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Y3M - Respiratory > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

What is the second most common cancer in the UK?

A

Lung cancer (carcinoma of the bronchus)

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2
Q

Risk factors of lung cancer.

A

Cigarette smoking

Passive smoking

Asbestos

Chromium

Arsenic

iron oxides

Radiation (radon)

Pre-existing lung diesease

Pulmonary fibrosis

HIV

Genetics

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3
Q

How can lung cancer be classified?

A

By histology

By molecular types

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4
Q

Histological classifications of lung cancer.

A

Small cell lung cancer (20%)

Non-small cell lung cancer (~80%)

Carcinoid tumours (~1%)

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5
Q

What subclasses of non-small cell lung cancer exist?

A

Adenocarcinoma (27-30%)

Squamous cell carcinoma (35%)

Large cell carcinoma (10-15%)

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6
Q

What do small cell lung cancers arise from?

A

Endocrine (Kulchitsky cells)

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7
Q

Molecular types of lung cancer.

A

EGFR (epidermal growth factor receptor) - commonly encountered in non-smokers, females and asian origin.

ALK (anaplastic lymphoma kinase) - commonly encountered in non-smokers, ex-smokers, young patients and male.

PDL1 - found in e.g. squamous cell carcinoma.

The molecular classifications guide treatment of the cancer.

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8
Q

Local symptoms of lung cancer.

A

Cough (80%)

Haemoptysis (70%) - fresh or old blood

Dyspnoea (60%)

Chest pain (40%)

Recurrent or slowly resolving pneumonias

Monophonic wheeze

Hoarse voice

Nerve compression

SVCO

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9
Q

Systemic symptoms of lung cancer.

A

Lethargy

Anorexia

Weight loss

Paraneoplastic syndromes

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10
Q

Signs of lung cancer.

A

Cachexia

Anaemia

Clubbing

Hypertrophic pulmonary osteoarthropathy causing wrist pain.

Supraclavicular or axillary lymphadenopathy

Consolidation, collapse or pleural effusion

Bone tenderness

Heaptomegaly

Confusion

Fits

Focal CNS signs

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11
Q

Complications of lung cancer.

A

RLN palsy

Phrenic nerve palsy

SVCO

Honrer’s syndrome

Rib erosion

Pericarditis

Atrial fibrillation

Metastatic

Non-metastatic neurological

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12
Q

Investigations of lung cancer.

A

CXR -> CT -> PET CT -> Biopsy -> Histology

Cytology - sputum and pleural fluid

Fine needle aspiration

Biopsy

CT

Bronchoscopy

PET/CT EBSU scan

Radionuclide bone scan

MRI

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13
Q

CXR findings in lung cancer.

A

Peripheral nodules

Hilar enlargement

Consolidation

Lung collapse

Pleural effusion

Bony secondaries

Reticular shadowing

Or completely normal…

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14
Q

What is the gold standard of lung cancer diagnosis?

A

Standard biopsy

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15
Q

Why is a CT scan done in lung cancer?

A

To stage the cancer or guide bronchoscopy.

The bronchoscopy can give histology and assess operability.

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16
Q

What is EBUS?

A

Endobronchial ultrasound for assessment and biopsy.

17
Q

What can be done to assess staging in lung cancer?

A

PET

PET/CT EBUS

MRI

18
Q

Why might a radionuclide bone scan be done in lung cancer?

A

If metastases are suspected

19
Q

When might an MRI be done in lung cancer?

A

Usually only done in Pancoast tumours to assess involvement of nerves and arteries.

20
Q

Other lung tumours

A

Bronchial adenoma

Hamartoma

Malignant mesothelioma

21
Q

What is the staging system of lung cancer?

A

TNM

22
Q

N-staging of lung cancer.

A

N0 - no involvement

N1 - Peribronchial and/or ipsilateral hilum

N2 - Ipsilateral mediastinum or subcarinal involvement

N3 - Contralateral medistinum or hilum, scalene or supraclavicular.

23
Q

What does pleural effusion mean in terms of staging?

A

Pleural effusion counts as metastatic disease

24
Q

Paraneoplastic syndromes of lung cancer.

A

Lambert-Eaton syndrome - SmCC

Cushing’s (ACTH) - SmCC

SIADH - SmCC

Hypercalcaemia (PTHrP) - SqCC and adenocarcinoma

Hypertrophic pulmonary osteoarthropathy - adenocarcinoma

Clubbing - all lung cancer

Peripheral sensory neuropathy - SmCC

Stiff person syndrome - SmCC

Dermatomyosistis/polymyositis - all

25
Q

What is Lambert Eaton syndrome?

A

Similar to Myasthenia gravis but antibodies are to voltage-gated Ca2+ channels on pre-synaptic membrane instead.

There gait difficulty, autonomic involvement

Hyporeflexia and weakness

Lambert-Eaton is similar to MG except amplitude increases greatly post-exercise.

26
Q

Why does finger clubbing happen in lung cancer?

A

The mechanism is unclear.

Platelet theory;

Megakaryocytes are normally fragmented into platelets in the lungs. If the lungs are not working correctly the megakaryocytes might not be cleaved and traeol to periphery and become lodged in capillaries of fingers and toes.

This releases platelet-derived growth factor and vEGF which lead to tissue growth, vasuclar permeability and recruitment of inflammatory cells.

This does not explain all clubbing however and is just a theory.

27
Q

Why is PET scan superior to CT in staging?

A

It detects small metastases that are not seen on CT staging.

28
Q

Diagnostic tests of lung cancer (according to workbook)

A

Bloods - FBC, U&Es, Calcium, LFTs, INR

CXR

Staging CT - spiral CT thorax and upper Abdo

29
Q

Treatment of lung cancer.

A

Curative surgery for stages I and II assuming they are fit for surgery

Surgery and adjuvant chemotherapy clinical trial for stage IIa assuming their fit for it.

Chemo - III/IV disease and PS 0-2 (performance status)

Radiotherapy - curative (CHART - continuous hyperfractionated accelerated radiotherapy) in people not fit for surgery or palliative care.

Palliative care

30
Q

Prognosis of Non-small cell lung cancer.

A

10-13% 5 year survival

Stage 1 with resection - 60-70%

Stage II with resection - 30-55%

Stage III - 7%

Stage IV - 1%

31
Q

Treatment of small cell lung cancer.

A

Rapid growth rate makes surgery difficult.

Chemotherapy and palliative radiotherapy.

Left untreated the median survival is 4-12 weeks.

Combination chemotherapy the median survival is 6-15 months.

32
Q

What is mesothelioma?

A

A malignant tumour arising from the parietal or visceral mesothelial lining of the lung.

It occurs in the pleura.

33
Q

What is mesothelioma associated with?

A

Asbestos

34
Q

Latent period between exposure and development of mesothelioma.

A

Can be up to 45 years.

35
Q

Clinical features of mesothelioma.

A

Chest pain

SOB

Weight loss

Finger clubbing

Recurrent pleural effusion

Lymphadenopathy

Hepatomegaly

Bonepain

Abdo pain

36
Q

Investigations of mesothelioma.

A

CXR/CT

Pleural thickening and effusion.

Bloody pleural fluid.

Biopsy/thoracoscopy

37
Q

Diagnosis of mesothelioma.

A

Made by history and histology.

It is however commonly diagnosed post-mortem

38
Q

Management of mesothelioma.

A

Pemetrexed and cisplatin chemotherapy.

39
Q
A

Y3M - Respiratory (21 decks)

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