Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y4 - CCC & PC > Big 4 - Lung Cancer > Flashcards

Big 4 - Lung Cancer Flashcards

1
Q

What is the prevalence of lung cancer?

What are the outcomes usually like?

A

It is reasonably common - accounts for 13% of all cancers but 21% of all cancer deaths

It has poor outcomes with a 5% 10-year survival - this is mainly because it presents at more advanced stages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What gender / age range tends to be affected by lung cancer?

A
  • it is more commonly seen in men, but trends are increasing for both genders
  • it is a cancer of the elderly population - takes off around 60 but peak is at 80-85
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Are the number of lung cancer cases increasing or decreasing?

A
  • lung cancer cases in men are decreasing (blue line)
  • lung cancer cases in females are becoming more common (pink line)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When does lung cancer tend to present?

How does this affect survival?

A

lung cancer tends to present at an advanced stage - stage IV, followed by III

survival is highest for the earlier stages and lower for stage IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How is lung cancer associated with socioeconomic deprivation?

A

it is linked with deprivation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What type of cancer are the majority of lung cancers?

How does smoking affect this?

A
  • most lung cancers are non-small cell carcinomas (NSCC)

these may be adenocarcinomas, large cell carcinomas or squamous cell carcinomas

  • smoking is the largest risk factor for ALL lung cancers
  • adenocarcinoma has the largest proportion of non-smokers affected
  • it is very rare to see small cell cancer (SCC) in a non-smoker
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How has the histology of the most common lung cancer changed with smoking habits?

A
  • squamous cell carcinoma was originally the most common sub-type
  • adenocarcinoma has become more common after introduction of fine filter cigarettes
  • this allows for smaller particles to be deposited within the alveoli
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How does lung cancer typically present?

A
  • cough
  • breathlessness
  • haemoptysis
  • chest pain
  • weight loss
  • bone pain
  • RUQ pain
  • headaches / nausea / neurological signs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Why is it concerning when someone presents with symptoms of lung cancer?

A

symptoms only tend to appear in advanced disease which is difficult to treat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Why is haemoptysis a particularly concerning sign in lung cancer?

A
  • it shows that the cancer is sitting very centrally
  • the cancer may not be advanced, but is likely to be a T3/T4 lesion that may not be suitable for surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What localised therapies may be used in lung cancer?

A

surgery or radiotherapy

radiotherapy can be curative or palliative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What systemic therapies can be used in lung cancer?

A
  1. chemotherapy
  2. immunotherapy
  3. targeted therapy

these are NOT curative when used on their own

used palliatively or as an adjunct to localised therapies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the typical symptoms of a Pancoast (apical) tumour?

A
  • ptosis (drooping of the eyelid)
  • meiosis (constriction of the pupil)
  • anhidrosis
  • pain / numbness / tingling in the ipsilateral arm
  • weakness of the small muscles in the ipsilateral hand
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why is it important to determine comorbidities and performance status of a patient?

A
  • performance status (how well a patient can perform ADLs without assistance) tells you how aggressive you can be with treatment
  • some treatments can be contraindicated with other medical conditions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Can you stage lung cancer from a CXR?

A
  • CXR allows you to estimate the stage, but you cannot know this for sure without an image of the abdomen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Before deciding on how to treat a patient, what do you need to know?

A
  • the intent of the treatment - curative or palliative?
  • the stage of the disease - is there nodal or metastatic disease?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

If a fit patient has locally advanced cancer (no spread), what is the usual treatment approach?

A

trimodality treatment

  • this involves neoadjuvant chemoradiation followed by surgery
  • this allows for downsizing of the tumour prior to surgery
  • if surgery is not possible (e.g. brachial plexus involvement) then definitive concurrent chemoradiation would be preferred
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the most aggressive chemotherapy for lung cancer?

What are the drawbacks of using this?

A

cisplatin

chemotherapy is NOT curative for lung cancer

the chances of response are only around 30%

19
Q

When might cisplatin not be used?

A

it cannot be used with some comorbidities

  • lung cancer patients are often smokers with diabetes + ischaemic disaeses where cisplatin might not be recommended
20
Q

When might chemotherapy be chosen over chemoradiation?

A
  • in more severe disease where nodes of the supraclavicular fossa are involved (T3), there is concern about whether cervical nodes may be affected
  • in this case, radiation is not suitable
21
Q

What symptoms may a patient present with if the cancer has occluded the trachea?

What management must be performed here?

A
  • they may present with stridor due to narrowing of the airway
  • airway compression is managed with high flow O2 and steroids
22
Q

What does small-cell lung cancer appear like under a microscope?

A

it is typical of small, oval, purple cells with:

  • grainy / scanty cytoplasm
  • frequent mitoses (divisions)
  • open nuclei
  • absent nucleoli
  • dense neurosecretory granules
23
Q

How do small cell lung cancers tend to present differently to NSCLCs?

A
  • SCLCs tend to be present more centrally and cause irritation / obstruction of major airways
  • haemoptysis is also more common
  • they are also associated with paraneoplastic syndromes
24
Q

What are the 3 most common paraneoplastic syndromes?

A
  1. ectopic ACTH production (Cushing’s syndrome)
  2. SIADH
  3. Eaton Lambert syndrome

cancer does not present with chest symptoms, but those of the syndrome

25
Q

Why can Cushing’s syndrome occur in SCLC?

A
  • the cancer starts in the neuroendocrine cells of the lungs
  • these cells produce glucocorticoids, including cortisol
  • constant exposure to high levels of cortisol results in symptoms of Cushing’s syndrome
26
Q

What are some of the symptoms of Cushing’s syndrome?

A
  • increased hair growth
  • decreased libido
  • weight gain with thin arms + legs
  • easy brusing
  • round “moon” face
  • wide purple stretch marks, mainly on the abdomen and breasts
27
Q

What is SIADH?

A

syndrome of inappropriate ADH secretion

  • lung cancer cells release ADH
  • unlike ADH release by the pituitary gland, ADH from cancer cells is NOT suppressed by low sodium levels / normal blood volume

this results in hyponatraemia

28
Q

What are the symptoms of SIADH in lung cancer?

A
  • N&V
  • tiredness
  • muscle cramps
  • shaking
  • headaches / confusion
  • decreased urine volume + increased concentration

the symptoms are caused by hyponatraemia and tend to be vague

29
Q

What is meant by Lambert-Eaton syndrome and why does it occur?

A
  • there is generation of antibodies against voltage-gated calcium channels on presynaptic nerve terminals
  • this results in a decrease in acetylcholine (ACh)
  • the primary presentation is muscle weakness

over 50% cases are associated with SCLC, the rest are autoimmune

30
Q

What symptoms are associated with Lambert-Eaton syndrome?

A
  • muscle weakness, fatigue + pain
  • difficulty walking
  • reduced reflexes
  • weakness in muscles of eyes, face + throat
  • speech + swallowing problems
31
Q

What is the main treatment approach for SCLC?

A

CHEMOTHERAPY

  • surgery is rarely used
  • the cancer has a fast doubling time so need to start systemic treatment fast
  • depending on how well the patient is and where the tumour is, radiotherapy may be used as well
32
Q

Where does radiotherapy tend to be used in a SCLC patient?

A
  • SCLC has a predominance of going to the brain as a first site of relapse
  • radiotherapy to the brain is given even if there are no mets
  • relapse / brain mets often mean it is the end of life
33
Q

How is chemotherapy given in SCLC?

A
  • it is the only cancer where chemotherapy is given as an in-patient
  • there are often 4 cycles, but the patient is discharged after the first one
34
Q

How is the response rate to chemotherapy different for SCLC and NSCLC?

A
  • NSCLC has a 30% response rate to chemotherapy
  • SCLC has a 70-80% response rate
  • due to the fast doubling time, the responses are not long-lived
  • radiotherapy is also given to try and consolidate this
35
Q

What chemotherapy agent is commonly used for SCLC?

A

carboplatin etoposide

36
Q

What is a significant side effect of radiotherapy to the brain in SCLC?

A

there is often significant memory impairment (particularly short term)

37
Q

What is the mainstay treatment for lung cancers in general?

A

radiotherapy

  • many patients with lung cancer have other comorbidities and are not suitable for surgery

radiotherapy aims to hit the cancer and spare organs at risk

38
Q

Why is radiotherapy becoming increasingly favoured over surgery?

A
  • early-stage cancers can have similar local control rates to surgery
  • high doses can be supplied to the tumour and spare organs at risk
  • treatment can be delivered over a short period of time (3-8 tx)
  • can treat patients who are unwell
39
Q

What is meant by oncogene addiction?

A

some cancers with genetic, epigenetic or chromosomal irregularites become dependent on one or several genes for survival

cancer cells rely on continuous signalling from these oncogenes for survival

40
Q

What does oncogene addiction mean for treatment?

A
  • drugs can be developed to specifically target certain mutations that are driving division of that cancer

e.g. ALK & EGFR in adenocarcinoma

Oncogene driven tumours are NOT common and < 10% of all lung cancer cases

41
Q

How does immunotherapy in NSCLC work?

A
  • tumour cells switch off the immune system in order to grow
  • they bind to T-cell receptors PD-1 and PD-L1
  • immunotherapies block the attachment of tumour cells to T cells
  • the immune system can recognise the tumour cells and mount a response to kill the cancer cells
42
Q

What are the benefits of immunotherapy over chemotherapy?

A
  • immunotherapy is discriminatory, whereas chemotherapy attacks any cells that are actively dividing
  • this results in death of the bone marrow, gut lining, hair loss + skin rashes
  • immunotherapy does not have the toxic side effects of chemotherapy

death of bone marrow results in neutropenic spesis, thrombocytopenia + anaemia

43
Q

What are the common side effects of immunotherapy?

A
  • thyroid imbalance is the most common, but any organ can be affected

caused by the immune system attacking other organs + cancer cells

44
Q

When can immunotherapy be used to treat lung cancer?

A

1st line treatment:

  • it can be used alone to treat stage IV disease
  • or combined with chemotherapy

2nd line treatment:

  • it can be used after radical treatment for maintenance in stage III disease

Y4 - CCC & PC (34 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions