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YR6: RESPIRATORY > Lung Cancer > Flashcards

Lung Cancer Flashcards

(46 cards)

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1
Q

How is lung cancer classified?

A

Small cell lung cancer (SCLC- 20%)
Non-small cell lung cancer (NSCLC- 80%)

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2
Q

What are the subtypes of NSCLC?

A

Adenocarcinoma
Squamous
Large cell
Alveolar cell carcinoma
Bronchial adenoma

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3
Q

What is the most common type of lung cancer?

A

Adenocarcinoma

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4
Q

List 3 risk factors for lung cancer

A

Tobacco smoking
Exposure to carcinogens: passive smoking, RADON, asbestos
FH

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5
Q

List 5 general symptoms of lung cancer

A

Cough
Dyspnoea
Haemoptysis
Chest pain
Weight loss

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6
Q

List 3 general signs of lung cancer

A

Fixed monophonic wheeze
Supraclavicular lymphadenopathy or persistent cervical lymphadenopathy
Clubbing

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7
Q

Give 3 pathological features of SCLC

A

Usually CENTRAL
Arise from APUD cells
a/w ectopic ADH + ACTH secretion

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8
Q

What are the 3 paraneoplastic manifestations of SCLC?

A

ADH: hyponatraemia

ACTH: Cushing’s syndrome

Lambert-Eaton syndrome

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9
Q

How does the ectopic ACTH in SCLC present?

A

HTN
Hyperglycaemia
Hypokalaemia (high cortisol can lead to hypokalaemic alkalosis)
Bilateral adrenal hyperplasia

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10
Q

What is Lambert-Eaton syndrome?

A

AI disorder, development of Abs to VGCC causing myasthenic like syndrome

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11
Q

Where are adenocarcinomas commonly located?

A

Peripherally

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12
Q

Which lung cancer is most commonly seen in non-smokers?

A

Adenocarcinoma

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13
Q

Which form of lung cancer is almost always seen in smokers?

A

Small cell carcinoma

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14
Q

Give 2 paraneoplastic manifestations of adenocarcinoma

A

Gynaecomastia
Hypertrophic pulmonary osteoarthropathy (HPOA)

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15
Q

Which type of lung cancer most commonly causes caveatting lesions?

A

Squamous

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16
Q

Give 2 features of alveolar cell carcinoma

A

Not related to smoking
++ sputum

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17
Q

What is the most common type of bronchial adenoma?

A

Carcinoid

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18
Q

List 4 paraneoplastic manifestations of squamous cell lung cancer

A

PTHrP secretion causing hypercalcaemia
Clubbing
Hypertrophic pulmonary osteoarthropathy
Hyperthyroidism due to ectopic TSH

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19
Q

Give 2 indications for referral using the suspected cancer pathway for an appointment within 2w

Study These Flashcards
A

CXR findings suggestive of lung cancer
>,40 with unexplained haemoptysis

20
Q

To which patients should an urgent (<2w) CXR be offered?

Study These Flashcards
A

> ,40 + 2 unexplained Sx or if they’ve ever smoked + 1 unexplained Sx:
* cough
* fatigue
* SOB
* chest pain
* weight loss
* appetite loss

21
Q

In which patients should an urgent (<2w) CXR be considered?

Study These Flashcards
A

> 40s with any of:
* persistent/ recurrent chest infection
* finger clubbing
* supraclavicular lymphadenopathy or persistent cervical lymphadenopathy
* chest signs consistent with lung cancer
* thrombocytosis

22
Q

What imaging is performed for suspected lung cancer?

Study These Flashcards
A

CXR
Contrast CT of lower neck, thorax + upper abdomen

23
Q

Once confirmed diagnosis from imaging, what does bronchoscopy allow?

Study These Flashcards
A

Biopsy to obtain histological dx
Sometimes aided by endobronchial US

24
Q

What investigation is typically performed in NSCLC? How?

Study These Flashcards
A

PET scanning
Uses 18-fluorodeoxygenase which is preferentially taken up by neoplastic tissue

25
Why is PET scanning performed in NSCLC?
Establishes eligibility for curative Tx Has been shown to improve diagnostic sensitivity of local + distant metastatic spread
26
What bloods should be performed in suspected lung cancer?
FBC: may show anaemia/ raised platelets LFTs: raised if liver mets U+Es: baseline. Hyponatraemia in SCLC serum Calcium: high in squamous
27
In what percentage of patients with lung cancer is CXR normal?
10%
28
What procedure is performed prior to surgery for NSCLC? Why?
Mediastinoscopy as CT does not always show mediastinal LN involvement
29
Describe management for stage I and II NSCLC in patients suitable for surgery
Lobectomy or pneumonectomy with curative intent +/- neoadjuvant + post-op chemo/ chemoradiotherapy
30
What surgeries can be performed for elderly/ co-morbid patients instead of pneumonectomy?
Wedge resection or Segmentectomy
31
Describe management for stage I and II NSCLC in patients NOT suitable for surgery
Radiotherapy with curative intent +/- neoadjuvant chemo
32
List 6 contraindications to surgery in NSCLC
Stage IIIb or IV (metastatic) FEV1 <1.5L Malignant pleural effusion Tumour near hilum Vocal cord paralysis SVC obstruction
33
Describe management for stage III NSCLC
Chemoradiotherapy +/- immunotherapy Possibly surgery
34
Describe management of extensive stage III or stage IV NSCLC
Palliative radiotherapy
35
What is the difference between limited and extensive SCLC?
Limited: No distant mets (T1-4, N0-3, M0) Extensive: Distant mets
36
Describe management of SCLC if limited disease
Chemo + Radiotherapy if good response to chemo + Prophylactic cranial irradiation
37
Why is Prophylactic cranial irradiation performed in SCLC?
High risk of developing brain mets
38
Describe management of SCLC with extensive disease
Chemo + immunotherapy + Prophylactic cranial irradiation +/- palliative radiotherapy
39
Describe management for relapse for SCLC after initial treatment
Further chemo (max. 6 cycles) Palliative radiotherapy to control local Sx
40
List 3 complications of lung cancer due to local disease spread
Nerve palsy SVC obstruction Pericarditis
41
List 5 common sites of metastasis of lung cancer
Brain Spinal cord Bone Liver Adrenal glands
42
What is the investigation of choice for suspected lung cancer?
CT
43
What is the most common cause of superior vena cava obstruction?
Lung cancer
44
What can PTHrP secretion in SCC present with?
Raised serum calcium Bone + abdo pain Kidney stones Low mood
45
How does ectopic ACTH in small cell lung cancer usually present?
HTN Hyperglycaemia Hypokalaemia Alkalosis Muscle weakness
46
Give 2 complications of lung cancer
Hoarseness Stridor

YR6: RESPIRATORY (38 decks)

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