Lung Cancer Lecture Flashcards
What stats are important regarding the prevalence of lung cancer?
Second mosy common cancer in the UK - 13% of all new cancers
Worst survival rates from big four - only 30% of patient alive one year post diagnosis
What is the most common symptoms of lung cancer?
Cough
What are the different symptoms of lung cancer?
Cough - or change in chronic, failure to resolve in 2 to 3w is red flag
Weight loss
SOB - disproportionate, may wheeze are related to obstruction, may be due to spread to pleura, pericardium, mediastinum or lymphatics.
Haemoptysis - streaking sputum, several successive days
Chest pain
Hoarse voice
Cord compression (from spinal mets), Paraneoplastic syndromes
What is the chest pain like in lung cancer?
Persistent but not specific ache
Can be referred from diaphragm or brachial plexus
Can indicate ribs/spine mets or direct invasion of pleura, mediastrinium or pericardium
(lung parenchyma has no pain receptors)
What are the signs/symptoms of a direct intrathoracic invasion from a lung cancer?
Hoarseness (recurrent laryngeal nerve)
SVC obstruction
Dysphagia from oesophageal compression
Elevated diaphragm
Pericardial involvement with arrhythmia or effusion
What are some signs of lung cancer?
Cachexia
Finger clubbing
Pleural effusion
Lymphadenoptahy
Stridor
Tracheal deviation (lobar/lung collapse due to bronchus obstruction)
How strong is the correlation between smoking and lung cancer?
1 in 5 smokers will get lung cancer
Ex-smokers - risk declines compared to when continued smoking, lower for less pack history and longer time since last smoked
Non-smoker - 0.5% risk
What are some common risk factors for lung cancer?
Smoking
Asbestos exposure
Underlying interstitial lung disease
COPD
What is the main flow chart process in diagnosis/management of lung cancer?
Confirm diagnosis of cancer: Histological/cytology confirm from biopsy
Confirm stage - extend of spread
Assess patient fitness for treatment/patient wishes
What is the typical diagnostic process for lung cancer?
CXR +ve
Urgent referall to chest clinic
CT scan
Then simultaneous:
A) assess FIT, PFTs, Blood tests
B) bronchoscopy/EBUS, CT guided FNA, pleural tap, mediastinoscopy
If feasible that treatment would be beneficial have a PET scan.
What are the two main types of lung cancer?
Small cell lung cancer
Non-small cell lung cancer
What is meant by small-cell lung cancer?
Is of neuroendocrine origin
Small and round cells
Associated with smoking
High metastasis rates and fastest growing rate, anaplastic, often in multiple sites
Usually arise centrally within the lungs, often small tumour with large node as presentation
Make up 20% of lung tumours
What is the typical treatment management of a small cell lung cancer?
Often stage 4 at time of diagnosis
Generally considered inoperatble due to high incidence of disseminated disease at presentation - may be used at part of multimodal therapy.
Tend to be chemo with/out radiation.
What is meant by a non-small cell lung cancer?
Orignate in the epithelial cells of the lungs - from central bronchi to terminal alveoli.
Typically develops in the outer portions of lungs.
Types include - adenocarcinoma, sqaoumous cell carcinoma, large-cell carcinoma
Can be fast or slow growing
Treatment is surgical, medical or radiation
What are the trends of prognosis with small cell lung cancer?
Limted stage - 12w without treatment, 12m after chemo, up to 10% 5yr survival
Extensive stage - 6w no treatment, 8months chemo, 0% five year
