Lung Cancer Flashcards
(44 cards)
How common is lung cancer?
Third most common cancer in the UK behind breast and prostate
What is the biggest cause of lung cancer?
Cigarette smoking is the biggest cause and around 80% of lung cancers are thought to be preventable.
What are the two types of lung cancers?
Non-small cell lung cancer
(80%)
Small cell lung cancer (20%)
What are the four types of non-small cell lung cancers?
Adenocarcinoma (around 40%)
Squamous cell carcinoma (around 20%)
Large-cell carcinoma (around 10%)
Other types (around 10%)
What do small cell lung cancer (SCLC) cells contain?
Neurosecretory granules that can release neuroendocrine hormones.
This makes SCLC responsible for multiple paraneoplastic syndromes.
Signs
Cachexia
Finger Clubbing
Hypertrophic pulmonary osteoarthropathy
Anaemia
Horner’s syndrome (if the tumour is apical)
Enlargement of supraclavicular and axillary lymph nodes
Signs on examination
Consolidation (pneumonia)
Collapse (absent breath sounds, ipsilateral tracheal deviation)
Pleural effusion (Stony dull percussion, decreased vocal resonance and breath sounds)
Paraneoplasmic syndromes
Cushing’s syndrome, SIADH, and Lambert-Eaton syndrome (suggest small-cell), hyperparathyroidism (suggests squamous cell)
What are the features of adenocarcinoma?
Located peripherally (in the smaller airways)
Histology: glandular differentiation
More common in non-smokers and Asian females
Metastasise early
Responds well to immunotherapy
What are the features of squamous cell carcinoma?
Located centrally (in the bronchi)
Histology: squamous differentiation (keratinisation)
More common in smokers
Secrete PTHrP, causing hypercalcaemia
Metastasise late (via lymph nodes)
What are the features of large carcinoma?
Located peripherally and centrally
Histology: large and poorly-differentiated
More common in smokers
Metastasise early
What are the features of small cell?
Located centrally
Histology: poorly-differentiated
More common in older smokers
Metastasise early
Secrete ACTH (Cushing’s syndrome) and ADH (SIADH)
Associated with Lambert-Eaton syndrome
What are the risk factors for lung cancer?
Main: smoking
Air pollution (indoor and outdoor)
Family history of cancer, especially lung cancer
Male sex
Radon gas (typically affects miners)
Clinical features of lung cancer
Unexplained cough for at least 3 weeks (with or without haemoptysis)
Unintended weight loss (>5% in 6 months)
New-onset dyspnoea
Pleuritic chest pain (due to the tumour invading the pleura or the chest wall)
Bone pain (due to metastases – commonly the spine, pelvis and long bones)
Fatigue (due to anaemia of chronic disease)
What is the first line investigation for suspected lung cancer?
CXR
Findings suggesting cancer:
Hilar enlargement
“Peripheral opacity” – a visible lesion in the lung field
Pleural effusion – usually unilateral in cancer
Collapse
After a CXR, what investigations are used?
Staging CT scan
PET-CT
Bronchoscopy with endobronchial ultrasound
Histological diagnosis
Why would a staging CT scan be used for lung cancer?
To establish the stage and check for lymph node involvement and metastasis.
Should be contrast enduced.
Why would a PET-CT scan be used?
To identify areas that the cancer has spread to by showing areas of increased metabolic activity suggestive of cancer
What do PET-CT scans include?
Injecting a radioactive tracer (usually attached to glucose molecules) and taking images using a combination of a CT scanner and a gamma ray detector to visualise how metabolically active various tissues are.
What does a bronchoscopy involve?
Endoscopy of the airways (bronchi) with ultrasound on the end of the scope.
This allows for detailed assessment of the tumour and ultrasound guided biopsy.
What is a histological diagnosis used for and how can it be carried out?
Check the type of cells in the cancer requires a biopsy.
This can be either by bronchoscopy or percutaneously (through the skin).
How is lung cancer staged?
I - One small tumour (<4cm) – localised to one lung
II - Larger tumour (>4cm) – may have spread to nearby lymph nodes
III - Tumour that has spread to contralateral lymph nodes, or grown into nearby structures (e.g. trachea)
IV - Tumour that has spread to lymph nodes outside the chest, or other organs (e.g. liver)
Management:
Non-small cell lung cancer
Stage I-III
Surgery: options include lobectomy/pneumonectomy in patients with intact lung function, or wedge resection in patients with reduced lung function (e.g. elderly, underlying respiratory conditions).
Pre-operative chemotherapy
Post-operative chemotherapy and radiotherapy: may not be needed in some cases of stage I lung cancer.
What can be given to patients with non-small cell lung cancer who cannot have surgery?
Stages I-III
Stereotactic ablative radiotherapy (SABR).
Directing a more intense and focused beam of radiation at the tumour
Reduces the number of radiotherapy sessions needed and minimises damage to surrounding tissue.
