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103 theme 4 > lung cancer symposium > Flashcards

lung cancer symposium Flashcards

1
Q

what is the epidemiology of lung cancer

A

leading cause of cancer death
Four people die from lung cancer in the UK every hour
Despite label ‘smokers disease’ 1:8 have never smoked

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2
Q

why are there poor survival of lung cancer rates

A

Patients present late with advanced stage – 40% via ED

Early symptoms similar to common smokers symptoms

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3
Q

what are causes of lung cancer

A

70% are caused by smoking

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4
Q

what are types of lung cancer

A

Usually in a smoker of more than 20 years:
Respiratory
Metastatic- from spread to distant sites
Paraneoplastic/systemic

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5
Q

what are symptoms of lung cancer

A 
Cough
haemoptysis
dyspnoea
wheeze
chest pain
hoarseness
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6
Q

Common systemic and metastatic presenting symptoms in lung cancer

A 
Weight loss
Anorexia, nausea
Malaise
Fatigue
From secondary sites eg CNS, bone, skin
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7
Q

Paraneoplastic syndromes in lung cancer

A

Frequently seen:
Hyponatraemia- small cell carcinoma
Hypercalcaemia- squamous cell carcinoma
Less commonly- gynaecomastia, pruritis, cerebellar degeneration, peripheral neuropathy

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8
Q

Common signs on examination

A

clubbing
cachexia
supraclavicular, cervical lymphadenopathy
Stridor due to large airway disease or vocal cord palsy (hoarse voice)
focal chest signs of lung collapse, fixed wheeze
pleural effusion

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9
Q

sub types of cancer

A

Squamous- central; invade locally, frequent cavitation, hypercalcaemia (20%)
Adenocarcinoma- peripheral lung; more common in non-smokers (40%)
Large cell (5%)
Undifferentiated (18%)
Small cell - central; early lymphatic spread; paraneoplastic syndromes (13%)

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10
Q

investigations to confirm cancer diagnosis

A

CT
Bronchoscopy
Endobronchial Ultrasound Needle aspiration
Other biopsy procedure eg percutaneous CT thorax, peripheral lymph node/liver
PET scanning- a nuclear medicine scan, utilising the high uptake of a glucose analogue (2,3 FDG) in tumour cells

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11
Q

how is a lung cancer staged

A

to determine treatment and prognosis

accounts tumour size, involvement of local structures, lymph and blood metastases

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12
Q

what is the T descriptor

A

T0 no primary
T1 tumour less than 3cm, surrounded by lung
T2 more than 3cm, or extends to visceral pleura, or collapse of part of lung, or tumour in main bronchus
T3 at lung apex, less than 2cm from carina, complete lung collapse, invading mediastinal pleura, chest wall, pericardium, diaphragm, phrenic nerve
T4 invading heart, great vessels, trachea, carina, oesophagus, mediastinum, vertebra, RLN, malignant pleural effusion

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13
Q

what is nodal staging

A

N0 no regional lymph node metastases
N1 spread to ipsilateral hilar
N2 to ipsilateral mediastinal and sub carinal nodes
N3 to contralateral mediastinal and hilar nodes, supraclavicular nodes

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14
Q

what is M staging

A

M0 no distant metastases
M1 distant metastases present
Commonly axial skeleton, liver, brain, skin, lung and adrenal glands

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15
Q

how is newly diagnosed lung dealt with

A

lobectomy or radical treatment (radio or chemotherapy)

radiotherapy in palliative to relieve symptoms

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16
Q

what is palliative care for

A 
Cancer
Progressive advanced organ failure
Neurodegenerative illness
Sudden fatal medical condition
e.g. acute stroke, ischaemic limbs, withholding or withdrawing life-saving interventions
17
Q

When might palliative care have a role in lung cancer management?

A

In the terminal phase
After active oncological treatment or as only possible treatment
During treatment
Peri-diagnosis

18
Q

what are types of lung cancer

A

Carcinoma, Sarcoma, Lymphoma, Mesothelioma

19
Q

what does small cell carcinoma look like under a microscopic

A

Widespread bulky disease
Small, dark, delicate cells with little cytoplasm
‘salt and pepper’ chromatin in the nuclei
Azzopardi effect

20
Q

what might adenocarcinoma first appear

A

malignant cells lining alveolar spaces

typically peripheral, contains fibrous tissue and shows variable differentiation which correlates with prognosis

21
Q

where does squamous cell carcinoma begin

A

arise from squamous metaplasia & dysplasia of bronchial epithelium
Central origin often
Cigarette smoke provokes squamous metaplasia, then dysplasia of bronchial epithelium

22
Q

how can SCC and AC be distinguished between

A

can be difficult
Looking for specific proteins can help
eg TTF1 expression is typical of adenocarcinoma

23
Q

how can therapy of AC be determined

A

subdivided according to key mutations
EGFR mutations targeted with tyrosine kinase inhibiting agents (eg erlotinib, gefitinib)
ALK fusion proteins (EML4-ALK) targeted with ALK Tki (eg crizotinib)
PD1/PD-L1 (Pembrolizumab)
Precious tissue is prioritized for testing to permit rational therapy

24
Q

how does lung cancer spread

A

Local and direct spread
Adjacent lung, Intrapulmonary metastasis
Pleura and Pleural Cavity

Lymphatics within Lung
Lymph Nodes – Hilar,
Mediastinal

Liver, Bone, Brain, Adrenal

25
Q

How is NSCLC treated

A

stage 1/2 - lobectomy, radiotherapy +/- chemo

palliative - RT to relive symptoms, chemo can also be used (often in conjunction) to improve QoL/survival

26
Q

how is SCLC treated

A

chemo primary treatment (more effective on SC then NSC)

symptom control, remission and enhancing survival

27
Q

what is fibrosing alveolitis

A

chronic fibrotic condition
ionising radiation, air pollution, and diesel engine exhaust
Chromium
Iron oxide, nickel

28
Q

options for treating lung cancer

A

surgery - robot assisted
radiotherapy
drugs- chemo, immunotherapy, targeted drugs

29
Q

what are surgical considerations

A 
Operative mortality
Cardiovascular mordidity
Lung function
Post-operative quality-of-life/dyspnoea
Surgical approach
Chemotherapy – pre or post-op
Post-operative radiotherapy
30
Q

what is SABR

A

stereotactic ablative body radiotherapy

High energy x-rays delivered via multiple small beams, tracking breathing motion

31
Q

What are the types of surgery

A

wedge resection
lobectomy
pneumonectomy

32
Q

what is palliative radiotherapy used for

A 
Bone pain
Spinal cord compression
Superior venal caval obstruction
Brain metastases
Bleeding (haemoptysis)
33
Q

what is personalised therapy

A

Tailoring therapy according to tumour gene expression and treatment sensitivities.
Targeting mutations eg EGFR, ALK and Ros1, leading to better outcomes for a proportion of pts with adenocarcinoma
Using the immune system

103 theme 4 (20 decks)

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