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Lung Cancer Flashcards

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1
Q

What is the first line investigation for suspected lung cancer

A

CXR

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2
Q

List the investigation carried out to diganose lung cancer

A

CXR - first line
CT chest, abdo, pelvis - for staging and checks for node involvement and mets
PET scan - good at identifying mets
Bronchoscopy - can take biopsy at ime this t

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3
Q

How do you tell if a CXR has appropriate inspiration

A

Should show at least the 10th or 11th posterior rib

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4
Q

How much of the chest should the heart take up on CXR

A

Less than 50% of the total diameter of the chest

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5
Q

What is the most common lung cancer

A

Adenocarcinoma

Followed by squamous cell

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6
Q

Which is more common small cell or non-small cell lung cancer

A

Non-small cell

Makes up 85% of lung cancer cases

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7
Q

Which lung cancers are associated with smokers

A

Adenocarcinoma - smoking and asbestos are risk factors
Squamous cell - smoking is main cause
Small cell - almost exclusively smokers

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8
Q

Which lung cancers tend to metastasise early

A

Small cell - poor prognosis as aggressive

Large cell

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9
Q

Which lung cancers tend to metastasise early

A

Small cell - poor prognosis as aggressive

Large cell

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10
Q

Squamous cell cancers tend to develop in which part of the lung

A

Central areas

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11
Q

What is the main treatment for small cell lung cancer

A

Chemotherapy with platinum-based drugs usually forms the mainstay of treatment
Surgery is usually not an option

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12
Q

Surgery is a treatment option in which lung cancer patients

A

Stage I or Stage II disease
Dependent on performance status, prognosis + likelihood of
success.
Can be used alongside chemo

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13
Q

Which type of immunotherapy is used in lung cancer

A

Immune checkpoint inhibitors
When these checkpoints are turned on they signal T cells to not mount an immune
response.
Checkpoint inhibitor immunotherapy works by blocking the binding of checkpoints to their partner proteins, thus preventing the ‘turning off’ of T cells.
This aids the immune system in mounting an immune response against the cancer

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14
Q

Immunotherapy can cause what side effects

A 
Fatigue
Nausea & vomiting
Rash
Diarrhoea 
Shortness of breath

Although typically better tolerated than traditional chemo

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15
Q

Which paraneoplastic syndrome is associated with squamous cell carcinoma of the lung

A

Ectopic parathyroid related peptide production

This acts like parathyroid hormone and leads to hypercalcaemia

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16
Q

What are the symptoms of hypercalcaemia

A

Stones, bones, abdominal moans
and psychic groans

Renal stones, and also diabetes insipidus.
Bone problems e.g. osteoporosis and pathological fractures.
Abdominal moans meaning abdominal pain, constipation,
nausea and vomiting.
Psychic groans referring to depression, anxiety, irritability
and psychosis.

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17
Q

Hypercalcaemia of malignancy can be caused by which cancers

A

Squamous cell lung cancer

Bone mets - common with lung, breast and prostate

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18
Q

How do you treat hypercalcaemia in malignancy

A

If severe or symptomatic, the patient can be admitted to hospital
and treated with IV fluids and IV bisphosphonate therapy.
If mild and asymptomatic the blood tests can just be monitored.

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19
Q

Which paraneoplastic syndromes are associated with small cell lung cancer

A 
Lambert-Eaton Syndrome 
Cushing's Syndrome 
Syndrome of inappropriate ADH secretion 
Cerebellar ataxia 
Limbic encephalitis 
Dermatological
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20
Q

What are the unmodifiable risk factors for lung cancer

A

Age

Genetics - risk increases if 1st degree relative had it

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21
Q

List some modifiable risk factors for lung cancer

A 
Smoking  - mainly small cell and squamous 
Occupational exposure 
Air pollution 
Ionising radiation exposure 
Poor diet
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22
Q

List some of the intrathoracic symptoms of lung cancer

A 
Cough
Dyspnoea
Chest pain
Haemoptysis
Chest infection
Hoarseness
Pleural effusion
Superior Vena Cava Obstruction
Pancoast tumour/syndrome
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23
Q

List the common sites of mets from lung cancer and their symptoms

A

Liver - can cause pain if capsule stretched
Bone - lytic lesions, pain, can cord compression
Adrenal - asymptomatic
Brain - mass symptoms (ICP)

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24
Q

List some of the paraneoplastic syndromes associated with lung cancer

A 
Hypercalcaemia
SIADH secretion
Neurologic manifestations
Haematological manifestations
Hypertrophic osteoarthropathy
Dermatomyositis, polymyositis
Cushing’s syndrom
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25
What surgical treatments are available for lung cancer
Wedge resection Segmentectomy Lobectomy Pneumonectomy Can also do hilar and mediastinal node sampling Palliative procedures such as stenting and debulking
26
What is the prupose of adjuvatn chemo and radiotherapy following lung surgery
``` Chemo = improves survival Radio = prevents local recurrence ```
27
What is the best option for cure in lung cancer
Surgery - treatment of choice if curative | Radiotherapy is the next best
28
How is radiotherapy used palliatively in lung cancer
Used to treat bony mets and cord compression | Palliative radiotherapy is at a lower dose and fewer fractions
29
What is the typical dose for conventional external beam radiotherapy for lung cancer
55 Gray in 20 fractions
30
What prophylactic treatment is used in small cell lung cancer
Prophylactic cranial irradiation due to high risk of brain mets 20% have them at diagnosis, 80% by time of death It halves the incidence
31
List some of the temporary side effects of lung radiotherapy
``` Fatigue Shortness of breath Cough Oesophagitis Skin changes After prophylatoc cranial radio - Headaches, nausea, hair loss ```
32
Side effects from radiation tend to peak when
After the completion of treatment
33
List some of the permanent effects of radiotherapy toxicity following lung treatment
Breathlessness due to fibrosis After Stereotactic ablative body radiotherapy (SABR) - Brachial plexopathy - Myelopathy - Rib fractures After prohylactoc cranial - memory/cognitive impairment Secondary malignanc
34
Which type of lung cancer is usually most chemo responsive
Small cell
35
Are targeted therapies and immunoherapies used for curative or palliative treatment
They have no established role in curative regimes | Some targeted ones can be used as 1st line palliative
36
Targeted therapies are mainly used for which types of lung cancer
Non-small cell | A number of mutations have been found in the molecular pathways which are involved in its development - EGFR, ALK, ROS1
37
Targeted therapies are usually tolerated better than traditional chemotherapies - true or false
True
38
List some of the adverse effects of targeted lung cancer therapy
Rash Diarrhoea Pulmonary toxicity Hepatotoxicity
39
List some of the adverse effects of lung cancer immunotherapy
``` Immunosuppression Fatigue Skin changes Mucositis Diarrhoea Colitis, Hepatotoxicity Pneumonitis Endocrinopathies ```
40
What is the basis of immunotherapy
Based upon premise of immune system playing key role in defence against malignancy Drugs act on the immune system to help it fight cancer cells
41
What happens to the trachea position in lung consolidation
Nothing - it remains central
42
What happens to the trachea position in lung collapse
It shifts towards the site of collapse
43
What happens to the trachea position in pleural effusion
It moves away from the side of effusion
44
What happens to the trachea position in pneumothorax
It moves away from the side of pneumothorax
45
What happens to the trachea position in pulmonary fibrosis
Nothing - it remains central
46
Which conditions can lead to decreased chest expansion
Lung consolidation, collapse, plueral effusion and pneumothorax will all lead to decreased expansion over the affected area In pulmonary fibrosis expansion is decreased symetrically
47
Which conditions can lead to dull percussion
Consolidation Lung collapse Will be stony and dull over an effusion
48
What is percussion like over a pneumothorax
It is resonant
49
What is percussion like over pulmonary fibrosis
It is normal
50
How is air entry affected by lung consolidation
Reduced - bronchial sounds
51
How is air entry affected by lung collapse
It is absent or reduced
52
How is air entry affected by pleural effusion
It will be absent over the fluid | Bronchial sounding above
53
How is air entry affected by pneumothorax
It is reduced
54
How is air entry affected by pulmonary fibrosis
It is normal
55
What are the features of Horner's syndrome
Miosis Enopthalmos - sunken eye Ptosis - droopy eyelid Unilateral loss of sweating
56
What causes Horner's syndrome
Invasion of cervical sympathetic plexus.and shoulder/arm pain-brachial invasion c8-t2 Can be cause by a pancoast lung tumour
57
What causes Horner's syndrome
Invasion of cervical sympathetic plexus.and shoulder/arm pain-brachial invasion c8-t2 Can be cause by a pancoast lung tumour
58
What are the indication for CXR
Unexplained/persistent haemoptysis (urgent) ``` 3 week history of the following unexplained: Cough Chest or shoulder pain Dyspnoea Weight loss Hoarseness Chest signs or finger clubbing Persistent lymphadenopathy (cervical/supraclavicular) Features suggestive of metastases ```
59
List features which suggest lung cancer mets
``` Confusion Weight loss Bone pain Headache Unsteady gait ```
60
Which CXR abnormalities may be caused by an underlying lung cancer
``` Mass lesions Consolidation Collapse Pleural effusion Pulmonary metastases Erosion of ribs ```
61
A normal chest x-ray excludes lung cancer - true or false
FALSE | Should still be referred to resp
62
Which methods can be used to obtain a tissue biopsy/sample for lung cancer diagnosis
Image guided percutaneous biopsy (CT-guided biopsy) Bronchoscopy Mediastinoscopy - sample from mediastinum and hilum Thoracoscopy - keyhole with ports through chest wall
63
What checks are done prior to bronchoscopy
``` Make sure there is informed consent Oxygen saturation on air Hb or platelets Coagulation (note, if LFT abnormal check coag) FEV1 - should be >40% ideally ```
64
Warfarin should be stopped prior to bronchoscopy - true or false
True | Patients should be switched to heparin 1 week before procedure
65
When is sputum cytology used in the diagnosis of lung cancer
Only used in patients with large central lesions where bronchoscopy and other tests are unsafe
66
Which technique is used for the diagnosis of peripheral lung tumours
Percutaneous CT-guided biopsy
66
Which technique is used for the diagnosis of peripheral lung tumours
Percutaneous CT-guided biopsy
67
Pneumothorax is a complication of percutaneous CT-guided biopsy - true or false
True
68
How is lung cancer staged
Based on CT scans, MRI, US and PET Non-small cell lung cancer is staged according to the TNM system Small cell lung cancer is categorised as either limited disease (confined to a single radiation field) OR Extensive disease
69
According to T staging (from TNM) which lung cancers are resectable
T1 and 2 are T3 tumours sometimes can be However, T4 tumours invade vital structures and are non-resectable
70
Describe the different N stages in lung cancer
N1 – ipsilateral hilar tumour spread N2 – ipsilateral mediastinal tumour spread; not resectable N3 – contralateral mediastinal tumour/ supraclavicular tumour spread; not resectable
71
What is the best scan for detecting metastatic bone disease
Bone scan This involves injection of radionuclides Increased uptake at sites of metastases leading to ‘Hot spots’
72
What is the most common cancer in non-smokers
Adenocarcinoma
73
Smoking cessation is still beneficial in patients who already have lung cancer - true or false
True! Continued smoking in lung cancer reduces life expectancy, increases risk of recurrence/metastases, reduces treatment efficacy and exacerbates treatment side-effects
74
Which factors are taken into account when deciding if a patient can go for curative surgery
``` Stage and type of cancer Age - morbidity increases with age Pulmonary function Co-morbidity Performance status ```
75
Patients of which performance status are eligible for surgery
0, 1 and 2
76
Which factors would make a lung cancer patient inoperable
Stage III or stage IV lung cancer Poor respiratory reserve, i.e. poor FEV1 Multiple co-morbidities making them a high risk surgical candidate WHO performance status 3 or 4
77
Which type of chemo is used for NSCLC
Platinum-based combination chemotherapy is recommended for patients with stage IIIb and IV Maximum of 4 cycles in patients with advanced NSCLC
78
Which type of chemo is used for SCLC
A platinum agent and etoposide | Duration of 3-6 cycles of chemotherapy in SCLC
79
Radiotherapy may be curative in some cases of NSCLC - true or false
True | If in stage 1 or 2 and not medically fit for or refusing surgery

Oncology (7 decks)

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