Resp Week 4 Flashcards
How much of LC is attributable to smoking?
85%
How many smokers get LC?
10%
What is a passive smoker?
An individual who has never smoked but who lives in the same household as someone who does smoke and within the confides of the house
How many recognised carcinogens are there in ciggarrettes?
60
What are the 2 recognised families of ciggarettes?
Polycyclic aromatic hydrocarbons and N-nitrosamines
Describe polycyclic aromatic hydrocarbons
- Unfiltered tobacco products, home rolled cigarettes, older type of cigarettes
- More likely to give lung cancer development a boost in the central part of the lung in the bronchi
Describe N-nitrosamines
- New types of cigarette
- more prone to causing adenocarcinomas (Periphery of lung)
Describe how inherited polymorphisms may affect the chances of getting LC
We all inherit a differeing risk of developing lung cancer due to how our body reacts to the carcinogens
for example we all have a different susceptibility to nicotine addiction
What are the 2 main pathways of carcinogens in the lung?
The lung periphery (adenocarcinoma) and the central lung airways (squamous cell carcinoma)
What are the 4 main types of LC and what are their prevelence in respect to each other
Squamous cell - 40% Adenocarcinoma - 41% Small cell carcinoma - 15% Large cell carcinoma - 4% [histologically there are 2 types, small cell and non small cell to which the prevalence is 15% and 85% respectively]
Describe primary LC
- Grows clinically silent for many years, presenting late in its natural history
- May have few, if any signs or symptoms until the disease is very advanced
- May be found incidentally during investigation for something unrelated
- Generally speaking symptomatic LC is fatal
- Central tumours involving large bronchi are more likely to bleed -> Causes haemoptysis-> take very seriously
Describe the effects of bronchial obstruction caused as one of the local effects of LC
- Collapse of the lung
- Leads to the retention of cells and secretions which would normally have been removed by the mucocillary escalator leading to endogenous lipid pneumonia
- Infection/abcess formation
- Bronchiectasis
Describe the pleural effects caused as one of the local effects of LC
- Inflammatory
- Malignant invasion
Describe how LC may directly invade the chest wall
Phrenic nerve -> diaphragmatic paralysis
L recurrent laryngeal nerve -> hoarse, bovine cough
Brachial plexus -> pancoast T1 damage
Cervical sympathetic -> Horners syndrome
What is a pulmonary mass?
An opacity in the lung over 3cm with no mediastinal adenopathy or atelectasis
What is a pulmonary nodule?
An opacity in the lung UP TO 3cm with no mediastinal adenopathy or atelectasis
What are the symptoms of LC
Chronic coughing Coughing up blood Wheeze Chest and bone pain Chest infections Difficulty swallowing Raspy, hoarse voice SOB Unexplained weight loss Nail clubbing
What are the clinical signs of LC
chest signs Clubbing Lymphadenopathy Horners syndrome Pancoast tumour Superior vena cava obstruction Heptaomegaly skin nodules (metastasis)
What are the initial investigations for LC
CXR FBC Spirometry Clotting screen Renal and liver functions Calcium levels
What are some of the more advanced investigations for LC?
Bronchoscopy EBUs Image guided lung biopsy Image guided liver biopsy FNA of neck node of skin metastasis Excision of cerebral metastasis Bone biopsy Mediastinoscopy/otmy Surgical excision biopsy
Describe the performance status for LC
0 = fully active 1 = symptoms but ambulantory 2 = 'up and about' >50%, unable to work 3 = 'up and about' <50%, limited self care 4 = bed or chair bound
What are the treatment options for LC
Surgery
Wedge resection
Lobectomy
Pneumonectomy
What are the 3 types of radiotherapy?
Radical - attempting to cure
Pallitative - symptoms, not attempting to cure
Sterotactic - Not attempting to cure, but trying to stop it getting worse
What are the 3 aspects of TNM staging?
- How big it is and how far it has spread/size and position of tumour (T)
- Whether cancer cells have spread into the lymph nodes (N)
- Whether the tumours have spread anywhere else in the body, i.e metastases (M)
Describe a T1 tumour
- Tumour less than or equal to 3cm in greatest dimension, surrounded by lung or visceral pleura without bronchoscopic evidence of involvement of the main bronchus
- T1a = minimally invasive adenocarcinoma tumour <=1cm in greatest dimension
- T1b = Tumour <=2cm
- T1c = Tumour <=3cm
