Lung + Pleural Cancer Flashcards
What risk factors as associated with lung cancer?
Smoking
Passive cigarette smoke
Occupational exposure
-asbestos
Family history
Air pollution
Diesel fumes
Ionising radiation
Industrial chemicals
Previous radiotherapy
Old age (most over 70 when present)
What part of the respiratory tract is most common site for lung cancer? What 4 main types of cancer can present here?
Bronchioles I.e. primary bronchiole carcinoma
Small cell carcinoma
Non-small cell carcinoma:
- adenocarcinoma
- large cell carcinoma
- squamous carcinoma
What type of cancer is linked with asbestos exposure and which part of the lungs does it affect?
Malignant mesothelioma
Pleural lining
Which cancer is most strongly associated with smoking? Which cells does this cancer arise from? How can it be managed?
Small cell carcinoma= rapidly growing + aggressive
Neuroendocrine cells (Kultchitsky cells) in large airways
Inoperable at presentation and very likely to have metastasised
Responds to chemo but poor prognosis
What are the 3 lung cancers which are classified as non-small cell carcinomas? What are the differences between them?
Adenocarcinoma
- Arises from mucous cells in bronchial epithelium
- associated with genetic mutations and is the most common bronchial carcinoma associated with non-smokers
- commonly spreads to pleura, brain and bones
Squamous cell carcinoma
- most common bronchial carcinoma
- located central to large airways i.e. can lead to obstructive lesions
Large cell carcinomas:
- large and poorly differentiated
- metastasise early
What is the common presentation of secondary lung cancer on a CXR? What are the common sites of origin?
Round nodules= “cannon ball mets”
Breast Bone Prostate Colon Ovary
What red flag symptoms would raise suspicion of cancer in patient history?
Smoking
Pre-existing COPD
Prolonged unexplained cough
Haemoptysis
Back pain- indication of spinal mets
Unintentional weight loss
What are the systemic signs of lung cancer?
- Fever, nausea, vomiting= signs which are similar to that of chest infection
- cachexia
- hoarseness and dysphagia= if recurrent laryngeal nerve affected or due to anatomical compression of oesophagus
- horners syndrome= pancoast tumour i.e. superior sulcus of lung
What are the peripheral signs of lung cancer?
Finger clubbing Muscle wasting of hand SVC obstruction -oedema of neck and face Lymphadenopathy= supraclavicular nodes
What are the possible chest signs associated with lung cancer?
Wheezing Stridor= high pitch breathing Consolidation Pleural effusion Lung collapse
What are paraneoplastic features of:
- Adenocarcinoma
- small cell
- squamous cell?
Gynaecomastia= due to increased oestrogen to androgen ration
SIADH ACTH: -non-typical Cushings -hypertension -hyperglycaemia -hypokalaemia -alkalosis -muscle weakness
PTH= causes HYPERCALCAEMIA
Clubbing
Hypertrophic pulmonary oestroarthropathy
Hyperthyroidism= due to ectopic TSH
What signs would indicate that an urgent CXR referral is required for patient with suspicion of cancer? What might you expect to find on the CXR?
Signs:
- haemoptysis
- chest symptoms for longer than 3 weeks
- chronic respiratory problems with acute unexplained changes in symptoms
Findings:
- hilar enlargement
- peripheral circular opacity
- collapse consolidation
- pleural effusion
What is the role of contrast-enhanced CT in lung cancer investigations?
Clarify location and size of nodules
Evidence of spread by scanning adrenals and liver
When are PET-CT scans used to investigation lung cancer patients?
What are they particularly sensitive for?
Potentially curable patients
Shows high areas of metabolic activity which can be used to highlight mets
I.e. can be superimposed over CT scans to create “hotspots”
What are the 4 main methods used for tissue diagnosis in suspected lung cancer?
Bronchoscopy
-when cancer visible in airway
EBUS-TBNA
-needle biopsy of LN or mass adjacent to airway
CT guided biopsy
-when not able to access mass via the airway
Surgical biopsy
-when non-invasive methods not successful
When is an immediate referral considered for patients with suspected lung cancer?
Signs of SVCO
Lower limb weakness with suspicion of cancer
Stridor
What are the indications for patient to be placed on the 2 week wait referral pathway for lung cancer?
Persistent haemoptysis in smokers or ex-smokers over 40 years
CXR signs of lung cancer
Normal CXR but high suspicion of cancer
HX of asbestos exposure and recent onset of CP, SOB and suspicious CXR
When is surgery the treat of choice for lung cancer? What is required pre-surgery? What are the surgical options?
Stage 1/2 NSCLC
Pre-surgery:
- lung function test
- CVS risk assessment
Lobectomy
Pneumonectomy
When is radiotherapy used to treat lung cancer?
Those not suitable for surgery with stage 1-3
Post-operative px with incomplete resection
When is chemotherapy indicated in cancer patients? What is its role in treatment?
Stage 3-4 to improve disease control and quality of life
SCLC= multi-drug regimens
Used as adjuvant to surgery or radiotherapy to improve patient outcomes
Palliative treatment in later stages to improve surgical and quality of life
What biological therapies can be used in lung cancer?
EGFR inhibitors
Monoclonal Ab eg Bevacizumab
What are the 4 most significant complications associated with lung cancer and how can they be managed?
SVCO
- stent
- radiotherapy or chemo
Hypercalcaemia
- IV fluids
- hydration
- IV bisphosphonates
Cerebral mets
- corticosteroids= symptomatic relief of raised intracranial pressure
- radiotherapy
Spinal cord compression
- TX w/i 24 hrs i.e. medical emergency
- corticosteroids
- radiotherapy
- surgery if appropriate
- referral to oncology physio
What symptoms does palliative lung cancer treatment aim to control?
Breathlessness= opiates
Cough= opioids
Chest pain= radiotherapy
Bronchial obstruction= external beam radiotherapy or stents
Pleural effusion= aspiration/drainage
Hoarseness
Bone pain= analgesia and single fraction radiotherapy
Which type of lung cancer is most common?
Non-small cell lung cancer= 80%
=adenocarcinoma/squamous cell carcinoma/large-cell carcinoma
What are the different extrapulmonary/paraneoplastic syndromes associated with lung cancer?
Recurrent laryngeal nerve palsy
Phrenic nerve palsy
Superior vena cava obstruction
Horner’s syndrome
SIADH + Cushing’s= SSLC
Hypercalcaemia= SCC
Limbic encephalitis= SCC
-body induced to produce autoantibodies against limbic system
Lambert-Eaton Myasthenic syndrome= SCC
What is Lambert-Eaton myasthenic syndrome? What type of lung cancer is it associated with?
SCC
SCC produces antibodies which target voltage-gated calcium channels on pre-synaptic terminals
-weakness in proximal muscles and intraocular muscles and pharyngeal muscles
I.e. diplopia/ptosis/dysphagia
If primary lung carcinoma was seen on CXR which other 3 investigations should be done to confirm diagnoses?
Bronchoscopy
Lung biopsy
CT TA
What are the 2 possible causes of unilateral chest pain which is not relieved by NSAIDs in lung cancer?
Rib mets
Local invasion of tumour to the chest wall
