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Flashcards in deck_1502664 Deck (49):
1

Describe incidence of lung cancer in men

• Commonest male cancer• Mortality around 100 per 100,000• Incidence falling slowly due to reduction in smoking

2

Describe incidence of lung cancer in females

• Exceeds breast cancer as a cause of death in women• Mortality rate around 40 per 100,000 • Incidence rising

3

How does incidence of lung cancer vary according to socioeconomic group?

• Wide variation• Rate three times higher in lowest compared with highest

4

What is the main risk factor for lung cancer?

• Smoking • 90% lung cancers in men 80% lung cancer in women

5

Give four aeitological factors which influence lung cancer

• Asbestos exposure• Radon exposure• Genetic factors • Dietary factors

6

What are the main signs and symptoms of lung cancer?

• Relatively non-specific

7

What are the main symptoms of a primary lung cancer tumour?

• Cough• Dyspnoea• Wheezing • Haemoptysis • Chest pain • Post-obstructive pneumonia • Weight loss • Lethargy/malaise

8

What are the main four symptoms of regional mestastases?

• Superior vena cava obstruction • Hoarseness (left recurrent laryngeal nerve palsy)• Dypnoea (phrenic nerve palsy)• Dysphagia

9

What are the main two symptoms of distant metastases

• Bone pain/fractures• CNS symptoms (headache, double vision, confusion)

10

What is paraneoplastic syndrome?

• Presence of a symptom or a disease due to the presence of cancer in the body, but not due to the local presence of cancer cells

11

What are the symptoms of paraneoplastic syndrome mediated by?

• Humoral factors (hormones and cytokines) secreted by tumour cells, or the immune response against tumour cells

12

What are the four main categories of paraneoplastic syndrome?

• Endocrine• Neurological• Skeletal• Haematological

13

Give two diseases which occur as an endocrine result of paraneoplastic syndrome

• Hypercalcaemia• Cushing's syndrome

14

Give two disease which occur as a neurological result of paraneoplastic syndrome

• Encephalopathy• Peripheral neuropathy

15

Give a skeletal disease which occurs as a result of paraneoplastic syndrome

• Finger clubbing

16

Give three diseases which occur as a a haemotolofical result of paraneoplastic syndrome

• Anaemia• Throbocytopenia • Disseminated Intravascular Coagulation

17

What are two other diseases which can come about as a result of paraneoplastic syndrome?

• Nephrotic syndrome• Anorexia or Cachexia

18

What occurs when lung cancer is first suspected in a patient in terms of investigations

○ Plain chest x-ray

19

What are three scans used for diagnosis and staging

• CT scan • PET scan• Isotope bone scan

20

What are the two staging systems for lung cancer?

• NumberTMN

21

What is a stage 1 cancer?

• Small cancer, localised to one area of the lung

22

What is a stage 2 and 3 cancer?

• Larger cancer, may have grown into surrounding tissues

23

What is stage 4 cancer?

Cancer has metastasised

24

What is the TMN staging system (Outline T, M and N) ?

• T - Size and position of tumour • N - Lymph node involvement• M - Metastases

25

What are the stages of T?

• T1 - T4

26

What is T1 in lung cancer

• T1 - cancer contained within the lung (

27

What is T2 in lung cancer

• Cancer has grown (3-7cm diameter)• Into main bronchus• Into the visceral pleura• Made parts of the lung collapse

28

What is T3 in lung cancer?

• Cancer has grown (>7cm diameter)• Invading chest wall, mediastinal pleura, diaphragm, pericardium• Complete lung collapse>1 cancer nodule in the same lob of lung

29

What is T4 in lung cancer

• Cancer invading mediastinum, heart, major blood vessel, trachea, carina, oesophagus, spine, recurrent laryngeal nerve • Cancer nodules in more than one lobe of the same lung

30

What is N0?

• No cancer in lymph nodes

31

What is N1?

• Cancer in lymph nodes nearest the affected lung

32

What is N2?

• Cancer in lymph node in mediastinum on the same side

33

What is N3?

Cancer in lymph nodes on the opposite side of the mediastinum/supraclavicular lymph nodes

34

What is M0?

• No evidence of distal cancer spread

35

What is M1?

• Lung cancer cells in distant parts of the body such as pleura, opposite lung, liver or bones

36

What are three ways in which tissue is biopsied in lung cancer?

• Bronchoscopy• Needle biopsy of the lung• Surgical biopsy

37

Why is biopsy important?

• To determine cell type, which can influence prognosis and treatment

38

What are the two main types of lung cancer?

• Non-small cell lung cancer• Small cell lung cancer

39

What is a feature of non-small cell carcinoma on presentation?

• More than 2/3rds have inoperable disease at presentation

40

What is a feature of small cell carcinoma on presentation?

• 3/4 have metastatic disease at presentation

41

What does prognosis of a lung cancer depend on?

• Cell type (small cell worse than non-small cell)• Stage of disease• Performance status • Biochemical markers• Co-morbidities ○ Cardiac or chronic respiratory disease

42

Give six different treatments for lung cancer

• Surgery• Radiotherapy• Chemotherapy• Combination therapy• Biological targeted therapies• Palliative care

43

When is surgery used for lung cancer?

• Mostly non-small cell

44

What is the difference between radical and palliative radiotherapy?

• Radical is curative• Palliative is symptom control

45

When is chemotherapy most effective, and when is it less so?

• Small cell - Potentially curative• Non small cell - Modest survival increase, symptom control

46

What is combination therapy?

• Combination of chemo and radiotherapy

47

What is a biological targeted therapy?

• EGFR and VEGF inhibition to prevent tymour growth

48

How is non-small cell lung cancer treated?

• Palliative radiotherapy for local symptoms • Chemotherapy -50 - 60% response rate• Combination therapy - Important in locally advanced diseaseTargeted agents - EGFR and VEGF

49

How is small cell cancer managed?

• Rarely operable• Combination therapy - Responds well, adding 1 year• Palliative Chemotherapy for symptoms• Death from cerebral metastases common