Session 9: Lung Cancer Flashcards
Describe the incidence of lung cancer.
Most common cancer to cause death in the UK.
Slightly more common in males than females.
35000 per year in UK
Risk factors of lung cancer.
Smoking (80-90%)
Environment such as asbestos, radon, chromium, nickel and arsenic.
Genetics
Prevention of lung cancer.
Stop smoking (education and negative advertisement etc…)
Screening
Pros and cons of screening for lung cancer.
It is becoming more and more common to screen for lung cancer.
Pros:
Can detect disease before the critical point and improve prognosis for patients
Can start treatment earlier and is more effective when applied before symptoms arise.
Cons:
Overdiagnosis
Exposure to radiation
Explain why staging is important in lung cancer.
It gives a prognosis for the patient.
Staging is also done to know which treatment is appropriate for the patient.
What staging is used for lung cancer?
TNM
Explain TNM briefly.
T - Size of tumour, number of nodules, location of nodules.
N - Spread to local lymph nodes
M - Metastasis into systemic circulation.
How can staging be assessed?
Either by imaging or tissue sampling.
Give imaging methods for staging of lung cancer.
CXR
CT scan
PET scan
MRI
USS
Bone scan
ECHO
Why might a ct scan be more useful than CXR in staging?
The CT scan is called a staging CT and scan both thorax and abdomen and not only thorax.
Why might a PET scan be more useful than a CT scan to assess staging in lung cancer?
PET scan more or less covers the whole body.
The PET scan can detect smaller nodules as well that hasn’t been detected on the CT.
Why might it be useful for a USS as well in assessment of staging?
USS can differ between hemangioma and metastases.
(Hemangioma looks like metastases on CT)
Give examples of tissue sampling done in assessment of staging.
Bronchoscopy
USS
CT biopsy
Thorocoscopy
Surgical
How might tissue sampling have other uses than staging?
It can be used to check for the histological type of lung cancer.
What are the main histological types of lung cancer?
Non-small cell carcinoma (80%)
Small cell carcinoma (12%)
Carcinoid (5%)
Give types of non-small cell carcinoma.
Squamous cell carcinoma (40%)
Adenocarcinoma (35%)
Large cell carcinoma (5%)
Why is it important to know what histological type of lung cancer a patient has?
Because they behave differently. Different types of lung cancer can exhibit different symptoms.
Also it is important to be aware of the histological cancer in order to know which treatment to use.
Small cell is much more aggressive than non-small cell lung carcinoma.
Give common location of metastases in lung cancer.
Brain
Draining lymph nodes
Pericardium
Liver
Adrenals
Bones
How might symptoms differ in lung cancer?
Primary tumour will exhibit certain symptoms
Regional metastases will exhibit different.
Distant metastases will act in their own way.
However most commonly patient have no symptoms.
Common symptoms of lung cancer.
Cough
Dyspnoea
Wheezing
Haemoptysis
Lung infection
Chest/shoulder pain
Weight loss
Lethargy/malaise
Give less common symptoms experienced in later staging.
Bloated face
Hoarseness
Dyspnoea
Dysphagia
Bone pain/fractures
CNS symptoms
Give signs of lung cancer
Cachexia
Pale conjunctiva
Lymphadenopathy
Horner’s syndrome
Finger clubbing
etc…
What are other symptoms that might be experienced (endocrine) and what is this syndrome called?
Paraneoplastic syndrome
Cushing’s (ACTH)
Hypercalcaemia (PTHrP)
SIADH (ADH)
Hypertrophic osteoarthropathy
Explain the behaviour of small-cell carcinoma.
It is an aggressive cancer which grow and metastasise rapidly.
It can have endocrine features where it produces ACTH or ADH.
