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
- Cough
- Dyspnoea
- Haemoptysis
- Chest / shoulder pain
- 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)
- Cervical lymph node fine needle aspiration (FNA)
- Pleural fluid aspiration (thorocentesis)
- CT biopsy – lung/pleura
- Thoracoscopy
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
