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Oncology > The Troublesome Cough - Lung Cancer > Flashcards

The Troublesome Cough - Lung Cancer Flashcards

1
Q

What are the 8 red flags for Lung cancer?

A
  1. Cough - dry/productive
  2. Haemoptysis
  3. Dyspnoea
  4. Hoarse voice - recurrent laryngeal nerve involvement
  5. Chest pain
  6. Fatigue
  7. Appetite loss
  8. Weight loss
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2
Q

What is a ‘para-neoplastic syndrome’?

A

A rare disorder caused by an immune response to a cancer. These are non-metastatic systemic effects.

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3
Q

Give 2 examples of para-neoplastic syndromes

A
  1. Hypercalcaemia in SCLC
  2. Hypertrophic pulmonary osteoarthropathy (HPOA)
  3. SIADH - SCLC
  4. Anaemia - NSCLC

There are many more

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4
Q

What information is needed before someone has a CT with contrast?

A
  • If they have had a previous contrast reaction
  • Renal function - if GFR <40ml/min then there is increased risk of AKI
  • DM - metformin? may need to be discontinued before contrast
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5
Q

When would you refer someone on the 2ww lung cancer pathway?

A
  1. If they have a CXR finding that is suggestive of lung cancer pathology
  2. Aged 40< with unexplained haemoptysis
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6
Q

Why is it so important to consider PMHx in patients presenting with potential lung cancer?

A

This gives us an idea of the patients’ performance status and allows us to consider which treatment options may be suitable for them

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7
Q

Which bloods need to be taken at a 2ww lung clinic and why?

A
  1. FBC - check for anaemia of chronic disease
  2. U&E and renal function - check fitness for chemotherapy
  3. Bone profile - to check for metastases (bone) or para-neoplastic syndromes
  4. LFT - if abnormal may not tolerate chemo. Also check for mets
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8
Q

Which further investigations would you request at the 2ww clinic?

A
  1. Pulmonary function tests
  2. CT scan with contrast - thorax and abdomen (before the bronchoscopy)
  3. Bronchoscopy and biopsy - histology and staging
  4. PETCT scan - if disease is localised and potentially curable
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9
Q

What factors are important to consider when deciding on what treatment a patient will receive?

A
  1. Stage of disease (TMN)
  2. Performance status
  3. Co-morbidities - cardiac/pulmonary compromise
  4. Histology of the cancer
  5. Patient preference
  6. Social support for the patient
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10
Q

At the diagnosis visit of the patients’ lung cancer journey, what do you think the aims of the visit should be?

A
  1. Reassess the patient - are they still stable?
  2. Explain the diagnosis to the patient and answer any questions they may have (remember SPIKES)
  3. Gain rapport and trust with the patient
  4. Agree upon a treatment plan
  5. Request any further tests that may be required
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11
Q

What is the common early side effect of radiotherapy for lung cancer?

A

Oesophagitis - usually occurring within 2 weeks of commencing treatment. Usually short lived and settles within 2-4 weeks of completion

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12
Q

What is the common late side effect of radiotherapy radical treatment for lung cancer?

A

Dyspnoea - lung damage. Can occur 2-3 weeks into the therapy but can progress for several months after Tx.

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13
Q

What are the 3 most common histological types of lung cancer?

A
  1. Small cell lung cancer (SCLC) - 15%
  2. Squamous cell carcinoma - 30%
  3. Adenocarcinoma - 30-40%
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14
Q

Where is SCLC typically located?

A

Centrally in the lung fields

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15
Q

SCLC is a rapidly growing cancer, how long does it take for the tumour to double in size approximately?

A

29 days (so around every month)

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16
Q

What is the median survival for SCLC without treatment?

A

2-4 months

17
Q

What is the median survival for SCLC in patients with extensive metastatic disease who receive treatment?

A

6-12 months

18
Q

What is the median survival for SCLC in patients with localised disease who receive treatment?

A

16-24 months

19
Q

Where is a squamous cell carcinoma (SCC) normally located?

A

Centrally in the lung

20
Q

Why does SCC have a very good survival rate?

A

It’s operability

21
Q

How long does it take on average for the SCC tumour to double in size?

A

90 days (around 3 months)

22
Q

Where is an adenocarcinoma typically located?

A

Peripherally in the lungs

23
Q

How long does it take on average for an adenocarcinoma to double in size?

A

160 days (around 5 months)

24
Q

What is concerning about an adenocarcinoma?

A
  1. It can metastasise early

2. It can occur in non-smokers

25
Q

How do we stage lung cancer?

A

Using the TNM approach

26
Q

When is a tumour classed as; T1?

A

When it is <3cm

27
Q

When is a tumour classed as; T2?

A

When it is 3-5cm

Or when it involves the main bronchus but not the carina

28
Q

When is a tumour classed as; T3?

A

It measures 5-7cm
It invades the chest wall
There is more than 1 nodule in the same lobe

29
Q

When is a tumour classed as; T4?

A

It measures >7cm

It invades local structures e.g. mediastinum, heart, trachea

30
Q

When is Nodal staging classed as; N0?

A

No nodal involvement

31
Q

When is Nodal staging classed as; N1?

A

A singular local, ipsilateral node involvement

32
Q

When is Nodal staging classed as; N2?

A

1< ipsilateral mediastinal node(s)

33
Q

When is Nodal staging classed as; N3?

A

Contralateral mediastinal nodes

34
Q

When is a metastatic tumour scored as; M1a?

A

There is a separate tumour/nodule(s) in a contralateral lobe

35
Q

When is a metastatic tumour scored as; M1b?

A

When there is a single extra-thoracic metastases in a singular organ

36
Q

When is a metastatic tumour scored as; M1c?

A

There are multiple extra-thoracic metastases

37
Q

How many patients with lung cancer are thought to develop brain metastases at some point during their disease?

A

Up to 1/3

38
Q

If a patient with known previous lung cancer presented with symptoms of brain mets, what investigations would you organise and why?

A
  1. MRI brain - check for no CVAs and look for mets
  2. CXR - may show recurrent lung cancer
  3. Bloods - FBC, CRP, U&E, LFT, glucose
39
Q

What percentage of patients with lung cancer diagnosed in the UK have a 1 year survival chance?

A

30%

Oncology (7 decks)

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