Lung Cancer Flashcards by Eilidh Middleton

What is the most important aetiological factor in lung cancer

Smoking

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There are different types of primary lung cancer and they are divided into 2 main groups.

Name these two main groups

small cell lung cancer (SCLC)

non small cell lung cancer (NSCLC)

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There are different types of primary lung cancer and they are divided into 2 main groups: non-small cell lung cancer and small cell lung cancer.

Which is most common?

Non small cell lung cancer

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Small cell lung cancer (SCLC) are most commonly caused by?

Smoking

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Small Cell Lung Cancer – less common but worse prognosis. Why is this?

Tend to spread quite early on.

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Small cell lung cancers are also classed as neuroendocrine tumours.

What are Neuroendocrine tumours

Rare tumours that develop in cells of the neuroendocrine system.

In small cell lung cancer, the tumour starts in the neuroendocrine cells of the lung.

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Non small cell lung cancer account for 80% of lung cancer cases.

What are the three main types?

Adenocarcinoma

Squamous cell carcinoma

Large cell carcinoma

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There are three main types of non small cell lung cancer: adenocarcinoma, squamous cell carcinoma and large cell carcinoma.

Which is the most common type of non small cell lung cancer?

adenocarcinoma

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Adenocarcinoma is a type of non small cell lung cancer (NSCLC).

It tends to be located where in the lungs?

Tend to occur in lung peripheries

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Adenocarcinoma is a type of non small cell lung cancer (NSCLC).

What cells are affected?

Starts in the mucus-secreting gland cells that line the airways

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Squamous cell lung cancer is a type of ___

a) small cell lung cancer
b) non-small cell lung cancer

b) non-small cell lung cancer

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Adenocarcinoma lung cancer is a type of ___

a) small cell lung cancer
b) non-small cell lung cancer

b) non-small cell lung cancer

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Large cell lung cancer is a type of ___

a) small cell lung cancer
b) non-small cell lung cancer

b) non-small cell lung cancer

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Adenocarcinoma is the most common histological type of lung cancer.

What is the second?

Squamous cell lung cancer

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Large cell lung cancer tend to metastasis ____

a) early
b) late

a) early

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Small cell lung cancer has a ____ prognosis

a) good
b) poor

b) poor

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What is the most common type of lung cancer in non-smoker

Adenocarcinoma

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Mesothelioma is a lung malignancy affecting the mesothelial cells of the pleura.

What is it strongly linked to

Asbestos inhalation

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Small cell lung cancer occurs almost exclusively in which patient group

In smokers

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Name some of the risk factors for lung cancer

Smoking

Other environmental agents e.g. asbestos, silica, welding fumes, coal

HIV

Organ transplantation

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In the majority of lung cancer cases patients are asymptomatic.

If there are symptoms, what are the classic symptoms?

Chronic cough

Malaise

Haemoptysis

Cancer symptoms e.g. Weight loss, night sweats, fevers, recurrent infections

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Hoarseness is a potential symptom of lung cancer.

How does this occur?

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Occurs in Pancoast tumours which pressing on the recurrent laryngeal nerve

What are the two key examination findings of lung cancer that automatically indicate an urgent referral

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Finger clubbing

Lymphadenopathy – often supraclavicular nodes

Squamous cell NSCLC typically occurring in the ____ parts of the lungs

a) Central
b) Peripheral

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a) Central

What are the 3 signs of pleural effusion on respiratory examination

Dull (‘stony dull') percussion Reduced vocal fremitus Reduced breath sounds

What is the cancer that is associated with Horners syndrome

Pancoast tumour

Horner’s syndrome is a triad of symptoms. Name the symptoms

Partial ptosis Anhidrosis Miosis

Define Paraneoplastic syndromes

Refer to remote effects of tumours - usually due to hormones produced by the tumor or antibodies produced by the immune system. They can affect the function of other bodily tissues and organs and cause symptoms at sites distant from the tumor

Name some of the paraneoplastic syndrome signs that can be caused by small cell lung cancer

Cushing’s syndrome Lambert-Eaton syndrome

Name some of the paraneoplastic syndrome signs that can be caused by squamous cell lung cancer

Hyperparathyroidism Hyperthyroidism due to ectopic TSH

Name some of the paraneoplastic syndrome signs that can be caused by Adenocarcinoma lung cancer

Gynaecomastia

Name some of the Extrapulmonary manifestations of lung cancer

Recurrent laryngeal nerve palsy Phrenic nerve palsy Superior vena cava obstruction Horner’s syndrome Syndrome of inappropriate ADH (SIADH) Cushing’s syndrome Hypercalcaemia

Recurrent laryngeal nerve palsy is a potential extrapulmonary manifestation of lung cancer. Describe how lung cancer causes this?

The cancer pressing on or affecting the recurrent laryngeal nerve as it passes through the mediastinum. Presents with a hoarse voice

Phrenic nerve palsy is a potential extrapulmonary manifestation of lung cancer. Describe how lung cancer causes this?

Caused by nerve compression causes diaphragm weakness Presents as shortness of breath

Superior vena cava obstruction is a potential extrapulmonary manifestation of lung cancer. Describe how lung cancer causes this?

Caused by direct compression of the tumour on the superior vena cava Presents with facial swelling, difficulty breathing and distended veins in the neck and upper chest. “Pemberton’s sign” is where raising the hands over the head causes facial congestion and cyanosis

Superior vena cava obstruction is a potential extrapulmonary manifestation of lung cancer. What are the symptoms of this?

Presents with facial swelling, difficulty breathing and distended veins in the neck and upper chest.

What are the 4 common sites for lung cancer metastasis

Brain Breast Adrenals Bone

Refer people using a suspected cancer pathway referral for lung cancer. How long does a patient have to wait for an appointment

Appointment within 2 weeks

What is the gold standard investigation for lung cancer

Chest X-Ray

What are the 4 key findings on chest x-ray for lung cancer *

Hilar enlargement “Peripheral opacity” – a visible lesion in the lung field Pleural effusion – usually unilateral in cancer Collapse

Biopsy is required for histology of the lung cancer. What two ways are we able to acquire biopsy samples

Either taken by bronchoscopy or percutaneous biopsy (through the skin)

Imaging is important aspect of investigating lung cancer. Name the 3 imaging modalities that are important in investigating lung cancer

Chest X-Ray Staging CT (chest, abdomen and pelvis) Bronchoscopy (endoscopy)

Consider an urgent chest X-ray (to be performed within 2 weeks) to assess for lung cancer in people aged 40 years and over with any of the following. Name the 5 following things

1. Persistent or recurrent chest infection 2. Finger clubbing 3. Supraclavicular lymphadenopathy or persistent cervical lymphadenopathy. 4. Chest signs consistent with lung cancer 5. Thrombocytosis (high platelet count)

What is the staging tool used in lung cancer

TNM staging

The options for managing lung cancer include: chemotherapy, radiotherapy, surgery, palliative What options are used in managing small cell lung cancer

chemotherapy, radiotherapy, palliative Surgery is not useful as the cancer has poor prognosis – usually metastatic disease by time of diagnosis

What is the first line management option for non small cell lung cancer

Surgery

What are the management options for non small cell lung cancer

Chemo, radio, palliative and surgery are all options 1^st line management is surgery Consider adjuvant chemotherapy and radiotherapy to improve outcomes in certain patients or as part of palliative treatment to improve quality of life Radiotherapy may be curative alone if caught early enough

What are the management options for small cell lung cancer

Poor prognosis – usually metastatic disease by time of diagnosis Receive combination of chemotherapy and radiotherapy Palliative in a lot of cases

Several options for surgical removal of a lung cancer. First line surgical option for lung cancer

Lobectomy (removing the lung lobe containing the tumour)

Several options for surgical removal of a lung cancer. Name the 3 surgical options

Lobectomy (removing the lung lobe containing the tumour) Segmentectomy or wedge resection (taking a segment or wedge of lung to remove the tumour) Pneumonectomy (removal of entire lung)

What is Lobectomy

Surgical removal of the lung lobe containing the tumour

What is Segmentectomy or wedge resection

Surgical option taking a segment or wedge of lung to remove the tumour

What is Pneumonectomy

Surgical removal of entire lung

Name three palliative treatment options for lung cancer

Chemotherapy Radiotherapy Endobronchial treatment with stents or debulking can be used to relieve bronchial obstruction caused by lung cancer

Lung Cancer Flashcards

(54 cards)