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Lung Cancer Flashcards

(46 cards)

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1
Q

What cancer causes the most deaths in the UK in both genders?

A

Lung cancer

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2
Q

Risk factors of lung cancer

A
  • Smoking
  • Asbestos exposure
  • Radon exposure
  • Family history
  • Airflow obstruction
  • Occupational carcinogens
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3
Q

Types of lung cancers

A

Non small cell lung cancers
Small cell lung cancers

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4
Q

Types of non small cell carcinomas

A

Squamous cell carcinoma
Adenocarcinoma
Large cell carcinoma

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5
Q

What are small cell lung cancers characterised by?

A

Rapid growth
Tendency to metastasise
Poor survival rates

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6
Q

Staging of lung cancer

A

TNM staging

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7
Q

Symptoms of patient with lung cancer

A
  • Persistent cough
  • Dyspnoea
  • Haemoptysis
  • Recurrent lung infections
  • Weight loss
  • Hoarse voice
  • Malaise
  • Chest/shoulder pain
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8
Q

Signs of patient with lung cancer

A
  • finger clubbing
  • cachexia
  • horners syndrome
  • consolidation
  • muffled heart sounds
  • hepatomegaly
  • skin metastases
  • pale conjunctiva
  • cervical lymphadenopaty
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9
Q

What is cachexia?

A

Weakness + wasting of body
Due to chronic illness

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10
Q

What is Horner’s syndrome?

A

Triad of:
Miosis
Anhidrosis
Partial ptosis

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11
Q

What type of tumour is Horner’s syndrome associated with?

A

Pancoast tumours
At very top of lungs
Compress sympathetic nerve pathways in neck

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12
Q

Diagnostic tests of lung cancer

A
  • bloods: FBCs, U&Es, calcium, LFTs, INR
  • CXR
  • staging CT: spiral CT thorax + supper abdomen
  • CT guided biopsy
  • PET scan
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13
Q

Who should be referred for an urgent CXR 2WW for suspected cancer?

A
  • chest x ray findings suggestive of lung cancer
  • > 40 with unexplained haemoptysis
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14
Q

Who should be offered an urgent CXR 2WW to assess for lung cancer?

A

people >40 if they have 2 or more of: (unexplained)
or >40 + have smoked before + 1 or more of:
- cough
- fatigue
- SOB
- chest pain
- weight loss
- appetite loss

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15
Q

Prognosis of lung cancer

A
  • generally poor
  • usually already metastasised by the time symptoms arise
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16
Q

What is mesothelioma?

A

Cancer of the mesothelioma layer of the pleural cavity

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17
Q

What is the main risk factor for mesothelioma?

A

Asbestos exposure

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18
Q

presentation of mesothelioma

A
  • dyspnoea
  • weight loss
  • chest wall pain
  • clubbing
  • right lung affected more than left
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19
Q

management of mesothelioma

Study These Flashcards
A
  • chemotherapy
  • surgery if operable
  • poor prognosis
20
Q

List 5 molecular markers of lung cancer

Study These Flashcards
A

EGFR
ALK
RAS
PD1
PDL1

21
Q

Outline performance status of lung cancer

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A
  • 0: no symptoms + normal activity level
  • 1: symptomatic but able to do normal daily activities
  • 2: symptomatic but in bed/chair <half day with some assistance for daily activities
  • 3: symptomatic + in bed/chair >1/2 day
  • 4: bedridden
  • 5: dead
22
Q

What type of lung cancer is most commonly associated with non smokers?

Study These Flashcards
A

Adenocarcinoma (NSCLC)

23
Q

What are some paraneoplastic syndromes in small cell lung cancers?

Study These Flashcards
A
  • SIADH + hyponatraemia due to abnormal release of ADH
  • Cushing’s syndrome: due to abnormal release of ACTH
  • Lambert-Eaten syndrome: body attacks neuromuscular junctions > myasthenic syndrome
  • limbic encephalitis
24
Q

What are some paraneoplastic syndromes in non small cell lung cancers?

Study These Flashcards
A

squamous cell carcinoma:
- humeral hypercalcaemia of malignancy due to release of PTHrP > stimulates PTH receptors
- hyperthyroidism due to ectopic TSH
.
adenocarcinomas:
- hypertrophic pulmonary osteoarthropathy: triad of serositis, finger clubbing + arthropathy of large joints
- gynaecomastia

25
Paraneoplastic syndromes of NSCLC - squamous cell carincoma
hypercalcamia due to secretion of parathyroid hromone related protein
26
paraneoplastic syndromes of NSCLC - adenocarinoma
- **hypertrophic pulmonary oesteoarthropathy** - triad of serositis, finger clubbing + arthropathy of large joints - **gynaecomastia**
27
What are the 3 ectopic secretions possible from lung cancer? What does this cause?
- **ACTH** > Cushing’s syndrome (SSLC) - **ADH** > SIADH (SSLC) - **PTH related peptide** > raised PTH > hypercalcaemia (NSSLC - squamous cell carcinoma)
28
How can tissue sampling be obtained for lung cancer staging?
CT biopsy Bronchoscopy + US guided biopsy
29
Treatment of lung cancer
- **surgery** (first line for NSCLC) - **radiotherapy**: radical or palliative - **chemotherapy**: radical, neoadjuvant or adjuvant - **palliative care** - **combination of chemo + radio** (SCLC) - **biological targeted therapies**: based on mutation
30
Types of chemotherapy for lung cancer
- **radical** - **neoadjuvant**: chemo before surgery - **adjuvant**: chemo after surgery (only if
31
What are the two most common types of lung cancers?
Squamous cell carcinomas Adenocarcinomas (Both NSCLC)
32
Surgery options for lung cancer + types of surgery
- segmentectomy or wedge resection - lobectomy - penumonectomy (whole lung) . - throacotomy - video assisted thoracoscopic surgery (*keyhole*) - robotic surgery
33
Three main thoracotomy incisions
- anteriolateral - axillary - posterolateral (most common for thorax)
34
Features of squamous cell lung cancer
- NSCLC - typically central - PTHrP secretion > Hypercalcaemia - strong association with finger clubbing - cavitation lesions - hypertrophic pulmonary oesteoarthropathy
35
Features of adenocarcinoma lung cancer
- NSCLC - typically peripheral - most common lung cancer in non smokers
36
Features of large cell lung carcinoma
- NSCLC - typically peripheral - may secrete B-hCG
37
Surgical contraindications in lung cancer
- metastases present - FEV1 <1.5L - malignant pleural effusion - tumour near hilum - vocal cord paralysis - SVC obstruction
38
Features of small cell lung cancers
- usually central - ectopic ADH + ACTH secretion - Lambert-EAton syndrome > myasthenia gravis like syndrome
39
Outline how SSLC can cause lambert Eaton myasthenia syndrome
- caused by antibodies against SCLC - target voltage gated calcium channels on the presynaptic terminal in motor neurones - proximal muscle weakness - can affect intraocular muscles > diplopia - levator muscles > ptosis - pharyngeal muscles > slurred speech + dysphagia
40
What is superior vena cava obstruction?
- Complication of lung cancer - medical emergency - due to direct tumour compression on SVC - presents with facial swelling, SOB, + distended neck + upper chest veins - Pemberton’s sign: raising hands over head > facial congestion + cyanosis
41
What is Pemberton’s sign? What s it seen in?
- raising the hands over the head > facial congestion + cyanosis - SVC obstruction as a complication of lung cancer
42
Findings of CXR in lung cancer
- hilar enlargement - peripheral opacity - unilateral pleural effusion - collapse
43
Where does lung cancer commonly metastasise to?
- liver - brain - bones - adrenal glands - lymph nodes
44
Why does Horner’s sydnrome cause partial ptosis and not full?
Levator palpabrae sueprioris has both sketch and smooth muscle components Smooth muscle is innervate by sympathetic nervous system Skeletal muscle innervated by Oculomotor nerve
45
Management of small cell lung cancer
- very early stage - considered for surgery - but most are later stage + metastatic at time of diagnosis: - **chemotherapy + radiotherapy combination** - palliative care
46
What factors would make a patient a candidate for surgical resection in cancer?
Localised tumour Not frail/medically fit for surgery

Respiratory System (25 decks)

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