Session 7 - Lung Cancer Flashcards
Describe incidence of lung cancer in men
- Commonest male cancer
- Mortality around 100 per 100,000
- Incidence falling slowly due to reduction in smoking
Describe incidence of lung cancer in females
- Exceeds breast cancer as a cause of death in women
- Mortality rate around 40 per 100,000
- Incidence rising
How does incidence of lung cancer vary according to socioeconomic group?
- Wide variation
* Rate three times higher in lowest compared with highest
What is the main risk factor for lung cancer?
- Smoking
- 90% lung cancers in men
80% lung cancer in women
Give four aeitological factors which influence lung cancer
- Asbestos exposure
- Radon exposure
- Genetic factors
- Dietary factors
What are the main signs and symptoms of lung cancer?
• Relatively non-specific
What are the main symptoms of a primary lung cancer tumour?
- Cough
- Dyspnoea
- Wheezing
- Haemoptysis
- Chest pain
- Post-obstructive pneumonia
- Weight loss
- Lethargy/malaise
What are the main four symptoms of regional mestastases?
- Superior vena cava obstruction
- Hoarseness (left recurrent laryngeal nerve palsy)
- Dypnoea (phrenic nerve palsy)
- Dysphagia
What are the main two symptoms of distant metastases
- Bone pain/fractures
* CNS symptoms (headache, double vision, confusion)
What is paraneoplastic syndrome?
• Presence of a symptom or a disease due to the presence of cancer in the body, but not due to the local presence of cancer cells
What are the symptoms of paraneoplastic syndrome mediated by?
• Humoral factors (hormones and cytokines) secreted by tumour cells, or the immune response against tumour cells
What are the four main categories of paraneoplastic syndrome?
- Endocrine
- Neurological
- Skeletal
- Haematological
Give two diseases which occur as an endocrine result of paraneoplastic syndrome
- Hypercalcaemia
* Cushing’s syndrome
Give two disease which occur as a neurological result of paraneoplastic syndrome
- Encephalopathy
* Peripheral neuropathy
Give a skeletal disease which occurs as a result of paraneoplastic syndrome
• Finger clubbing
Give three diseases which occur as a a haemotolofical result of paraneoplastic syndrome
- Anaemia
- Throbocytopenia
- Disseminated Intravascular Coagulation
What are two other diseases which can come about as a result of paraneoplastic syndrome?
- Nephrotic syndrome
* Anorexia or Cachexia
What occurs when lung cancer is first suspected in a patient in terms of investigations
○ Plain chest x-ray
What are three scans used for diagnosis and staging
- CT scan
- PET scan
- Isotope bone scan
What are the two staging systems for lung cancer?
• Number
TMN
What is a stage 1 cancer?
• Small cancer, localised to one area of the lung
What is a stage 2 and 3 cancer?
• Larger cancer, may have grown into surrounding tissues
What is stage 4 cancer?
Cancer has metastasised
What is the TMN staging system (Outline T, M and N) ?
- T - Size and position of tumour
- N - Lymph node involvement
- M - Metastases
What are the stages of T?
• T1 - T4
What is T1 in lung cancer
• T1 - cancer contained within the lung (<3cm diameter)
What is T2 in lung cancer
- Cancer has grown (3-7cm diameter)
- Into main bronchus
- Into the visceral pleura
- Made parts of the lung collapse
What is T3 in lung cancer?
- Cancer has grown (>7cm diameter)
- Invading chest wall, mediastinal pleura, diaphragm, pericardium
- Complete lung collapse
> 1 cancer nodule in the same lob of lung
What is T4 in lung cancer
- Cancer invading mediastinum, heart, major blood vessel, trachea, carina, oesophagus, spine, recurrent laryngeal nerve
- Cancer nodules in more than one lobe of the same lung
What is N0?
• No cancer in lymph nodes
What is N1?
• Cancer in lymph nodes nearest the affected lung
What is N2?
• Cancer in lymph node in mediastinum on the same side
What is N3?
Cancer in lymph nodes on the opposite side of the mediastinum/supraclavicular lymph nodes
What is M0?
• No evidence of distal cancer spread
What is M1?
• Lung cancer cells in distant parts of the body such as pleura, opposite lung, liver or bones
What are three ways in which tissue is biopsied in lung cancer?
- Bronchoscopy
- Needle biopsy of the lung
- Surgical biopsy
Why is biopsy important?
• To determine cell type, which can influence prognosis and treatment
What are the two main types of lung cancer?
- Non-small cell lung cancer
* Small cell lung cancer
What is a feature of non-small cell carcinoma on presentation?
• More than 2/3rds have inoperable disease at presentation
What is a feature of small cell carcinoma on presentation?
• 3/4 have metastatic disease at presentation
What does prognosis of a lung cancer depend on?
• Cell type (small cell worse than non-small cell)
• Stage of disease
• Performance status
• Biochemical markers
• Co-morbidities
○ Cardiac or chronic respiratory disease
Give six different treatments for lung cancer
- Surgery
- Radiotherapy
- Chemotherapy
- Combination therapy
- Biological targeted therapies
- Palliative care
When is surgery used for lung cancer?
• Mostly non-small cell
What is the difference between radical and palliative radiotherapy?
- Radical is curative
* Palliative is symptom control
When is chemotherapy most effective, and when is it less so?
- Small cell - Potentially curative
* Non small cell - Modest survival increase, symptom control
What is combination therapy?
• Combination of chemo and radiotherapy
What is a biological targeted therapy?
• EGFR and VEGF inhibition to prevent tymour growth
How is non-small cell lung cancer treated?
- Palliative radiotherapy for local symptoms
- Chemotherapy -50 - 60% response rate
- Combination therapy - Important in locally advanced disease
Targeted agents - EGFR and VEGF
How is small cell cancer managed?
- Rarely operable
- Combination therapy - Responds well, adding 1 year
- Palliative Chemotherapy for symptoms
- Death from cerebral metastases common
