Session 7 COPD + Lung Cancer Flashcards
Give the main causes of COPD
- SMOKING
- Alpha-1-antitrypsin deficiency (roughly 1% of cases)
- Occupational exposure (e.g. Coal dust)
- Pollution
Define COPD
COPD is characterised by airflow obstruction, which is usually progressive and not fully reversible. It is predominantly caused by smoking
Which two conditions does COPD encompass?
Emphysema and Chronic Bronchitis
Describe Emphysema
- destruction of terminal bronchioles + distal airspace
- formation of bullae: larger redundant airspaces
- supporting structures destroyed causing collapse of airways on expiration
Describe chronic bronchitis
- chronic mucus hypersecretion
- caused by inflammation in large airways due to toxins
- causes remodelling and narrowing of airways
Give some symptoms of COPD
- Cough and sputum production are frequently first symptoms
- breathlessness is often progressive
Give some signs of COPD
- Purse lipped breathing
- tachypnoea
- use of accessory muscles to aid breathing
- hyperinflation of thorax
- wheeze or quiet breath sounds on auscultation
What investigation would be commonly use to investigate COPD?
Spirometery
What will the results be from spirometery if COPD is apparent?
- FEV1 < 80% of predicted
- FEV1 : FVC ratio < 70%
What pharmacological managements may be used in COPD patients?
- Bronchodilators - Beta-2 agonist (Salbutamol)
- Antimuscarinics (Ipratropium)
- Steroids (Aminophylline)
- Mucolytics (Carbocysteine)
Apart from smoking cessation what other non-pharmacological interventions any we take with COPD patients?
- Pulmonary rehabilitation (increasing amounts of exercise)
- Long term Oxygen therapy
- Lung volume reduction
- Lung transplant in young patients is an option
Give some risk factors for lung cancer
- SMOKING
- Asbestos exposure
- Radon exposure
- Genetic factors
- Dietary factors
What are some of the signs and symptoms of a primary lung tumour?
- Cough - Dyspnoea
- Wheezing - Haemoptysis
- Chest Pain - Post-obstructive pneumonia
- Weight Loss - Lethargy
What is Paraneoplastic syndrome?
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
What are some symptoms of paraneoplastic syndrome in lung cancer?
- Hypercalcaemia
- Cushing’s syndrome
- Encephalopathy
- Finger Clubbing
- Anaemia
- Nephritic syndrome
What are some of the imaging techniques that can be used in lung cancer diagnosis?
- Plain Chest XR
- CT scan
- Pet scan
- Isotope bone scan
What does the T in TNM staging, look at?
Size and position of tumour
What would a staging of N0 indicate?
Non cancer in lymph nodes
What would a staging of N2 indicate?
Cancer in lymph nodes in mediastinum, but on same side s primary tumour
Describe the M part of TMN staging
Are there distal metastases?
M0 = No evidence of distal spread
M1 = Metastases in distal parts of body; pleura, opposite lung, liver or bones etc
What does prognosis of lung cancer deepend on?
- Cell type (Small or non-small cell)
- Stage of disease
- Performance status
- biochemical markers
- co-morbidities
What are treatment options for lung cancers in general?
- Surgery
- Radiotherapy
- Chemotherapy
- Biological targeted markers
- Palliative care
Why is the mortality rate for lung cancers so high?
Patients usually present only when he disease has severely progressed. These patients are usually old with co-morbidities and hence cannot have drastic treatment
