Lung tumors Flashcards
What stage of cancer do patients usually present with?
Advanced disease (stage III or IV)
cancer which spreads to the lung
breast colorectal prostate kidney melanoma thyroid lymphoma
tumors can be divided into b_______ and p_______
bronchial (95%)
pleural (5%)
Aetiology
Smoking
Asbestos exposer
Radon inhalation
Types of NSCLC
Squamous
Adenocarcinoma
Large cell
What’s the 3rd most common cause of death in the UK?
Bronchial carcinoma
Symptoms due to local disease
cough, chest pain, haemoptysis and breathlessness
What would spread to the left recurrent laryngeal nerve cause?
hoarseness and bovine cough
Where is it most likely to metastasise to?
Bone and brain
Symptoms of non-metastatic manifestations
rare apart from finger clubbing
malaise, lethargy, weight loss
What is paraneoplastic syndrome?
when a tutor secretes a protein that has a specific effects.
Classic Ca lung: low Na, high Ca, increased PTH
SIADH (syndrome of inappropriate ADH) secretion
How to confirm the diagnosis?
CXR: tutors show as a round shadow, with a fluffy/spiked edge
What would lymphangitis carcinomatis cause?
streaky shadowing throughout the lung
How would you determine the histology?
cytological examination of sputum
Bronchoscopy: biopsies and washings
How to assess the spread of the tutor?
TMN staging
Bronchoscopy
CT thorax
PET scan** to look for intrathoracic lymph node mets
How to determine pt suitability for major op
physical ex + resp function tests
WHO performance status
What is a synergistic effect?
when using 2 drugs, you have an amplified effect than just adding the 2 together — ? toxicity
NSCLC Tx
early stage: surgery, radical RT
later stages: CT + RT, palliative chemo, palliative care
What is CHART
continuous hyper-refracted accelerated radiotherapy
radical RT for NSCLC
How to treat SCLC is confined to a single anatomical or radiation field?
combined chemo and RT
25% 5YSR
How to treat extensive SCLC disease
chemo
Why use prophylactic cranial irradiation?
10% of SCLCs have brain mets at Dx, but 65% have them at autopsy.
SE’s of chemo
alopecia
nausea + vomiting
peripheral neuropathy
constipation + diarrhoea
Chemo mechanism of action
cause cell death or prevent cell growth, through inhibiting microtubule function, protein function or DNA synthesis
How does EGFR receptor inhibition work for NSCLCs?
Some NSCLCs have too much EGFR on their cell surface –> faster growth
This mutation can be targeted by some drugs
So at Dx, sent for test for 100 mutations
Which has a worse prognosis SCLC or NSCLC?
SCLC
