Lung Cancer - causes and treatment Flashcards

1
Q

Pathological Diagnosis of Lung Cancer

A

Histopathology uses the clinical method
Distribution of tumour, gross appearances - number/shape/size
Growth pattern at margin of tumour
Histological type, prognostic and predictive features
All requires a multidisciplinary approach

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

Small Cell Carcinoma

A

Widespread bulky disease
Small, dark, delicate cells with little cytoplasm
‘Salt and pepper’ chromatin in the nuclei
Azzopardi effect

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

Squamous Cell Carninoma

A

Central origin often

Cigarette smoke provokes squamous metaplasia, then dysplasia of bronchial epithelium

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

Patterns of Spread of Lung Cancer

A

Local and direct spread - adjacent ling, intrapulmonary metastasis; pleura and pleural cavity
Lymphatic - lymphatics within lung; lymph nodes (hilar and mediastinal)
Systemic spread - liver, bone, brain, adrenal

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

When might palliative care have a role in lung cancer management

A

In terminal phase
After active oncological treatment or as only possible treatment
During treatment
Peri-diagnosis

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

Increasing palliative care need

A
Psychological distress
Losing weight
Cough worsening
Worsening pain (analgesia, radiotherapy)
Exploring wishes now fully acknowledging disease not curable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Epidemiology

A

478000 new cases in UK each year
Third most common cancer
35000 die each year
20% of all new cancers
More deaths than breast and colo-rectal, bladder and uterine combined
Leading cause of cancer death
Lung cancer is now the leading cause of cancer death in women
Four people die from lung cancer in the UK every hour
Despite label smokers disease 1:8 have never smoked

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Causes of Lung Cancer

A

70% are caused by smoking
Deaths in men have reduced by more than a quarter
Lung cancer deaths in women are increasing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Symptoms of Lung Cancer

A

Usualy in a smoker of more than 20 years

  • respiratory (cough, haemoptysis, dyspnoea, wheeze, chest pain, hoarseness)
  • metastatic (from spread to distant sites); (weight loss, anorexia, nausea, malaise, fatigue)
  • paraneoplastic/systemic (hyponatraemia - small cell carcinoma; hypercalcaemia - squamous cell carcinoma; gynaecomastia; pruritis; cerebellar degeneration; peripheral neuropathy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Common signs on examination

A

Clubbing
Supraclavicular, cervical lymphadenopathy
Stridor due to large airway disease or vocal cord palsy
Focal chest signs of lung collapse, fixed wheeze
Pleural effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Clinical features of sub-types

A

Non small cell (NSCLC):
Squamous- central; invade locally; frequent cavitation; hypercalcaemia common (20%).
Adenocarcinoma- peripheral lung; more common in non-smokers Most common (40%).
Large cell (5%).
Undifferentiated (18%).
Small cell: central; early lymphatic spread; paraneoplastic syndromes (13%)

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

Investigations

A

CT
Bronchoscopy
Endobronchial Ultrasound Needle aspiration
Other biopsy procedure e.g. percutaneeous CT thorax, peripheral lymph node/liver
PET scanning

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

TNM Staging in Lung Cancer

A

Staging is one of the important factors in determining treatment and prognosis in lung cancer (general fitness and patient wishes being the others)
It takes into account tumour size, involvement of local structures, lymph and blood metastases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Role of surgery in NSCLC

A

Consider surgery for all patients with stage 1 and 2 disease
Usually involves lobectomy
In practice around 20% in UK undergo potentially curative resection for lung cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Other radical treatment for NSCLC

A

Radical radiotherapy (good symptom relief, but not expected to cure)
+/- chemotherapy (improve quality of life, modest improvement in survival, may be used in conjunction with radiotherapy)
Usually reserved for those with stage 1 or 2 disease who are unfit for surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Small cell lung cancer treatment

A

Chemotherapy is primary treatment and more effective than in NSCLC
Excellent for symptom control, can induce remission
Prolongs survival by months
Some patients (5%) with limited disease become long term survivors

17
Q

Outcomes

A

Only 15% 5 year survival
Slow improvement
Worse than N America and Europe
Outcomes vary within the Uk