Revision Flashcards
What are the clinical signs of lung cancer?
Lymphadenopathy Finger clubbing Cyanosis Hyperinflation Horners syndrome - tumour invades the cervical sympathetic nerves which results in a smaller pupil on one side and a dropping top eye lid. Hepatomegally Dullness on auscultation
What are the symptoms of lung cancer?
Haemoptysis SOB Cough Malaise Weight loss Chest pain Fatigue Recurrent infections
What is a paraneoplastic syndrome?
A paraneoplastic syndrome is a disease or symptom that is the consequence of cancer in the body but, unlike mass effect, is not due to the local presence of cancer cells. These phenomena are mediated by humoral factors (by hormones or cytokines) excreted by tumor cells or by an immune response against the tumor.
State some affects of paraneoplastic syndromes
Hyponatraemia - low sodium in blood
Anaemia - low RBCs in blood
Hypercalceamia - High calcium in the blood
o symptoms - abdominal pain, constipation, confusion
o causes - parathyroid hormone related protein, bone metastasis
Dermatomyositis/ Polymyositis
- proximal muscle weakness
Eaton-Lambert Syndrome
- Upper limb weakness
Cerebellar ataxia - cerebellum becomes inflamed or damaged. The cerebellum is the area of the brain responsible for controlling gait and muscle coordination
Sensorimotor neuropathy
Endocrine effects
- ACTH, SIADH -> small cell
- DTH -> NSCLC (squamous)
Pan coast tumour
-invasion of brachial plexus
What are the consequence that can occur when cancer cells migrate and metastasis else where in the body?
Bone pain
- about 50% of cancer patients will have a bone metastasis
- often worse at night
- pathological fracture will give symptoms
- bone metastasis in the vertebrae can compress the spinal cord
Spinal cord compression
- limb weakness
- paraesthesia {abnormal sensation, typically tingling or pricking ‘pins and needles’}
- bladder/bowel dysfunction
Cerebral metastases
- head ache
- vomiting
- dizziness
- ataxia
- focal weakness
Thrombosis - clotting of blood
What are the two main types of lung cancer? and what are the percentage of prevalence of both?
Small cell lung cancer (SCLC) - 15%
Non small cell lung cancer (NSCLC) - 85%
What are the three main types of NSCLC? and what are their percentages of prevalence?
squamous - 30% (hard to treat)
adenocarcinoma - 55%
large cell undifferentiated - 5%
What is the main aetilogical cause for squamous non small cell lung cancer?
smoking!
How is NSCLC staged?
By TNM.
Tumour - size
Nodes - any lymph nodes involved
Metastasis - local or distant metastasis
How long does it take NSCLC and SCLC to double in size?
NSCLC - 129 days
SCLC - 29 days
What is neoadjuvant therapy used for?
Used before surgery to decrease the size of a tumour to make it more operable.
It has be proven to be very beneficial in stage III
What is adjuvant therapy used for?
Used post operatively to increase the chances of a cure.
DRUGS - cisplatin + vinoreloine
Thought to be detrimental in stage I and II.
Staging:
What does TX stand for ?
Primary tumour cannot be assessed
Staging:
What does TO stand for?
There is no evidence of a primary tumour
Staging:
What does Tis stand for?
carcinoma in situ
What other observational staging can be done for a cancer patient?
Performance status
0 (well) -> 4 (bed bound)
What percentage of cancer patients have advanced disease (stage III/IV)?
80%
What can be done to treat stage III cancer (locally advanced) - 30% ?
Chemo + radio therapy
Radical therapy:
- High dose (~55 Gy+)
- Optimal number of fractions should be given (not too less as there would be not affect on the tumour but not too many as too many have been shown not to give therapeutic benefit and would just give a lot more side effects)
ChemoRadio therapy:
- increased survival compared to RT on its own
- will kill cancer cells that have not been detected yet as it travels in the blood stream.
What can be done to treat Stage IV (distant metastasis) - 60% ?
Systemic therapy
Palliative care as the cancer is incurable
- RT given to primary tumour to give symptomatic relieve
- Chemo gives symptomatic benefit and increases survival
Name a drug used for maintenance chemotherapy and what benefits it gives?
Pemetrexed
improves survival by 3-5 months
When are targeted drugs used?
Targeted drugs are used when a cancer patient has a recognised mutation which is causing the cancer.
These drugs should only be used in patients that have the specific mutation.
These drugs have been proven to work very effectively even when the cancer has been very progressed.
What do targeted drugs inhibit?
Tyrosine kinase inhibitors
Name four mutations that can b treated by targeted drugs?
EGFR (15%)
ALK (5%)
BRAF (2%)
ROS (1%)
Name a drug that is used for immunotherapy.
Nivolumab BMS
