Lung tumours Flashcards
What is lung cancer?
Carcinoma (malignant tumour) of the bronchus or pleura. [PTS]
What are the main types of lung cancer in order of prevalence?
Non-small cell (80%) -squamous 35%, adenocarcinoma 30%, large-cell 15%
Small-cell (20%) [KC]
Give 3 risk factors for lung cancer.
Smoking Asbestos Chromium Arsenic [pts]
Give 3 features of lung squamous cell carcinoma.
May cavitate with central necrosis
Cause obstructing lesions of bronchus with post-obstructive infection
Local spread common, metastases relatively late. [kc]
Give 3 features of lung adenocarcinoma.
Originate from mucus-secreting glandular cells, causes excess mucus secretion
Most common type in non-smokers.
May cause peripheral lesions on X ray/CT
Metastases common to bones, brain, pleura, lymph nodes and adrenal glands.
Give 3 features of small-cell lung carcinoma.
Tumour arising from neuroendocrine (APUD) cells.
Often secrete polypeptide hormones
Arise centrally and metastasise early.
Which lung cancer is more likely in a non-smoker?
Adenocarcinoma
Give 3 local effects of lung cancer.
Cough (40%) - 3-week cough -> CXR!
Chest pain (20%) - sharp pleuritic pain as chest wall and pleura well innervated.
Haemoptysis (7%) - tumour bleeds into airway
Breathlessness - occlusion, SOBOE, may also have COPD
Wheeze - monophonic, partial obstruction
Hoarse voice - left recurrent laryngeal nerve compression. [kc]
What would be the effect of metastases to the adrenal gland?
Asymptomatic - no adrenal insufficiency [kc]
Give a clinical feature of metastatic spread to the liver.
Liver - anorexia, weight loss, nausea, RUQ pain [kc]
Give a clinical feature of metastatic spread to bone.
Bony pain, fractures, risk of spinal cord compression
Give a clinical feature of metastatic spread to the lymph nodes.
Lymphadenopathy?
Give a clinical feature of metastatic spread to the brain.
Space occupying lesion -> raised ICP -> headache.
Give 3 paraneoplastic syndromes seen in non-small cell lung cancer.
Clubbing
Anorexia
Hypertrophic pulmonary osteoarthropathy (clubbing, periostitis)
Give 3 differential diagnoses of cough other than lung cancer.
COPD Asthma (diurnal variation) Sarcoidosis Heart failure Upper airway cough syndrome/ post-nasal drip
Give 3 investigations you would do to diagnose lung cancer.
Staging, tissue diagnosis, assess fitness for treatment. [ck] CXR Chest CT Biopsy - surgical Bronchoscopy [pts]
Give the T stages for lung cancer.
TNM staging.
T1a,b,c: <1,<2,<3cm. contained within the lung;
T2a,b: <4,<5cm/ spread to bronchus or pleura but not chest wall.
T3: 5-7cm/ >1 tumour in same lobe/ spread to chest wall, phrenic nerve or pericardium.
T4: >7cm/ >1 lobe affected/ spread outside chest wall. [cancer research uk]
Give the N stages for lung cancer.
N1= in lung or hilar LNS N2 = in mediastinal or subcarinal LNs N3 = contralateral hilar, mediastinal or supraclavicular LNs.
Describe the M stages for lung cancer.
M1a - both lungs/ pleura/ pericardium (effusion)
M1b - single met outside the chest
M1c - multiple mets outside the chest.
What determines management for lung cancer?
Tumour resectability and patient fitness for operation as well as patient preference.
How is operability assessed?
WHO performance status: how restricted they are and how much time they spend in chair/bed.
ECG, lung function, exercise capacity
[lecture 8/12/17]
Describe the management of stage 1 or 2 NSCLC.
Surgical excision
Radical deep X ray therapy
[lecture, pts]
Describe the management of stage 3 or 4 NSCLC.
Palliative chemotherapy
Chemo + radio therapy
Supportive and palliative care
[lecture, pts]
Give 3 local complications of lung cancer.
Recurrent laryngeal nerve palsy Horner's syndrome SVC obstruction Pericarditis AF [ohcm]
What is horner’s syndrome?
Disruption of the sympathetic pathway that runs from the hypothalamus to the eye, causing miosis (pupil constriction), ptosis (eyelid dropping), and anhidrosis (no sweating) on the affected side.
How can SCLC be classified?
Limited disease: Disease limited to one hemithorax including supraclavicular lymph nodes.
Extensive disease: spreading further than this.
How is limited SCLC treated?
Chemotherapy
Thoracic and cranial deep x-ray therapy
How is extensive SCLC treated?
Chemotherapy
Supportive care.
Give 5 cancers which are likely to metastase to the lung.
Breast Colorectal Prostate Kidney Thyroid Melanoma Lymphoma.
What are the 4 types of malignant pleural tumours?
Mesothelioma
Primary lymphoma
Pleural thymoma
Pleural sarcoma [lecture]
Give 1 type of benign pleural tumour.
Fibrous tumour [lecture]
What is mesothelioma?
Malignancy of the cells that line the body cavities, including the pleura. Associated with asbestos. [pts]
When does peak incidence of mesothelioma occur?
about 40 years after asbestos exposure. [pts]
Describe the pathophysiology of mesothelioma.
- Mesotheliomal cells engulf asbestos fibres
- The fibres disrupt the mitotic spindle, causing mutations, commonly loss of chromosome 22.
- Sustained cellular damage by fibres also contributes.
[pts]
Mesothelial cells line thoracic and abdo cavities. Mostly affects lungs and pleura but can affect abdo organs if swallowed and other linings. [osmosis]
Also cause inflammation
Describe the presentation of mesothelioma.
Pleuritic pain
Dyspnoea
Bloody sputum if invades into blood vessel.
Pneumothorax
Systemic - fatigue, fever, sweats, weight loss
What investigations would you do for ?mesothelioma?
Thoracentesis (pleural aspiration, reduces effusion]
CXR
CT scan
Pleural biopsy, may be guided by CT [lecture]
How can mesothelioma be differentiated from other lung cancers?
Mesothelial plaques express calretinin, which is important for regulating intracellular calcium levels.
Biopy - immunostained with an antibody that reacts with calretinin to give ‘fried egg-shaped’ cells.
How does mesothelioma cause pneumothorax?
Mesothelioma destroys lung tissue between bronchial tree and the pleural space, leaving air in the pleural space. [osmosis]
Give 3 findings on X ray (and/or CT?) for mesothelioma.
Nodular pleural thickening
Pleural effusion
Pneumothorax [osmosis]
Why is mesothelioma prognosis poor?
Cancer extremely resilient, spread to multiple organs before detected. [osmosis]
Describe the management of mesothelioma.
Symptom control
Palliative chemotherapy and/or radiotherapy
Radical/debulking surgery [lecture]
Is mesothelioma a transudative or exudative cause of pleural effusion?
Exudative.
Exudates are caused by inflammation (cancers, infection).
Transudates are caused by disturbances of pressure (HF, cirrhosis).
Give 2 complications of mesothelioma.
Reduced lung function
Metastases
