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Flashcards in Lung cancer. Deck (74):

What percentage of lung cancers are incurable at the time of presentation?



How do primary lung tumours tend to present?

With recurrent pneumonia and Stridor.


How is a common symptom that lung cancers that have invaded locally present with?

With haemoptysis.


What do we find when the cancer has invaded the recurrent laryngeal nerve?

Nerve palsy means the patient will probably have a hoarse voice.


How does the patient present if the tumour has invaded the pericardium?

Breathlessness, afib and pericardial infusion.


How does the patient present if the tumour has invaded the oesophagus?



How does the patient present if the tumour has invaded the brachial plexus?
What kind of tumours does this generally happen with?

Muscle weakness and pain in the arm and the hand.
Usually a pancoasts lung apex tumour.


How does the patient present if the tumour has invaded the pleural cavity?

Pleural effusion


How does the patient present if the tumour has invaded the SVC?

Can sometimes see a lump in the neck caused by a distended jugular vein. Anastomoses to the inferior vena cava can cause protruding veins on the chest and the stomach.


What are common sites of metastasis from lung cancer?

Liver, bone, brain, adrenal and skin.


What kind of onset do cerebral metastasis cause?

Insidious causing: weakness, visual disturbance, seizures and headaches that are worse in the morning but don't cause photophobia.


What are some of the paraneoplastic symptoms seen with lung cancer?

Finger clubbing
Hypertrophic pulmonary osteoarthropathy
Weight loss
Weakness - eaton lambert syndrome.


What does HPOA stand for and what is it?

Hypertrophic pulmonary osteoarthropathy.
Is combines clubbing and periostitis of the small hand joints especially the DIPs. It can cause distal expansion of the long bones and painful, swollen joints.


What is SIADH?

Syndrome of inappropriate Antidiuretic hormone secretion.


What is eaton lambert syndrome?

LEMS - rare autoimmune disorder that is characterised by muscle weakness of the limbs.


What is lymphadenopathy defined as?

Enlargement of two or more contiguous lymph node groups.


What are we looking for on examination for lung cancer?

Finger clubbing, breathlessness, cough, Stridor, bloated face and hoarse voice.

Lymphadenopathy, tracheal deviation.

Dull percussion and enlarged liver.


What investigations do we do for lung cancer?

FBC, coag screen.
U and Es.
Chest X-ray
CT scan of thorax.
PET scan.
Endobronchial ultrasound (EBUS).
Not sputum cytology.


How can we obtain tissue samples for diagnosis of lung cancer?

Biopsy from bronchoscopy.
CT guided biopsy.
Lymph node aspirate
Aspiration of pleural fluid.


What is an EBUS and how is it performed?

Endobronchial ultrasound.
Bronchoscope with ultrasound tip which enables visualisation of the hilar and mediastinal structures. Allows us to target and sample lymph nodes. It is a day case procedure.


Why do we do PET scans for lung cancer?

Tumours will uptake radiolabelled glucose and light up.
Allows us to see Mets and morphology of the tumour.


What is the median survival rate for bronchial carcinoma in the UK?

5.8 months.


What is the 1 year survival rate for bronchial carcinoma?



What are the two categories of bronchial carcinoma?

Small cell and non small cell.


How rapidly does small cell cancer progress?
Do we normally operate?
How does it respond to treatment?

Rapidly progressive with early metastasis.
Rarely suitable for surgery as it often has unrecognisable micro-metastasis.
Good initial response to chemo due to the rapid cellular turnover.


What do the majority of patients with small cell lung cancer also have by the time they present?

Lymph disease.
Bulky central mass with mets.


What type of lung cancer is the most common?

Non small cell cancer.


What kinds of cancer does non small cell cancer include?

Squamous and adenocarcinomas.


How does non small cell cancer respond to chemo?

Less responsive than small cell.


How can we sometimes cure non small cell lung cancers?

Surgery or radical radiotherapy.


What type of lung cancer has the best one year survival rates?

Non small cell.


What type of lung cancer has the worst one year survival rate?

Cancer of unknown cause.


Why are we sometimes unable to find out what kind of lung cancer the patient has?

We cannot get tissue for testing.
E.g. With a high apex tumour that cannot be reached by bronchoscopy and is surrounded by emphysema tissue. A biopsy needle may pop it and increase breathlessness in an already sick patient.


What different treatments can we use for lung cancer?

Surgery, radiotherapy, chemotherapy and palliative care.


What four questions do we need to ask ourselves to see if surgery should be carried out?

Can it be cut out?
Is the disease localised?
Will The patient survived the operation?
What will the residual lung function be?


What lung cancer stages do we operate on?

N1 and occasionally N2 if there is enough gods lung tissue left after the surgery.


What is the problem with doing a PET scan of the head?

The pituitary always lights up due to its high metabolic activity and so could hide something.


What two types of surgical approach can we take to lung cancer?

Thoracotomy and VATS (video assisted thorascopic surgery).


Do we operate on patients with a vocal cord palsy?

No as it has invaded the RLA and therefore the mediastinum and is inoperable.


How much bronchi does a surgeon need left to tie off?
What does this mean for some tumours?

A tumour within 2cm of the carina is inoperable.


What do we see on X-ray after a pneumonectomy and why?

Completely white as the whole cavity has filled with fluid.


What tests do they do to stage for chemo?

Bronchoscopy or needle biopsy, CT scan and performance status ECOG score.


What is the ECOG score otherwise called and what is it for?

Eastern cooperative oncology group score.
Otherwise called the WHO or zubrod score.
Runs from 0-5. 5 being dead and 0 being in perfect health. It is a performance score, to see how well people's quality of life is e.g. How long are they unable to leave the house.


What ECOG scores will we offer radical treatment to?

0 or 1.


Why do we use cytotoxic chemotherapy?

It is very rarely curative but can give patients a longer survival time.
Although this does come with side effects.


How is cytotoxic chemotherapy carried out?
What cells does it target?

IV infusions and detailed imaging taken every 3-4 weeks as an outpatient.
Is a whole body treatment that targets rapidly dividing cells.
Different agents are used for different cell types.


What other treatment is usually given to lung cancer patients alongside cytotoxic chemotherapy and why?

Prophylactic cranial irradiation. Chemo can't cross the blood brain barrier and giving radiation is shown to improve survival rates in small cell lung cancer patients as well as preventing disabling symptoms of metastasis.


What drugs are prescribed to help with the side effects of chemo?

Steroids and anti emetics.


What type of cells does chemo for small cell lung cancer target and what major side effect can this lead to?

Rapidly dividing cells meaning it also targets bone marrow.
This means patients can become neutropenic. This means the treatment can kill patients even if the cancer doesn't.


What are the side effects of chemotherapy?

Nausea and vomiting, tiredness, bone marrow suppression leading to infection and anaemia, hair loss and pulmonary fibrosis.


What is radiotherapy and what is it used for?

Ionising radiation - usually x Rays with an external beam.
Used for radical treatment of lesions under 5cm.
Palliative delaying treatment for mets.


What are the downfalls of radiotherapy?

It has a maximum cumulative dose.
Collateral damage can happen.
Is targeted so is no good for subclinical Mets.
Can result in skin damage.


What does maximum cumulative dose mean in relation to radiotherapy?

There is a maximum a patient can have in a life time, so if there is a later relapse, radiotherapy may not be available.


What can we see on an xray after radiotherapy?

A perfect square of fibrosis from tissue damage surrounding where the lesion was.


What is done before radiotherapy to plan for it and why?

A CT planning scan to find multiple angles of attack and ensure the beam is at its maximum at the point of the tumour.


What are the benefits and drawbacks of inserting a stent for lung cancer?

Can open an airway an receive Stridor by displacing the tumour that has been pushing on it. This means that the tumour that has been displaced may now be pushing on something else.


What is photodynamic therapy?

Patient given photo sensitive drugs about a week prior to treatment. They stay out of sunlight to avoid damage. The tumour is then blasted to activate the photosensitive dye and target tumour cells to die.
These die within a week and then bronchial toileting is done.


What can endobronchial therapy be used to do?

Insert a stent, to give photodynamic or laser therapy or deliver radioactive pellets.


How common are lung neoplasms?

Benign primary tumours are rare.
Primary malignant tumours and mets are common.


What are chemical risk factors for lung cancer?

Asbestos, smoking, nickel, chromates, radiation and atmospheric pollution.


What hormone does squamous lung cancer produce?



What hormone does small cell lung cancer produce?



What are the 4 common smoking associated types of lung cancers in order of most to least prevalent?

Squamous carcinoma
Small cell
Non small cell


What other types of lung cancer do we get other than the 4 smoking associated types?

Neuroendocrine and bronchial gland tumours. Can be adenoid cystic carcinoma or mucoepidermoid carcinoma.


What antigen is most commonly displayed by small cell lung cancer and adenocarcinoma?

TTF-1 (thyroid transcription factor).


What antigen is most commonly displayed by squamous lung cancer?



Order the types of lung cancer in order of worst prognosis to best?

Small cell
Larges cell


What causes most adenocarcinomas and what mutation do they display?

Smoking related, often show K Ras and wild type EGFR.


What is Gefitinib and what is it used to treat?

Tyrosine kinase inhibitor which shows some activity in non small cell lung cancers. Usually adenocarcinomas that are sensitive. Only tumours with mutated EGFR respond.


What are the five most common tumours to metastasise to bone?

Breast, prostate, colorectal and lung cancer.
More rarely thyroid.


What is a primary malignant neoplasms of the pleura?



What part of the lung is a common site if invasion by lung carcinomas and metastatic tumours?

The pleura.


What are peripheral adenocarcinomas?

Atypical adenomatous hyperplasia. Neoplastic cells spread along alveolar walls. They are true invasive adenocarcinomas.


How frequent is lung cancer in Scotland?

The most frequent cancer of mean and women.