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The Respiratory System > The Management of Lung Cancer > Flashcards

The Management of Lung Cancer Flashcards

1
Q

What are the risk factors for developing lung cancer

A
  • Smoking
  • Air pollution
  • Radon gas
  • Asbestos (especially if also a smoker)
  • Family history
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2
Q

Why are such low numbers of patients with lung cancer offered treatment with curative intent

A

Because lung cancer tends to present late in the progression of the disease.

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3
Q

What is thought to possibly detect lung cancer at an early stage in development

A

CT scans however there is a risk of false positive result which can lead to unnecessary operation. There are also new clinical trials with blood biomarkers for the detection of lung cancer.

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4
Q

What are some of the symptoms of lung cancer

A
  • Haemoptysis

- Dyspnoea

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5
Q

Why are symptoms not diagnostic of lung cancer

A

Because none of the symptoms are specific to lung cancer and may be due to other conditions such as COPD or bronchiectasis.

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6
Q

What technique is used to try and determine the type of tissue in a tumour

A

Biopsy

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7
Q

Which cancers are included under the term “non small cell lung cancer”

A

Adenocarcinoma and squamous cell carcinoma

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8
Q

What is the rate of progress of small cell carcinomas

A

Small cell carcinomas progress very quickly

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9
Q

What is needed for a definitive diagnosis of small cell lung cancer

A

Radiology and biopsy - a definitive diagnosis is never given following radiology alone.

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10
Q

What does squamous cell carcinoma show up with on radiology

A

A mass with a cavity inside. This is specific to this type of cancer only.

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11
Q

In which group does squamous cell carcinoma tend to arise in

A

Older people.

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12
Q

Which type of lung cancer is more common in younger people

A

Adenocarcinoma

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13
Q

What tends to cause adenocarcinoma

A

Smoking - particularly of long cigarettes 9the ones which are supposed to contain less nicotine). Those who smoke cannabis also are more likely to develop adenocarcinoma.

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14
Q

What forms in adenocarcinoma

A

A glandular growth pattern and scar tissue.

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15
Q

What is the staging method used for lung cancer

A

TNM staging (tumour, node, metastasis)

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16
Q

How many “T” stages are there in the TNM classification of lung cancer

A

Four

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17
Q

What is the T1 stage of lung cancer

A

The tumour is less than 3cm in size.

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18
Q

What is the T2 stage of lung cancer

A

The tumour is 3-7cm in size. Features include -

  • Atelectasis (part of the lung)
  • Invasion (visceral pleura, main bronchus more than 2cm from the carina)
19
Q

What is the T3 stage of lung cancer

A

The tumour is more than 7cm in size. Features include -

  • Atelectasis (whole lung)
  • Invasion (phrenic nerve, diaphragm, chest wall, mediastinal pleura, main bronchus less than 2cm from the carina)
20
Q

What is the T4 stage of lung cancer

A

Invasion

21
Q

How many stages are there in the “N” category of the classification of lung cancer

A

Four

22
Q

What is the N0 stage of lung cancer

A

No lymph node involvement

23
Q

What is the N1 stage of lung cancer

A

Involvement of the ipsilateral, bronchopulmonary and hilar nodes

24
Q

What is the N2 stage of lung cancer

A

Involvement of the ipsilateral, mediastinal and subcarinal nodes

25
Q

What is the N3 stage of lung cancer

A

Involvement of the contralateral hilar, contralateral mediastinal and supraventricular nodes.

26
Q

How many stages are there in the “M” category of lung cancer

A

Two

27
Q

What is the M0 stage of lung cancer

A

No metastasis

28
Q

What is the M1 stage of lung cancer

A

Metastasis to distant sites.

29
Q

What are the three best methods used for lymph node evaluation

A

Mediatinoscopy, Endobronchial ultrasound and PET. CTs are also sometimes used and can be effective.

30
Q

What is the new diagnostic and staging algorithm for lung cancer

A

Chest x-ray followed by CT/PET to exclude T4/M1 disease. Then tissue diagnosis and evaluation of the mediastinum.
This is followed by bronchoscopy/CT biopsy/endobronchial ultrasound and treatment.

31
Q

How is a PET performed

A

PET scans identify more metabolically active areas of which tumours are. The patient is injected with radioactive glucose and the metabolically active parts show up bright.

32
Q

What are the treatment options for non small cell lung cancer

A
  • Resection - this is only suitable in very few patients but has a high 5 year survival rate (70%)
  • Chemo and radiotherapy - this has a poorer 5 year survival (30%)
  • Palliative chemotherapy to increase survival by a few months
  • Palliative radiotherapy for symptom control
  • Supporting care for symptom control.
33
Q

How long do patients with lung cancer tend to live following diagnosis

A

More than 90% of lung cancer patients die 2 years after diagnosis.

34
Q

What is one benefit of chemotherapy

A

There is less detrimental effect on the patients quality of life compared to the uncontrolled progression of the cancer spread

35
Q

Which mutation could present a new approach to treatment of lung cancer

A

The EGFR mutation

36
Q

Which cancer has a particularly high rate of EGFR mutation

A

Adenocarcinomas

37
Q

Which groups of patients tend to respond well to EGFR blocking therapy

A

East Asian people, people with adenocarcinoma, females, non-smokers.

38
Q

What leads to the particularly poor prognosis of small cell lung cancer

A

It is very aggressive and has rapid dissemination so many patients present with distant metastasis.

39
Q

What is considered to be limited disease in small cell lung cancer

A

The cancer is restricted to one hemithorax with or without involvement of ipsilateral nodes.

40
Q

What is considered to be extensive disease in small cell lung cancer

A

The cancer has spread beyond one hemithorax.

41
Q

Which treatments are small cell lung cancers particularly sensitive to

A

Chemotherapy and radiotherapy.

42
Q

What is the median survival of limited small cell lung cancer

A

10-15 months.

43
Q

What is the median survival of extensive small cell lung cancer

A

7-10 months.

The Respiratory System (20 decks)

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