S11 S1 Lung Cancer Flashcards
Lung Cancer:
Statistics:
- How common?
- Survival rate?
- Prevalance?
Risk factors
- List some
Statistics:
Lung cancer is the 3rdmost common cancerin theUK, with around 48,000 lung cancer-related deaths in the UK every year – the most common cause of death from cancer for both males and females. It has a10% survivalrate, and in 2015 it is thought that 79% of lung cancers in the UK were preventable.
Prevalence – increases with age and poor socio-economic group
Risk Factors:
The biggest risk factor for developing lung cancer is tobacco smoking.
Other less common risk factors include occupational carcinogens (namely asbestos and radon) and genetics.
Also:
- asbestos
- Radon gas
Screening
- Some general facts about screening i.e. when it is appropriate to use
- What is the screening like for lung cancer?
Screening:
• Disease with serious consequences
• High prevalence of detectable disease
• Test detects little pseudo-disease (overdiagnosis)
• Test detects disease before the critical point
• Test causes little morbidity
• Test affordable and available
• Treatment more effective when applied before symptomatic detection
• Treatment not too risky or toxic
Screened through: Chest radiography, low-dose CT
Type of lung cancer
- 3 main types
Non-small cell lung cancer
Small cell lung cancer
Mesothelioma
Non-small cell lung cancers:
- Prevalance
- General factors about they
- General prognosis?
- 3 types:
- List them
- Explain the associated symptoms
Carcinoma: an invasive malignant epithelial tumour
Non-small cell lung cancers (NSCLC) make up around 80% of lung cancer diagnosis. Generally, non-small cell lung cancers metastasise slower, meaning localised treatment options like surgery are more successful.
- Squamous cell carcinoma makes up around 40% of lung cancer and can be associated with paraneoplastic syndrome releasing PTHrP (see later).
- Adenocarcinoma makes up around 35% of lung cancer and is the type of lung cancer most commonly associated with non-smokers
- Large cell carcinoma makes up the remaining 5% of lung cancers attributed to NSCLC.
Small cell lung cancers:
- Prevalance
- Associated with which symptoms?
- Prognosis
- Treatment response?
Mesothelioma
- What is this a cancer of?
- Risk factor (main)
What are molecular markers, give some examples
Small cell lung cancers make up around 15% of lung cancers, and are more commonly associated with paraneoplastic sydromes. They commonly metastasise rapidly, but are often chemo-responsive.
Mesothelioma is a cancer of the pleura, and one of the main risk factors for this condition is asbestos exposure.
Molecular markers:
Look at gene mutations the tumour has. This helps to predict the course of treatment.
E.g. EGFR mutation, ALK mutation, KRAS mutation, ROS mutation etc.
Signs and Symptoms:
- Specific tumour symptoms
- Regional symptoms
- Distant symptoms
Specific tumour symptoms:
- A persistent cough that doesn’t go away or get worse
- Dyspnoea
- Haemoptysis
- Wheezing
- Lung infection
- Chest or shoulder pain
- Weight loss
- General malaise/lethargy
Lung cancer spreads to other parts of the body via the lymphatic system, and symptoms of metastatic spread are dependent on the places they have spread to:
Regional symptoms:
- Face bloating (due to compression of the superior vena cava)
- Voice hoarseness (due to compression of the left recurrent laryngeal nerve)
- Dyspnoea – as a result of the primary tumour itself, or due to anaemia (as a paraneoplastic syndrome), or pleural/pericardial effusions caused by regional metastases.
- Dysphagia (due to compression of the oesophagus)
- Chest pain (parietal pleural involvement)
Distant symptoms:
- Bone pain or fractures (due to distant metastatic spread)
- Central nervous system symptoms: (headache, double vision, confusion etc.)
- Metabolic symptoms, such as thirst, constipation, and seizures (as part of a paraneoplastic syndrome of ADH release)
May have NO symptoms
Clinical signs of lung cancer
- Finger clubbing
- Cachexia
- Pale conjunctiva associated with anaemia
- Cervical lymphadenopathy associated with local lymphatic spread
- Horner’s syndrome – a triad of miosis (constricted pupil), anhidrosis (lack of sweating) and ptosis (eyelid droop) on one side, due to compression of the sympathetic nerve pathways in the neck. This is often associated with Pancoast tumours, which occur in the very top of the lungs.
DID A CASE STUDY ABOUT A PANCOAST TUMOUR IN H N N - Pleural effusion
- Muffled heart sounds
- Hepatomegaly
- Skin lesions consistent with metastases
May have NO signs
Paraneoplastic Syndromes
- Syndromes that develop due to the cancer
Paraneoplastic Syndromes:
Paraneoplastic syndromes are triggered by an abnormal immune response to cancer, and are common in certain types of lung cancer. If a patient presents with symptoms of any of these conditions, it is important to rule out lung cancer as a cause.
Examples include:
For small cell lung cancer:
- Abnormal release of ADH, resulting in SIADH and abnormal water retention.
- Abnormal release of ACTH, causing increased release of cortisol that results in Cushing’s Syndrome.
- Lambert-Eaton Syndrome – where the body attacks the neuromuscular junctions causing myasthenia.
For squamous cell carcinoma – release of parathyroid hormone related peptide (PTHrP) which stimulates PTH receptors, causing a syndrome of hypercalcaemia called humeral hypercalcaemia of malignancy.
For adenocarcinomas – hypertrophic pulmonary osteoarthropathy (a triad of serositis, finger clubbing and arthropathy of the large joints).
Staging and Managemetn
- TNM staging - explain this
Where are the common sites for metastases to spread?
TNM:
Lung malignancies are staged via the TNM staging method, which can be determined using a variety of imaging methods, depending on the type, size and associated symptoms of the malignancy. Examples of imaging modalities include chest x-ray, staging chest CT, PET scan and MRI scan.
Sites:
Brain, draining lymph nodes, pericardium, lung, pleura, liver, adrenals, bone
Imaging:
- Which imaging used in patients who are being investigated due to potential lung cancer
Biopsy
- What is this?
- How?
- Where?
- Why may some patients not have a biopsy taken?
Some patients may not be physically fit enough to have a biopsy e.g. if it causes a pneumothorax, the patient would die of it. Some other patients may choose not to have a biopsy.
Performance status:
- What is this?
- How does this help working out the treatment?
Treatment:
- How can the treatment type be decided?
- List some potential treatment options
- Staging and type of treatment (don’t learn this, just get an idea around it
It is important to determine the stage of cancer as this can be used to guide treatment options, with stage I more likely to respond to radical therapy, but stage IV management is more likely to be centred around palliation.
Prognosis is generally poor in lung malignancies as the cancer has usually already metastasised by the time it becomes symptomatic. Examples of treatment options include surgery (normally for non-small cell carcinoma), radiotherapy (either radical or palliative), chemotherapy (can be radical, neoadjuvant, or adjuvant) or palliative care (if the cancer is too advanced).
70% of patients at presentation have advanced lung cancer where only palliative treatment is offered:
Overview of treatments
Summary - Route of what happens after presentation to treatment (or death)
