Lung Cancer Flashcards
(102 cards)
1
Q
What is lung cancer?
A
It is defined as the proliferation of malignant epithelial cells in the lungs
2
Q
How common is lung cancer in the UK?
A
It is the third most common cancer
3
Q
What is the mortality rate of lung cancer in the UK?
A
It has the highest cancer mortality rate
4
Q
What are the two main classifications of lung cancer?
A
Small Cell Lung Cancer (SCLC)
Non-Small Cell Lung Cancer (NSCLC)
5
Q
What is SCLC?
A
It is defined as lung cancer that results in abnormal proliferation of small epithelial cells
6
Q
Where are SCLC’s located?
A
They are located centrally in the bronchi
7
Q
Which patient group tends to be affected by SCLC?
A
Older smokers
8
Q
How quickly does SCLC metastasise?
A
It metastasises early during disease progression
9
Q
SCLC is associated with what syndromes? How?
A
Paraneoplastic syndromes
Small cells contain neurosecretory granules, which release neuroendocrine hormones – such as ACTH and ADH
10
Q
What percentage of lung cancer cases are SCLC?
A
15%
11
Q
What is the prognosis of SCLC in comparison to NSCLC?
A
The prognosis is worse for these patients
12
Q
What is NSCLC?
A
It is defined as lung cancer that results in abnormal proliferation of epithelial cells – other than small cells
13
Q
What percentage of lung cancer cases are NSCLC?
A
85%
14
Q
What is the prognosis of NSCLC in comparison to SCLC?
A
The prognosis is better for these patients
15
Q
What are the three subclassifications of NSCLC?
A
Adenocarcinoma
Squamous Cell Carcinoma
Large Cell Carcinoma
16
Q
What is the most common classification of lung cancer?
A
Adenocarcinoma
17
Q
What is adenocarcinoma?
A
It is defined as the abnormal proliferation of glandular cells within the epithelial tissue of the lung
18
Q
Where are adenocarcinomas located?
A
They are located peripherally in the bronchioles
19
Q
Which two patient groups do adenocarcinomas tend to affect?
A
Non-smokers
Asian females
20
Q
How quickly do adenocarcinomas metastasise?
A
It metastases early during disease progression
21
Q
What is squamous cell carcinoma?
A
It is defined as the abnormal proliferation of squamous cells within the epithelial tissue of the lung
22
Q
Where are squamous cell carcinomas located?
A
They are located centrally in the bronchi
23
Q
Which patient group tend to be affected by squamous cell carcinoma?
A
Smokers
24
Q
How quickly does squamous cell carcinoma metastasise?
A
It metastases late during disease progression
25
What is a characteristic feature of squamous cell carcinoma on CXR?
Cavitating lesions
26
What is large cell carcinoma?
It is defined as an undifferentiated malignant tumour that lacks the characteristic cytologic features of squamous cell carcinoma, adenocarcinoma and small cell carcinoma
27
Where are large cell carcinomas located?
They are located both peripherally in the bronchioles and centrally in the bronchi
28
Which patient group tends to be affected by large cell carcinomas?
Smokers
29
How quickly does large cell carcinoma metastasise?
It metastasises early in disease progression
30
What are the five risk factors of lung cancer?
Smoker
Male Gender
Family History
Air Pollution
Radon Gas Exposure
31
What is the main risk factor of lung cancer?
Smoking
32
What genetic mutation is associated with lung cancer? What induces this mutation?
KRAS
Smoking
33
What are the nine clinical features associated with lung cancer?
Chronic Cough > 3 Weeks
Haemoptysis
Dyspnoea
Pleuritic Chest Pain
Recurrent Pneumonia
Weight Loss
Fixed Monophonic Wheeze
Supraclavicular Lymphadenopathy
Finger Clubbing
34
What weight loss is deemed as significant?
> 5% in 6 months
35
Which clinical feature is specifically associated with adenocarcinomas?
Gynaecomastia
36
What are the four investigations used to diagnose lung cancer?
Blood Tests
Chest X-Ray (CXR)
Contrast CT Scan
Bronchoscopy
37
What two blood tests are conducted to diagnose lung cancer? Why?
FBC = Increased Plts, Increased Calcium Levels Indicate SSC, Increased ADH Levels Indicate SCLC
LFTs = Increased ALP & GGT Levels Indicate Hepatic/Bone Metastases
38
What is the first line investigation used to diagnose lung cancer?
CXR
39
What are the four signs of lung cancer on CXR?
Hilar Enlargement
Peripheral Opacities
Unilateral Pleural Effusion
Lung Collapse
40
In what two ways are contrast CT scans used to investigate lung cancer?
They are used to confirm the findings established on CXR
They are used to determine the staging of lung cancer
41
What is bronchoscopy?
It involves the insertion of a small camera into the bronchi
This enable direct visualisation of the lung cancer and a biopsy of the tumour to be obtained
42
What can bronchoscopy be conducted with? What is this? Why is it advantageous?
Endobronchial ultrasound (EBUS)
It involves the attachment of ultrasound equipment to the bronchoscope
This enables detailed assessment of the cancer and an ultrasound guided biopsy
43
How do we stage lung cancer?
It is initially staged with the TMM classification system and then converted to the I-IV staging system
44
What is stage I lung cancer?
It is defined as a small tumor (<4cm) localised to one lung
45
What is stage II lung cancer?
It is defined as a large tumour (>4cm)
There may be metastasis to nearby lymph nodes within the same lung
46
What is stage III lung cancer?
It is defined as lung cancer that has metastasised to contralateral lymph nodes or nearby respiratory structures (eg. trachea)
47
What is stage IV lung cancer?
It is defined as lung cancer that has metastasised to extra pulmonary structures
48
What are the five management options for NSCLC?
Surgical Management
Stereotactic Ablative Radiotherapy (SABR)
Chemotherapy
Targeted Therapies
Immunotherapy
49
When is surgery recommended to manage NSCLC?
It is the first line option in individuals with stage I – III NSCLC
50
What three surgeries can be used to treat NSCLC?
Lobectomy
Pneumonectomy
Wedge Resection
51
What is lobectomy?
It involves the surgical removal of the lung lobe containing the tumour
52
When is lobectomy recommended?
It is the first line surgical management option in individuals with intact lung function
53
What is pneumonectomy?
It involves the surgical removal of the whole lung containing the tumour
54
When is pneumonectomy recommended?
It is the second line surgical management option in individuals with intact lung function
55
What is wedge resection?
It involves the surgical removal of a wedge shaped segment of lung that contains the tumour
56
When is wedge resection recommended?
It is the first line surgical management option in individuals with reduced lung function – such as the elderly or those with underlying respiratory conditions
57
What are the six contraindications of the surgical management of non-small cell lung cancer?
Stage IIIb/IV Cancer
FEV1 < 1.5L
Malignant Pleural Effusion
Tumour Near Hilum
Vocal Cord Paralysis
Superior Vena Cava Obstruction
58
When is SABR recommended to manage NSCLC?
It is the second line option in individuals with stage I – III non-small cell lung cancer, who are unsuitable for surgery
59
What is SABR?
In comparison to conventional radiotherapy, SABR involves directing a more concentrated, focused beam of radiation at the tumour
60
What are the two advantages of SABR?
It reduces the number of radiotherapy sessions needed
It minimises damage to surrounding tissue
61
How is chemotherapy used to manage lung cancer?
It can be administered neoadjuvantly or adjuvantly, in combination with surgical or radiotherapy management techniques to improve the likelihood of success
62
When are targeted therapies recommended to manage NSCLC?
It can be used in individuals with stage IV non-small lung cancer
63
What are targeted therapies?
These drugs target mutations which drive the pathogenesis of lung cancer
64
What two targeted therapies are used to target EGFR mutations in lung cancer?
Gefitinib
Osimertinib
65
What targeted therapy is used to target ALK mutations in lung cancer?
Alectinib
66
What targeted therapy is used to target ROS1 mutations in lung cancer?
Crizotinib
67
When is immunotherapy recommended to manage NSCLC?
It can be used in individuals with stage IV non-small cell lung cancer
68
What is immunotherapy?
These drugs target immune checkpoints, which prevent the patient’s immune cells from targeting tumour cells
69
What are the three management options for SCLC?
Chemotherapy
Radiotherapy
Prophylactic Cranial Irradiation
70
What is prophylactic cranial irradiation? Why is recommenced in SCLC?
It involves the use of radiotherapy to prevent brain metastases
There is a high risk of brain metastases with small cell lung cancer
71
Why is surgery not usually recommended in SCLC?
It is usually metastatic by the time of presentation
72
What are the four common locations of lung cancer metastasis?
Brain
Bones
Adrenal glands
Liver
73
What are the eleven extrapulmonary complications of lung cancer?
Recurrent Laryngeal Nerve Palsy
Phrenic Nerve Palsy
Superior Vena Cava Obstruction
Horner’s Syndrome
Syndrome of Inappropriate ADH Secretion (SIADH)
Cushing’s Syndrome
Limbic Encephalitis
Lambert Eaton Myasthenic Syndrome
Hypercalcaemia
Hyperthyroidism
Hypertrophic Pulmonary Osteoarthropathy (HPOA)
74
How can lung cancer cause recurrent laryngeal nerve palsy?
When the tumour compresses the recurrent laryngeal nerve as it passes through the mediastinum
75
What is the additional clinical feature associated with recurrent laryngeal nerve palsy?
Hoarseness
76
How can lung cancer cause phrenic nerve palsy?
When the tumour compresses the phrenic nerve as it passes anterior to the lung root
77
What are the two additional clinical features associated with phrenic nerve palsy?
Diaphragm weakness
Dyspnoea
78
How can lung cancer cause superior vena cava obstruction?
When the tumour compresses the superior vena cava, which prevents venous drainage from the head and neck
79
What are the three additional clinical features associated with superior vena cava obstruction?
Facial swelling
Breathing difficulties
Vein distention in the neck and chest
80
What sign indicates that superior vena cava obstruction has become a medical emergency?
Pemberton’s sign
81
What is Pemberton's sign?
This is when the raising of hands over the head causes facial congestion and cyanosis
82
How can lung cancer cause Horner's syndrome?
When the tumour is present in the pulmonary apex, therefore compressing the sympathetic ganglion
83
What specific tumour is associated with Horner's syndrome?
Pancoast
84
What are the three additional clinical features of Horner's syndrome?
Partial ptosis
Anhidrosis
Miosis
85
Which classification of lung cancer is associated with SIADH? How?
SCLC
It stimulates ectopic ADH secretion due to neuroendocrine hormone release
86
What is the additional clinical feature associated with SIADH?
Hyponatraemia
87
Which classification of lung cancer is associated with Cushing's syndrome? How?
SCLC
It stimulates ectopic ACTH secretion due to neuroendocrine hormone release
88
What are the additional five clinical features associated with Cushing's syndrome?
Moon face
Central obesity
Abdominal striae
Buffalo hip
Skin changes
89
Which classification of lung cancer is associated with limbic encephalitis? How?
SCLC
It causes the immune system to produce anti-Hu antibodies against the limbic tissues of the brain – resulting in inflammation of this area
90
What are the four additional clinical features associated with limbic encephalitis?
Short term memory impairment
Hallucinations
Confusion
Seizures
91
What is Lambert Eaton myasthenia syndrome?
It is defined as an autoimmune condition, in which the immune system produces antibodies against small cell lung cancer cells
These antibodies specifically target the voltage gated calcium channels of these cells, located on the presynaptic terminals in motor neurones
92
When can Lambert-Eaton syndrome present?
It may precede the cancer diagnosis by a number of years
93
What is the characteristic clinical feature of Lambert Eaton myasthenic syndrome?
Muscle fatiguability
It results in the characteristic features of myasthenia gravis, in which muscles become progressively weaker during periods of activity and slowly improve after periods of rest
This usually means that clinical features are minimal in the morning and worse at the end of the day
94
What are the six clinical features of Lambert Eaton myasthenic syndrome?
Proximal Muscle Weakness
Diplopia
Ptosis
Facial Muscle Weakness
Dysphagia
Slurred Speech
95
Which classification of lung cancer is associated with hypercalcaemia? How?
Squamous cell
It stimulates ectopic parathyroid hormone (PTH-rp) secretion due to neuroendocrine hormone release
96
How are PTH levels affected by hypercalcaemia secondary to malignancy?
Decreased
97
Which classification of lung cancer is associated with hyperthyroidism? How?
Squamous cell
It stimulates ectopic TSH hormone secretion due to neuroendocrine hormone release
98
Which two classifications of lung cancer is associated with HPOA? How?
Squamous cell
Adenocarcinoma
They cause fibrovascular proliferation of the organs, lungs, bones and joints
99
What are the three additional clinical features associated with HPOA?
Periostitis
Finger clubbing
Large joint arthropathy
100
What is mesothelioma?
It is defined as a lung malignancy affecting the mesothelial cells of the pleura
101
What is the most common risk factor of mesothelioma?
Asbestos exposure
102
What is the management of mesothelioma?
Palliative care
