SDL Lung Cancer Flashcards
What are some risk factors for lung cancer?
Smoking
Age
Asbestos exposure (mesothelioma - pleural disease)
Radiation exposure
Occupational/environmental pollution (NOTE coal dust is NOT a risk factor) tar and nickel are
Family and genetic factors
Underlying lung pathology such as COPD or ILD
What are the key symptoms of lung cancer?
General: weight loss, fatigue, lymphadenopathy, loss of appetite.
Specific to lung cancer: wheeze, chest pain, cough (non-productive), pleural effusion, SOB, dyspnoea, heamoptysis, finger clubbing
What are some more syndrome symptoms that may occur in lung cancer?
Obstruction of SVC – Pemberton’s signs – raising hands over the head causes facial congestion and cyanosis - medical emergency
Pancost tumour – compression on brachial plexus – cause shoulder/arm pain, weakness/atrophy of mucles on ipsilater side on upper arm + Horners syndrome (apical lung cancer)
What are some complications of lung cancer?
Lobal collapse
Secondary spontaneous pneumthorax
Pleural effusion
Pericardial effusion
What investigations should be done for suspected lung cancer?
Bedside: obs
Bloods: FBC, LFTs, U&Es, CRP, (positive signs of cancer include: Anemia, leukocytosis, thrombocytosis, and hypercoagulable state)
Imaging: High resolution contrast CT (stage and management), CXR - typically initial to screen.
Other: Pulmonary lung function tests (baseline features)
What is the gold standard diagnostic tests for lung cancer?
lung biopsy and histopathology for diagnosis – commonly CT guided percutenaous or endobronchial ultrasound-guided transbronchial needle aspiration.
What are the NICE recommendation relating to CXR for suspected lung cancer?
Recommoned a CXR within 2w for 40yrs+ with clubbing, lymphadenopathy (Particularly supraclavicular), recurrent or persistent chest infections, thrombocytosis and chest signs of lung cancer.
If 2+ unexplained symptoms in over40yrs never smoked
if 1+ unexplained symptoms in over 40yrs who have ever smoking or asbestos exposure.
What is mesothelioma?
Cancer of the pleura/ other mesothelial tissue
Related to asbestos exposure
Poor prognosis - chemotherapy can improve outcomes but it is typically palliative.
What are the two main histological categories of lung cancer?
Small cell lung cancer
Non-small cell lung cancer
Give an overview of small cell lung cancer
15% of cases, 60% of which present with metastasis, poor prognosis, tends to be a proximal tumor near hilum (larger airways disease), includes neuroendocrine cells – strongest association with smoking.
What are the different types of non small cell lung cancer?
Adenocarcinoma (which involves glands in peripheral tissue) - commonly seen in non-smokers.
Squamous cell carcinoma (near main bronchus obstruct airway, cause dysplasia, affects sqaoumous cells - natural or metaplastic )
Large cell (rapidly growing presents in periphery or central lung tissue) - effects epithelial cells.
Compare the prognosis of NSCLC and SCLC**
SCLC - worse prognosis, very few diagnosed in stage 1/2, at stage 3/4 prognosis is roughly half that of NSCLC
NSCLS - better prognosis, more likely to be diagnosed at an earlier stage (although the majority still in stage 3/4)
For both combined - five yrs survival under 15%
Compare the risk factors for NSCLC and SCLC.**
Smoking and genetics increases the risk of both. However chronic heavy smokers are at a higher risk of SCLC. Genetics particularly EGFR mutation may have a stronger role in NSCLC
What are the common sites of metastasis of lung cancer?
Brain
Liver
Adrenal Gland
Bone
What is meant by paraneoplastic syndrome in lung cancer?
From small cell or squamous cell – often due to hormonal effects, ectopic crushing syndrome, inc ADH (water retention), inc parathyroid like substance (hypercalcemia), Lambert-Eaton myasthenic syndrome – antibodies against small cell lung cancer also target and damage VGCa2+Channels in presynaptic terminals in motor neurons leads to muscle weakness, particularly in the proximal muscles
