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Semester 3 - Respiratory > Session 7 - Lung Cancer > Flashcards

Session 7 - Lung Cancer Flashcards

1
Q

Describe incidence of lung cancer in men

A
  • Commonest male cancer
  • Mortality around 100 per 100,000
  • Incidence falling slowly due to reduction in smoking
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2
Q

Describe incidence of lung cancer in females

A
  • Exceeds breast cancer as a cause of death in women
  • Mortality rate around 40 per 100,000
  • Incidence rising
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3
Q

How does incidence of lung cancer vary according to socioeconomic group?

A
  • Wide variation

* Rate three times higher in lowest compared with highest

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4
Q

What is the main risk factor for lung cancer?

A
  • Smoking
  • 90% lung cancers in men

80% lung cancer in women

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5
Q

Give four aeitological factors which influence lung cancer

A
  • Asbestos exposure
  • Radon exposure
  • Genetic factors
  • Dietary factors
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6
Q

What are the main signs and symptoms of lung cancer?

A

• Relatively non-specific

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7
Q

What are the main symptoms of a primary lung cancer tumour?

A
  • Cough
  • Dyspnoea
  • Wheezing
  • Haemoptysis
  • Chest pain
  • Post-obstructive pneumonia
  • Weight loss
  • Lethargy/malaise
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8
Q

What are the main four symptoms of regional mestastases?

A
  • Superior vena cava obstruction
  • Hoarseness (left recurrent laryngeal nerve palsy)
  • Dypnoea (phrenic nerve palsy)
  • Dysphagia
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9
Q

What are the main two symptoms of distant metastases

A
  • Bone pain/fractures

* CNS symptoms (headache, double vision, confusion)

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10
Q

What is paraneoplastic syndrome?

A

• 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

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11
Q

What are the symptoms of paraneoplastic syndrome mediated by?

A

• Humoral factors (hormones and cytokines) secreted by tumour cells, or the immune response against tumour cells

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12
Q

What are the four main categories of paraneoplastic syndrome?

A
  • Endocrine
  • Neurological
  • Skeletal
  • Haematological
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13
Q

Give two diseases which occur as an endocrine result of paraneoplastic syndrome

A
  • Hypercalcaemia

* Cushing’s syndrome

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14
Q

Give two disease which occur as a neurological result of paraneoplastic syndrome

A
  • Encephalopathy

* Peripheral neuropathy

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15
Q

Give a skeletal disease which occurs as a result of paraneoplastic syndrome

A

• Finger clubbing

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16
Q

Give three diseases which occur as a a haemotolofical result of paraneoplastic syndrome

A
  • Anaemia
  • Throbocytopenia
  • Disseminated Intravascular Coagulation
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17
Q

What are two other diseases which can come about as a result of paraneoplastic syndrome?

A
  • Nephrotic syndrome

* Anorexia or Cachexia

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18
Q

What occurs when lung cancer is first suspected in a patient in terms of investigations

A

○ Plain chest x-ray

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19
Q

What are three scans used for diagnosis and staging

A
  • CT scan
  • PET scan
  • Isotope bone scan
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20
Q

What are the two staging systems for lung cancer?

A

• Number

TMN

21
Q

What is a stage 1 cancer?

A

• Small cancer, localised to one area of the lung

22
Q

What is a stage 2 and 3 cancer?

A

• Larger cancer, may have grown into surrounding tissues

23
Q

What is stage 4 cancer?

A

Cancer has metastasised

24
Q

What is the TMN staging system (Outline T, M and N) ?

A
  • T - Size and position of tumour
  • N - Lymph node involvement
  • M - Metastases
25
Q

What are the stages of T?

A

• T1 - T4

26
Q

What is T1 in lung cancer

A

• T1 - cancer contained within the lung (<3cm diameter)

27
Q

What is T2 in lung cancer

A
  • Cancer has grown (3-7cm diameter)
  • Into main bronchus
  • Into the visceral pleura
  • Made parts of the lung collapse
28
Q

What is T3 in lung cancer?

A
  • Cancer has grown (>7cm diameter)
  • Invading chest wall, mediastinal pleura, diaphragm, pericardium
  • Complete lung collapse

> 1 cancer nodule in the same lob of lung

29
Q

What is T4 in lung cancer

A
  • 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
30
Q

What is N0?

A

• No cancer in lymph nodes

31
Q

What is N1?

A

• Cancer in lymph nodes nearest the affected lung

32
Q

What is N2?

A

• Cancer in lymph node in mediastinum on the same side

33
Q

What is N3?

A

Cancer in lymph nodes on the opposite side of the mediastinum/supraclavicular lymph nodes

34
Q

What is M0?

A

• No evidence of distal cancer spread

35
Q

What is M1?

A

• Lung cancer cells in distant parts of the body such as pleura, opposite lung, liver or bones

36
Q

What are three ways in which tissue is biopsied in lung cancer?

A
  • Bronchoscopy
  • Needle biopsy of the lung
  • Surgical biopsy
37
Q

Why is biopsy important?

A

• To determine cell type, which can influence prognosis and treatment

38
Q

What are the two main types of lung cancer?

A
  • Non-small cell lung cancer

* Small cell lung cancer

39
Q

What is a feature of non-small cell carcinoma on presentation?

A

• More than 2/3rds have inoperable disease at presentation

40
Q

What is a feature of small cell carcinoma on presentation?

A

• 3/4 have metastatic disease at presentation

41
Q

What does prognosis of a lung cancer depend on?

A

• Cell type (small cell worse than non-small cell)
• Stage of disease
• Performance status
• Biochemical markers
• Co-morbidities
○ Cardiac or chronic respiratory disease

42
Q

Give six different treatments for lung cancer

A
  • Surgery
  • Radiotherapy
  • Chemotherapy
  • Combination therapy
  • Biological targeted therapies
  • Palliative care
43
Q

When is surgery used for lung cancer?

A

• Mostly non-small cell

44
Q

What is the difference between radical and palliative radiotherapy?

A
  • Radical is curative

* Palliative is symptom control

45
Q

When is chemotherapy most effective, and when is it less so?

A
  • Small cell - Potentially curative

* Non small cell - Modest survival increase, symptom control

46
Q

What is combination therapy?

A

• Combination of chemo and radiotherapy

47
Q

What is a biological targeted therapy?

A

• EGFR and VEGF inhibition to prevent tymour growth

48
Q

How is non-small cell lung cancer treated?

A
  • Palliative radiotherapy for local symptoms
  • Chemotherapy -50 - 60% response rate
  • Combination therapy - Important in locally advanced disease

Targeted agents - EGFR and VEGF

49
Q

How is small cell cancer managed?

A
  • Rarely operable
  • Combination therapy - Responds well, adding 1 year
  • Palliative Chemotherapy for symptoms
  • Death from cerebral metastases common

Semester 3 - Respiratory (18 decks)

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