Session 7 COPD + Lung Cancer

Question 1

Give the main causes of COPD

Answer 1

• SMOKING
• Alpha-1-antitrypsin deficiency (roughly 1% of cases)
• Occupational exposure (e.g. Coal dust)
• Pollution

Question 2

Define COPD

Answer 2

COPD is characterised by airflow obstruction, which is usually progressive and not fully reversible. It is predominantly caused by smoking

Question 3

Which two conditions does COPD encompass?

Answer 3

Emphysema and Chronic Bronchitis

Question 4

Describe Emphysema

Answer 4

• destruction of terminal bronchioles + distal airspace
• formation of bullae: larger redundant airspaces
• supporting structures destroyed causing collapse of airways on expiration

Question 5

Describe chronic bronchitis

Answer 5

• chronic mucus hypersecretion
• caused by inflammation in large airways due to toxins
• causes remodelling and narrowing of airways

Question 6

Give some symptoms of COPD

Answer 6

• Cough and sputum production are frequently first symptoms

- breathlessness is often progressive

Question 7

Give some signs of COPD

Answer 7

• Purse lipped breathing
• tachypnoea
• use of accessory muscles to aid breathing
• hyperinflation of thorax
• wheeze or quiet breath sounds on auscultation

Question 8

What investigation would be commonly use to investigate COPD?

Answer 8

Spirometery

Question 9

What will the results be from spirometery if COPD is apparent?

Answer 9

• FEV1 < 80% of predicted

- FEV1 : FVC ratio < 70%

Question 10

What pharmacological managements may be used in COPD patients?

Answer 10

• Bronchodilators - Beta-2 agonist (Salbutamol)
• Antimuscarinics (Ipratropium)
• Steroids (Aminophylline)
• Mucolytics (Carbocysteine)

Question 11

Apart from smoking cessation what other non-pharmacological interventions any we take with COPD patients?

Answer 11

• Pulmonary rehabilitation (increasing amounts of exercise)
• Long term Oxygen therapy
• Lung volume reduction
• Lung transplant in young patients is an option

Question 12

Give some risk factors for lung cancer

Answer 12

• SMOKING
• Asbestos exposure
• Radon exposure
• Genetic factors
• Dietary factors

Question 13

What are some of the signs and symptoms of a primary lung tumour?

Answer 13

• Cough - Dyspnoea
• Wheezing - Haemoptysis
• Chest Pain - Post-obstructive pneumonia
• Weight Loss - Lethargy

Question 14

What is Paraneoplastic syndrome?

Answer 14

The presence of a symptom or disease due to the presence of the cancer but not due to the local physical presence. Mediated by humorous factors secreted by the tumour or the immune response against them

Question 15

What are some symptoms of paraneoplastic syndrome in lung cancer?

Answer 15

• Hypercalcaemia
• Cushing’s syndrome
• Encephalopathy
• Finger Clubbing
• Anaemia
• Nephritic syndrome

Question 16

What are some of the imaging techniques that can be used in lung cancer diagnosis?

Answer 16

• Plain Chest XR
• CT scan
• Pet scan
• Isotope bone scan

Question 17

What does the T in TNM staging, look at?

Answer 17

Size and position of tumour

Question 18

What would a staging of N0 indicate?

Answer 18

Non cancer in lymph nodes

Question 19

What would a staging of N2 indicate?

Answer 19

Cancer in lymph nodes in mediastinum, but on same side s primary tumour

Question 20

Describe the M part of TMN staging

Answer 20

Are there distal metastases?
M0 = No evidence of distal spread

M1 = Metastases in distal parts of body; pleura, opposite lung, liver or bones etc

Question 21

What does prognosis of lung cancer deepend on?

Answer 21

• Cell type (Small or non-small cell)
• Stage of disease
• Performance status
• biochemical markers
• co-morbidities

Question 22

What are treatment options for lung cancers in general?

Answer 22

• Surgery
• Radiotherapy
• Chemotherapy
• Biological targeted markers
• Palliative care

Question 23

Why is the mortality rate for lung cancers so high?

Answer 23

Patients usually present only when he disease has severely progressed. These patients are usually old with co-morbidities and hence cannot have drastic treatment