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Respiratory > Lung cancer > Flashcards

Lung cancer Flashcards

1
Q

Lung cancer symptoms

A

persistent new cough or change in character of pre-existing cough
persistent LRTIs
chest/shoulder pain
dyspnoea
haemoptysis
lethargy, weight loss, anorexia (constitutional symptoms)
hoarseness

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2
Q

Lung cancer signs

A

often none
clubbing
signs of lung collapse, consolidation, pleural effusion
localised persistent wheeze (monophonic)
stridor
supraclavicular lymphadenopathy
hoarseness
SVC obstruction
Horner’s syndrome
features of paraneoplastic syndromes

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3
Q

SVC obstruction symptoms/signs

A

dyspnoea
orthopnoea
facial plethora
dilated/engorged veins
raised JVP
arm/face swelling

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4
Q

What causes Horner’s syndrome?

A

compression of sympathetic chain at roughly the level of C1

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5
Q

Features of Horner’s syndrome

A

miosis (constricted pupil)
ptosis (upper eyelid drooping)
anhidrosis (no sweat produced on one side of face/forehead)
enophthalmos (sunken in eye)

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6
Q

What are 2 lung cancer medical emergencies?

A

SVC obstruction
spinal cord compression

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7
Q

What investigations should be done if lung cancer is suspected?

A

CXR
CT staging (contrast) +/- biopsy
Bronchoscopy
Pulmonary function tests
6-minute-walk test
PET-CT scan
Bone scan
Cardiac investigations

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8
Q

What is WHO performance status 0?

A

fully active and able to carry out pre-disease activities without restriction

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9
Q

What is WHO performance status 1?

A

restricted in strenuous activity but ambulatory and able to carry out light work

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10
Q

What is WHO performance status 2?

A

ambulatory and self-caring, but unable to do light work
up and about more than 50% of the time

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11
Q

What is WHO performance status 3?

A

limited self care
in bed more than 50 % of the time

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12
Q

What is WHO performance status 4?

A

unable to self care
confined to bed or chair

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13
Q

Non-small cell lung cancer subtypes

A

squamous cell carcinoma
adenocarcinoma
large cell carcinoma

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14
Q

What are the 4 mesothelioma subtypes and which is the most common?

A

epithelioid (most common)
biphasic
sarcomatoid
desmoplastic

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15
Q

Where in the lung are small cell lung cancers normally located?

A

central

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16
Q

Where in the lung are adenocarcinomas normally located?

A

peripheral

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17
Q

Where in the lung are squamous cell carcinomas normally located?

A

central airways

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18
Q

Where in the lung are large cell carcinomas normally located?

A

peripheral

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19
Q

What factors are considered when staging a lung cancer?

A

location of primary tumour
tumour size and extent
lymph node involvement
presence of distant metastases

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20
Q

Why is ist important to stage lung cancer?

A

common language for communicating the severity of a person’s cancer
prognostic information
determines treatment options

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21
Q

What do TNM stand for in lung cancer staging?

A

T = tumour size
N = extent of spread to lymph nodes
M = presence of metastasis

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22
Q

What invasive options are available for staging of a lung cancer?

A

EBUS-TBNA (endobronchial ultrasound-guided transbronchial needle aspiration - central nodules

thoracoscopy - small peripheral nodules

mediastinoscopy - mediastinal nodes or masses

23
Q

What imaging methods can be used to help stage a cancer?

A

CT
PET-CT

24
Q

What is the aim of biopsying the primary lesion?

A

Histological diagnosis

25
Q

Who is in the MDT for lung cancer?

A

respiratory physicians
thoracic surgeons
oncologists
radiologists
histopathologists
lung cancer specialist nurses
palliative care team

26
Q

Lung cancer management options (general)

A

surgery
chemotherapy
radiotherapy
palliation

27
Q

When is surgical management indicated for lung cancer?

A

stage 1 and 2 disease (and some stage 3 disease)

28
Q

Define resectability

A

ability to completely excise the tumour at surgery

29
Q

Define operability

A

risk of mortality/morbidity from surgery

30
Q

What are the 3 main factors considered when assessing operability in lung cancer

A

risk of post-operative cardiac event
risk of peri-operative death
risk of post-operative dyspnoea

31
Q

What are the 4 types of resection that can be done to remove lung cancers surgically?

A

wedge resection
segmental resection
lobectomy (most common)
pneumonectomy

32
Q

What does VATS stand for?

A

video-assisted thoracoscopic surgery

33
Q

Complications of surgery to remove lung cancer

A

displacement of heart towards operated side
bronchial stump insufficiency
pneumothorax (potentially tension pneumothorax)
postoperative haemorrhage (hemothorax)
chylothorax (damage to thoracic duct)
atelectasis
pneumonia

34
Q

Acute side effects of radiotherapy

A

oesophagitis
pneumonitis
nausea/vomiting
bone marrow suppression

35
Q

Longer term side effects of radiotherapy

A

pneumonitis and pulmonary fibrosis
rib fractures
cardiac fibrosis and dysfunction
hypothyroidism

36
Q

What cell functions can chemotherapy target?

A

DNA replication/repair
cytoskeleton
nucleotide synthesis
hormones
specific receptors (eg. herceptin)

37
Q

Is chemotherapy curative in lung cancer?

A

no

38
Q

Lung cancer risk factors

A

smoking (tobacco + cannabis)
passive smoking
occupation exposure (asbestos, silica, coal)
HIV
organ transplantation
radiation exposure

39
Q

Squamous cell carcinoma important features

A

usually obstructive lesions of bronchus
can cavitate
local spread common, often late metastasis
PTHrp production leading to hypercalcaemia
associated with clubbing and HPOA

40
Q

What is HPOA?

A

hypertrophic pulmonary osteoarthropathy

41
Q

What cells do adenocarcinomas arise from?

A

mucous cells in bronchial epithelium

42
Q

Adenocarcinoma important features

A

can invade mediastinal lymph nodes and pleura
can metastasise to brain and bones
does not usually cavitate
if a non-smoker has lung cancer it will be adenocarcinoma
most likely to cause pleural effusions

43
Q

Small cell carcinoma important features

A

cause paraneoplastic syndromes (eg. Cushing’s, Addison’s)
spreads early - almost always inoperable
do respond to chemotherapy but have a poor prognosis

44
Q

What cells do small cell carcinomas arise from?

A

endocrine cells (Kulchitsky cells)

45
Q

Contraindications to surgery for lung cancer

A

malignant pleural effusion
SVCO
Horner’s syndrome
Vocal cord paralysis
Phrenic nerve paralysis

46
Q

What is radical chemotherapy?

A

given with the aim of cure
accept the likely side effects, longer course than palliative which is for symptom control

47
Q

What are 3 types of staging?

A

clinical staging (scans)
surgical staging (biopsies)
pathological staging

48
Q

NSCLC good prognostic factors

A

early stage disease at diagnosis
good performance status
no significant weight loss (<4%)
female

49
Q

Common biomarkers in lung cancer

A

EGFR (epidermal growth factor receptor)
K-ras oncogene
EML4-ALK Fusion oncogene
PDL1

50
Q

Squamous cell carcinoma immunohistochemical staining

A

TTF-1 negative
p63 positive
cytokeratin 5/6 positive

51
Q

Adenocarcinoma immunohistochemical staining

A

TTF-1 positive

52
Q

Small cell lung cancer paraneoplastic syndromes

A

SIADH
Ectopic ACTH production (Cushing’s)
Eaton-Lambert myasthenic syndrome
Hypercalcaemia
Peripheral neuropathy
PE/DVT risk

53
Q

Where does SCLC metastasise to?

A

BALLS
Brain
Adrenal
Liver
Lung
Skeleton

54
Q

SCLC biomarkers

A

nearly all immunoreactive for keratin, epithelial membrane antigen and thyroid transcription factor-1 (TTF-1)

most also stain positive for markers of neuroendocrine differentiation (eg. chromogranin A)

Respiratory (32 decks)

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