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Flashcards in Lung Cancer Deck (23):
0

What are the symptoms of a lung tumour that is compressing neighbouring structures?

SVC obstruction - causes distension of veins
Hoarse voice due to compression of the left recurrent laryngeal nerve
Dyspnoea due to compression of the phrenic nerve
Dysphagia
Horner's syndrome (pancoast tumour)

1

What are the typical symptoms of a primary lung tumour?

Cough, dyspnoea, wheezing (main airway obstruction), haemoptysis (bleeding from the tumour itself or from erosion in to pulmonary vessels), chest/shoulder pain, weight loss, lethargy/malaise

2

What is meant by a paraneoplastic syndrome?
Give examples of paraneoplastic syndromes due to lung cancer!

The presence of a symptom or disease due to the presence of cancer in the body but not due to the local presence of cancer cells
Small cell - Cushing's syndrome, SIADH, Lambert Eaton
Squamous cell - Hypercalcaemia
Non-small cell - hypertrophic osteoarthropathy

3

How are lung tumours classified?

Divided into two groups depending on the presence or absence of cells
Non-small cell lung cancer (including squamous cell (more likely to be central), Adenocarcinoma (peripheral), large cell carcinoma)
Small cell lung cancer - they behave very aggressively

Non small cell is the most common

4

What different treatments are available for the treatment of lung cancer?

Curative surgery for stages 1&2 (presuming fit for surgery)
Surgery and adjuvant chemotherapy clinical trial for stage 2a
Radiotherapy (radical is curative and palliative is for symptom control)
Chemotherapy - consider in patients with stage 3/4 and PS 0-2
Radiotherapy - curative CHART for people not fit for surgery OR palliative
Palliative care
Consider prophylactic cranial radiotherapy

5

What imaging techniques can be used in the diagnosis and staging of lung cancer?

Staging is the most important thing in determining treatment and prognosis
Investigations include plain chest x-Ray upon first suspicion, ct scan, pet scan, isotope bone scan

6

What are the two staging systems for lung cancer?

TNM and number

7

Outline the number staging system for lung cancer

Stage 1 - small cancer, localised to one area of the lung
Stage 2/3 - larger cancer, may have grown into surrounding tissues
Stage 4 - cancer has metastasised

8

What does the prognosis of lung cancer depend on?

Cell type
Stage of the disease
Performance status
Biochemical markers
Co-morbidities

9

What is the clinical pathway to diagnosis and treatment?

2 week referral from presentation to primary care
Chest X-Ray
Staging CT of chest, abdomen and pelvis
PET scan (uses radioactive glucose to look for areas of high metabolic activity as an indication of possible metastases)
Performance Status
MDT meeting to discuss patient and treatment options
62 day pathway from urgent referral

10

What are the stages of the WHO Performance Status system?

0: Asymptomatic
1: Restricted in strenuous physical activity
2: Up and about >50% of waking hours
3: >50% in bed, but not bed bound
4: Bedbound
5: Death

11

Who is involved in the MDT meeting?

Radiologist, surgeon, specialist nurse, respiratory physician, oncologist, palliative care team, LOROS representative

12

What are the different options for obtaining a biopsy?

US guided neck node FNA for cytology if lymphadenopathy
Endobronchial biopsy - if central ariway obstruction
EBUS - for lymph nodes or tumour near the central airways
CT guided biopsy - LA, if the tumour is peripheral
Thoracoscopy - if a pleural effusion is present, fluid MCS, camera in to the pleural cavity to take a biopsy

13

Lambert-Eaton myasthenic syndrome is a paraneoplastic syndrome associated with lung cancer. What is it?

Autoimmune disorder that is characterised by muscle weakness of the limbs, antibodies against pre-synaptic vg Ca2+ channels

14

What are the common sites for a lung cancer metastasis?

Liver, adrenal glands, bone, brain

15

What are the associated causes of lung cancer?

Smoking
Passive smoke exposure
Occupational exposure to asbestos
Radiation

16

What are the neurological paraneoplastic syndromes associated with lung carcinoma?

Anti-Hu syndrome - paraneoplastic sensory neuropathy, +/- paraneoplastic encephalomyelitis

Subacute cerebellar degeneration - anti-Hu/anti-Yo, anti-Ri

17

What is meant by Pemberton's sign?

Associated with SVCO
Ask the attention to lift both arms as high as possible and hold, watch the patient's face for congestion/venous distension
N.b resp distress may occur

18

What is the management of small cell lung cancer?

Poor prognosis
If T1-2a, N0, M0 consider surgery
Most patients will receive a combination of radiotherapy and chemotherapy

19

What is the management of non small cell lung cancer?

Only 20% are suitable for surgery
Poor response to chemotherapy
Curative or palliative radiotherapy

20

What is meant by hypertrophic pulmonary osteoarthropathy?

Aka Pierre Marie Bamberger syndrome
Paraneoplastic syndrome associated with non small cell lung cancer
Typically squamous cell, then adenocarcinomas
Clubbing and periositits
Can present with pain in both wrists

21

What is the difference between limited and extensive staging of disease?

Limited - can be contained and treated within one targeted field of radiotherapy

Extensive - distant metastases

22

Give two key difference between squamous cell carcinoma and adenocarcinoma

Squamous cell carcinoma has the strongest association with smoking and is also more commonly found near large airways

Adenocarcinoma is the most common type in non-smokers and has peripheral lesions