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MS-PA: Respiratory Diseases > PULMONARY NEOPLASTIC DISEASES > Flashcards

PULMONARY NEOPLASTIC DISEASES Flashcards

1
Q

What is the definition of lung cancer?

A

The term lung cancer, or bronchogenic carcinoma, refers to
malignancies that originate in the airways or pulmonary
parenchyma

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2
Q

What is the classification of lung CA ?

A

95 % of all lung cancers are classified as either
– Small cell lung cancer (SCLC) or
– Non-small cell lung cancer (NSCLC) (80%)

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3
Q

what is the Irish epidemiology of lung Ca ?

A
  • Lung cancer is the 3rd most common cancer in Ireland and 2668 cases per year.
  • Lung cancer (1916 total deaths in 2020) was the leading cause of
    cancer death.
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4
Q

What is the pathophysiology of lung cancer?

A

repeated exposure to carcinogens, such as cigarette smoke leads to dysplasia of lung epithelium. If the exposure continues, it leads to genetic mutations and affects protein synthesis. his, in turn, disrupts the cell cycle and promotes carcinogenesis.

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5
Q

What are the most common genetic mutations linked to small cell lung cancer ?

A

MYC, BCL2, and p53

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6
Q

What are the most common genetic mutations linked to non- small cell lung cancer ?

A

EGFR, KRAS, and p16

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7
Q

What are the risk factors for lung cancer ?

A

*Cigarette smoke: smoking or passive exposure
* Radon gas
* Occupational: asbestos, coal/gas, beryllium
*Environmental pollutants
* Therapeutic radiation from previous malignancy e.g. breast,
Hodgkin’s lymphoma

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8
Q

What is the median age of Lung Ca Diagnosis ?

A

72 years.

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9
Q

What condition is associated with 7 fold increase for lung CA?

A

Idiopathic Pulmonary Fibrosis

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10
Q

What are the symptoms of lung cancer ?

A
  • 45 % - 75% Cough – irritative effect from tumour
  • 46-68% Weight loss – systemic effect of cancer
  • 37- 58% Dyspnoea – bronchial obstruction/collapse/effusion/PE
  • Chest pain – chest wall / pleural invasion
  • Haemoptysis – friable tumour tissue, abnomal tumour vasculature
  • Bone pain – bony metastasis
  • Hoarseness – recurrent laryngeal nerve palsy from invasion by
    tumour
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11
Q

What are the signs of lung cancer ?

A
  • Cachexia and Clubbing
  • Hoarseness/dysphonia
  • Horner’s syndrome and Pemberton’s sign.
  • Tracheal deviation and Decreased chest expansion
  • Dullness to percussion and Diminished breath sounds
  • Bronchial breathing and Wheeze/Crackles.
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12
Q

What are the paraneoplastic syndromes seen in lung CA?

A
  • Hypercalcaemia (Squamous cell LC)
  • SIADH in SCLC
  • Ectopic ACTH secretion (Small Cell LC)
  • Cerebellar syndrome in SCLC
  • LEMS In SCLC.
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13
Q

What are the ddx in lung cancer ?

A
  • Pneumonia / Bronchitis
  • Exacerbation of COPD
  • PE or Parapneumonic effusion
  • Tuberculosis
  • Carcinoid tumour or Mesothelioma
  • Metastatic disease to lung
  • Benign lung disease: hamartoma, granuloma
  • Non-lung related: e.g. Heart failure
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14
Q

What are the Diagnostic Investigations- Lung Cancer?

A
  • CT Thorax/Liver/Adrenals: For staging =/- CT brian.
  • PET-CT
  • Bronchoscopy
  • Endobronchial Ultrasound and Trans-Bronchial Needle Aspiration of
    mass/lymph node for staging mediastinal disease.
  • US-guided pleural biopsy or pleural effusion aspiration.
  • CT-/U/S-guided biopsy of a peripheral lung/liver/adrenal/neck lesion
  • Sputum cytology
  • Radio-isotope bone scan for bone metastases
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15
Q

What is the requirement for definitive diagnosis ?

A

tissue histology or cytology is needed for a definitive diagnosis.

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16
Q

What are the features of Non-Small Cell Lung Cancer (NSCLC)?

A
  • Constitutes 80% of all lung cancers
  • Adenocarcinoma
  • Squamous cell
  • Large cell
17
Q

What are the features of Small Cell Lung Cancer (SCLC)?

A

*Constitutes 20% of all lung cancers
*Endocrine in origin and often associated with
paraneoplastic syndromes
*Can be diagnosed with EBUS-TNA

18
Q

What are the stagings of SCLC ?

A
  • Limited stage: tumour confined to the ipsilateral hemithorax and regional lymph nodes . It is possible to be included in a single radiotherapy port.
  • Extensive Stage: umour beyond the boundaries of limited disease and Includes distant metastases, contralateral supraclavicular and
    hilar lymph nodes, pericardial and pleural involvement.
19
Q

What is the STAGING OF NON-SMALL CELL LUNG CANCER?

A
  • T: grades the primary tumour characteristics
  • N: presence /absence of regional lymph node
    involvement
  • M: presence or absence of distant metastases
20
Q

What are the factors to consider in lung CA tx decision making ?

A
  • ECOG Performance Status
  • Histology
  • Staging/Extent of disease
  • Multi-Disciplinary Team Meeting
21
Q

What are the indications for ECOG Performance assessment ?

A
  • Performance status is a scoring system used to identify a cancer patient’s general wellbeing and
    activities of daily living.
  • Used to determine suitability for chemotherapy/need for dose adjustment.
  • Before starting treatment, patients should score no higher than 2 to be
    considered ‘fit’ for treatment.
22
Q

What is the management of limited stage SCLC?

A
  • Chemotherapy plus Thoracic Radiotherapy with Platinum-based chemotherapy + etoposide
  • Prophylactic cranial irradiation given due to propensity to
    develop brain metastases
23
Q

What is the management of extensive stage SCLC?

A
  • Palliative Chemotherapy
  • Can increase survival from 2 months to 10 months
  • Whole Brain Radiotherapy for brain metastases
  • Palliative Care
24
Q

What is the management of NSCLC?

A

*Stage I, II or III treatment modalities include surgery for lobar confined lesions.
* Chemotherapy (platinum-doublet) +/- bevacizumab (VEGF-inhibitor).
* For non squamous type add Pemetrexed also as adjuvent.
* Tyrosine-Kinase Inhibitors if EGFR mutation-positive.
* ALK tyrosine kinase inhibitor if ALK fusion oncogene positive or ROS-1
rearrangement eg Crizotinib/Alectinib.
* Check point inhibitors: Pembrolizumab if positive for PDL1 expression

25
Q

What is the management of NSCLC stage IV?

A

*Palliative Chemotherapy
*Bisphosphonates iv for bone metastases
*Inhibits osteoclasts
*Metastatectomy-brain, adrenal if oligo-metastatic disease

26
Q

What are the surgical interventions in NSCLC?

A

*Thoracotomy for lobectomy & pneumonectomy.
* Video-Assisted Thoracoscopic Surgery.

27
Q

What is Pancost tumor ?

A

Defines a tumour located at the apical pleuropulmonary groove, adjacent to the subclavian vessels. majority are NSCLC.

28
Q

What is the management of pancost tumor ?

A
  • Definitive chemoradiotherapy followed
    by surgical resection if no evidence of
    metastases
  • Chemoradiotherapy if metastatic
    disease
29
Q

What is the prognosis of SCLC?

A
  • Limited Stage: Median survival of 16 to 24 months and the 5 year survival rate is ~14%.
  • Extensive Stage: Median survival of 6 – 12 months with current
    available treatments.
30
Q
A

MS-PA: Respiratory Diseases (15 decks)

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