S12) Lung Cancer Flashcards
Describe the incidence of lung cancer
- Highest cancer related deaths world wide
- 35,000 deaths per year – UK
Identify 5 risk factors for lung cancer
- Smoking
- Asbestos
- Radon (from mining or indoor exposure)
- Other occupational carcinogens – chromium, nickel, arsenic
- Genetic/familial factors
Describe the impact of smoking on lung cancer
Smoking causes:
- ~90% of lung cancer deaths in men
- ~80% of lung cancer deaths in women
- ~20% of lung cancer cases in nonsmokers
Identify five symptoms reported by patients with lung cancer at the primary tumour stage
- PERSISTANT Cough
- Dyspnoea and wheeze
- Haemoptysis - tumour erosion in the airway
- Chest / shoulder pain
- recurrent lung infections - partial airway obstruction
- hoarse voice - compression of recurrent laryngeal nerve
- brachial nerve tumours - pan coast tumours in lung apex , small muscle wasting In hand, pain radiating down arm
- Weight Loss
Some are asymptomatic
Identify and describe five symptoms reported by patients with lung cancer at the regional metastases stage
- Bloated face – SVC obstruction
- Hoarseness – left recurrent laryngeal nerve palsy
- Dyspnoea – anaemia, pleural or pericardial effusions
- Dysphagia – oesophageal compression
- Chest pain – parietal pleural involvement
Identify two symptoms reported by patients with lung cancer at the distant metastases stage
- Bone pain/fractures
- CNS symptoms (headache, double vision, confusion etc.)
Identify three metabolic symptoms reported by patients with lung cancer
- Thirst (hypercalcaemia)
- Constipation (hypercalcaemia)
- Seizures (hyponatraemia – SIADH, small cell)
Identify six signs associated with lung cancer
- Cachexia
- Cervical lymphadenopathy
- Horners Syndrome
- Consolidation
- Finger clubbing (due to reduced oxygen)
- SVC obstruction
What are the associated clinical features of superior vena cava obstruction?
- Blushing of face
- Decreased CO (venous return)
- Visible vein
- Fatigue
Identify and describe some paraneoplastic syndromes accompanied with lung cancer involving the following systems:
- Endocrine
- CNS
- Haematological
- Cutaneous
- MSK
- Endocrine: hypercalcaemia, Cushing’s syndrome, SIADH
- Neurological: encephalopathy, Horner’s syndrome
- Haematological: anaemia, thrombocytosis
- Cutaneous: dermatomyositis
- Skeletal: finger clubbing
Which staging technique is used to classify lung cancer?
TNM staging
Which two staging tests are used for lung cancer?
- Imaging
- Tissue sampling
Which imaging techniques are used in the diagnosis and treatment of lung cancer?
- All: CT scan, CXR
- Some: PET scan, MRI, bone scan, ultrasound, echocardiogram
Identify five common methods used to obtain material for histological diagnosis in lung cancer
- Bronchoscopy – standard or with endobronchial ultrasound (EBUS) and needle biopsy of lung or pleura
- Cervical lymph node fine needle aspiration (FNA)
- Pleural fluid aspiration (thorocentesis)
- CT biopsy – lung/pleura
- Thoracoscopy
- bone biopsy
Identify the five different histological types of lung cancer
- Non-small cell lung cancer:
I. Squamous cell carcinoma ~40%
II. Adenocarcinoma ~35%
III. Large cell carcinoma ~5%
- Small cell carcinoma ~ 12%
- Rare tumours e.g. carcinoid ~5%
Describe the histological appearance a NSCLC adenocarcinoma
Describe the histological appearance a squamous cell lung cancer
Describe the histological appearance a large cell carcinoma
Describe the histological appearance a small cell carcinoma
Distinguish between NSCLC and SCLC in terms of:
- Origin
- Classification
- Metastatic potential
- Treatment
- 5 year survival
Identify the five molecular markers for lung cancer
- EGFR mutations
- ALK mutation
- KRAS mutations
- PD1 mutations
- PDL1 mutations
Which local and distant structures can lung cancer metastasise to?
List the different possible treatment options for lung cancer
- Surgery
- Radiotherapy
- Combination chemotherapy
- Combination therapy
- ‘Biological’ (‘Targeted’) therapies
- Palliative Care & other treatment
Outline surgery as a treatment option for lung cancer
- Mostly for NSCLC (20-25% operable)
- The best chance of cure
Outline radiotherapy as a treatment option for lung cancer
- Radical – with curative intent
- Palliative – symptom control
Outline combination chemotherapy as a treatment option for lung cancer
- SCLC – potentially curative in a minority
- NSCLC – modest survival increase, symptom control
Identify and describe the two different types of combine chemotherapy
- Neoadjuvant therapy – chemo before surgery to downstage the tumour
- Adjuvant therapy – chemo after surgery (no benefit if < stage 2)
Outline combination therapy as a treatment option for lung cancer
Combination chemo-radiotherapy is potentially curative
Outline the use of biological / targeted therapies in the treatment of lung cancer
- A potential ‘gamechanger’
- Based on mutational analysis (EGFR, ALK, RAS, PD1, PDL1)
Outline the use of palliative care and other treatments in the treatment of lung cancer
- Active symptom control e.g. analgesia, radiotherapy, airway stents, nutritional support, patient support groups
- Treatment of tobacco addiction, coronary heart disease & other conditions
how can superior vena cava obstruction be caused
- typically presents with dyspnea
- stridor
- difficulty swallowing
- caused by a large tumour or lymph
paraneoplastic syndrome
group of clinical disorders associated with malignant diseases
associated with malignant disease
arise from secretion of peptides or hormones in the tumour
inappropriate cross reaction between cells
2 most common:
humoural hypercalemia of malignancy
squamous cell carcinoma
what is a syndrome associated to small cell lung cancer
SIADH
syndrome of inappropriate ADH secretion
what is humoural hypercalemia
- parathyroid hormone - related protein secreted from tumour
- ectopic parathyroid secretion
- can also get PTH released from bone
paraneoplastic neurological syndrome
body makes antibodies to the tumour
these antibodies end up attacking other organs
