a lung caner specialist (6)

A
  1. persisitant haemoptysis in smokers/ex-smokers >40yro
  2. CXR suggestive of lung cancer
  3. finger clubbing
  4. severe weight loss
  5. superior vena cava obstruction
  6. neck nodes in smokers
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10
Q

3 types of cancer staging

A

clinical (CXR/CT/PET etc.)
surgical (bronchoscopy, EBUS-TBA, mediastinoscopy)
pathological (after complete resection and LN sampling)

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11
Q

why is using a CT scan alone not good for clinical staging

A

40% of suspicious LN are benign according to size criteria
20% of non suspicious LN are malignant

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12
Q

what are the 4 techniques used in surgical staging

A

brinchoscopy/EBUS-TBA; mediastinotomy/scopy; thoracoscopy; thoracotomy

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13
Q

what is EBUS-TBNA

A

Endobronchial Ultrasound-guided Transbronchial Needle Aspiration

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14
Q

if the disease is metastatic, where is the biopsy obtained from

A

the easiest site

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15
Q

what is the TNM staging system

A

Classification of Malignant Tumors:
T - tumour size (0-4)
N - number of nearby lymphnodes that are cancerous (0-3)
M - metastasis (0-1)

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16
Q

what is T staging (lung)

A

tumour size (every cm matters)
T0 - no evidence of primary tumour
T1 - tumor 3cm or less
T2 - tumor 3-5cm or has invaded pluera, involves main bronchus, associated w atelectasis
T3 - tumor 5-7cm or has involved the phrenic nerve, chest wall, pericardium
T4 - >7cm or has involved the diaphragm, mediastinum, heart, great vessels, trachea etc.

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17
Q

what is N staging (lung)

A

lymph node involvement
N0- no regional lymph node metastasis
N1 - metasestis in ipsilateral peribronchial/hilar lymphnodes, intrapulmonary involement
N2 - metastasis in ipsilateral mediastinal lymphnodes
N3 - metastasis in contralateral hilar, ipsilateral/contralateral scalene, supraclavicular lymphnodes

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18
Q

what is M staging

A

distant metastasis
M0- no distant metastasis
M1- distant metastasis
1a - single tumor nodule in contralteral lobe/pleural/pericardial nodules or malignant pleural/pericardia effusoin
1b - single extrathoracic metastasis in a single organ
1c - multiple extra thoracic metastases in one or several organs

19
Q

clinical vs pathological size

A

clinical - size of solid component
pathological - size of invasive component

20
Q

which stage is the baseline for oligometastases/progression

A

M1b

21
Q

how are multiple primary tumors staged

A

one TNM for each tumor

22
Q

what is the most common type of lung cancer

A

non-small cell lung cancer

23
Q

what are the 3 main types of NSCLC

A

adenocarcinoma (40%) - form glandular structures and generate mucins
squamous - square shaped cells that produce keratin, deplete calcium levels in bone making them brittle
large cell - lack glandular and squamous differnetiaiton

24
Q

what are pancoast tumors, what can they damage and what syndrome can they cause

A

cancers that start in the apex of the lung; cause damage to thoracic inlet, brachial plexus, cerviacle sympathetic nerve -> this results in Horner’s syndrome

25
Q

what is a key symptom of horner’s syndrome and why does it occur

A

compression of cervical sympathetic nerve means sweating cannot occur on the affected side; other symptoms include constricted pupil and drooping eyelid

26
Q

adenocarcinoma facts (9)

A

slow growin;g
Arises from mucous cells in the bronchial epithelium;
Commonly invades the mediastinal lymph nodes and the pleura, and spreads to the brain and bones;
tends to be in periphery of the lung ;
Does not usually cavitate ;
Most likely to cause pleural effusion;
Proportionally more common in non-smokers, women and in the Far East; usually TTF-1 positive

27
Q

squamous cell carcinoma facts (6)

A

commonly starts in the bronchi and may not spread as rapidly as other lung cancers;
On X-ray it is not possible to tell whether it is an abscess or a cancer (the border’s definition cannot be easily seen) but on the CT there is obviously a jagged border – indicating cancer;
Local spread is common, but metastasis are normally late;
Usually present as obstructive lesions of the bronchus leading to infection;
Often causes hypercalcaemia – by bone destruction or production of PTH analogues;
TTF-1 negative, p63 positive and cytokeratin 5/6 positive

28
Q

large cell carcinoma facts (2)

A

names after the large, round cells seen in this cancer;
grow quickly and spread => usually diagnoses in layter stages

29
Q

good prognostic factors for NSCLCs

A

early stage diagnosis; good performance status; no significant weight loss; female gender

30
Q

what is a bronchial carcinoid tumor

A

a low-grade malignancy of neuroendocrine cells - same cell of origin as small-cell carcinomas

31
Q

pathology of small cell lung cancer (SCLC)

A

uncontrolled proliferation of small, immature, neuroendocrine cells; usually develops centrally near main bronchus; grows fast and rapidly metasesises to other organs; secretes hormones causing paraneoplastic syndromes

32
Q

typical presentaiton of SCLC

A

large hilar mass - bulky mediastinal lymphadenopathy that causes cough and dyspnoea; earlier development of widespread mets

33
Q

what is SCLC strongly associated with

A

smoking

34
Q

what paraneoplastics syndromes may be caused by SCLC

A

SI-ADH (inappropriate ADH secretion resulting in hyponatraemia); Polyneuropathy (Antibodies against the myelin sheath); Cerebellar degeneration; Eaton-Lambert Myasthenic synrome (proximal muscle weakness that improves on repetition);(Hypertrophic pulmonary osteoarthropathy); Carcinoid syndrome; Ectopic ACTH secretion – causing Cushing’s syndrome; Hypercalcemia; DVT/PE

35
Q

what are 3 key investigations for SCLC

A

labs - FBC, LFT, LDH;
CT chest/abdo/plevis;
brain imaging (CT/MRI) - up to 30% have brian mets, esp when pts are symptomatic

36
Q

where does SCLC commonly metastasize to

A

B-brain
A-adrenal gland
L- liver
L-lung
S- skeleton

37
Q

limited and extensive SCLC classifications (TNM)

A

limited: any T, any N, M0
extensive: an T any N, M1a/b, T3/4 due to multiple lung nodules

38
Q

limited and extensive SCLC classifications (areas affected)

A

limited: disease confined to the ipsilateral hemithorax which can be safely encompassed within a radiation field
extensive: disease beyond the ipsilateral hemithorax, including malignant pleural or pericardial effusion

39
Q

what biomarkers are common in SCLC

A

all stain positive for: keratin; epitherlial membrane antigen; TTF-1 (thyroid transcription factor-1)
most stain positive for: neuroendocrine differentiation marks (e.g. chromogranin A)

40
Q

NSCLC management (3)

A

First-line: lobectomy;
Curative radiotherapy can also be offered to patients with stage I, II and III NSCLC;
Chemotherapy should be offered to patients with stage III and IV NSCLC to control the disease and improve quality of
life

41
Q

SCLC management

A

Generally palliative chemotherapy, as tumours are disseminated on presentation

42
Q

if a tumor compresses a blood vessel e.g. SVC what can occur

A

back up of blood resulting in facial swelling, SOB

43
Q

what cancer is most associated with non-smokers

A

adenocarcinoma

2B week 8 - lung cancers (5 decks)

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