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Flashcards in Lung cancer Deck (27)
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Describe the epidemiology of lung cancer

3rd commonest cancer in the UK
Largest cause of cancer-related mortality in UK and worldwide. 5-year survival is only 13%.
3rd commonest cause of death after CAD and CVD
85% occur in smoker or ex-smokers
44% are diagnosed aged 75 and older
Higher incidence in urban areas


Name 5 risk factors for lung cancer

Increasing age

Environmental: radon gas, asbestos, radiation and chemicals, air pollution

Host: pre-existing lung disease, previous radiation therapy, HIV, immunosuppression, genetics


Categorise the different types of primary lung cancer

Small cell lung cancer (12%)
Non-small cell lung cancer (87%)
-Adenocarcinoma: commonest
-Squamous cell carcinoma
-Large cell carcinoma


Name 3 cancers related to the lungs

Pancoast tumours: pulmonary apex
Mesothelioma: pleura
Metastatic lung cancer


Where does metastatic lung cancer commonly originate from?

Kidney: cannonball metastases


Describe the features of small cell lung cancer

Accounts for 12% of lung cancers
Arises from neuroendocrine cells
10% paraneoplastic: ACTH (Cushing's), ADH (SIADH)
Often arises centrally
Metastasises early


Describe the features of squamous cell carcinoma

Arises from epithelial cells
Associated with keratin production
May secrete PTHrP (hypercalcaemia)
Occasional cavitation with central necrosis
Obstructing lesions of bronchus with infection
Local spread common
Metastasise relatively late


Describe the features of adenocarcinoma

Commonest lung cancer in UK
Originate from mucus-secreting glandular cells
Most common type in non-smokers
Often peripheral lesions on CXR/CT
Subtype: bronchoalveolar cell carcinoma
Commonly metastasises


Describe the features of large cell carcinoma

Often poorly differentiated
Metastasises relatively early


Name 5 local effects of lung cancer

Lung cancer is often asymptomatic, and presents late.

Cough*: 3-week cough merits CXR
Monophonic wheeze: partial obstruction

Chest pain:
-pleuritic: invasion of chest wall or pleura
-dull central ache: large-volume mediastinal nodes
Recurrent infection: post-obstructive pneumonia

Hoarse voice: recurrent laryngeal nerve compression
Nerve compression: pancoast tumour
-Klumpke's paralysis (C8/T1): claw hand
-Horner's syndrome: anhidrosis, ptosis, miosis
Direct invasion of phrenic nerve

SVC obstruction
Tracheal tumour: progressive dyspnoea and stridor


How does superior vena cava obstruction present?

Dyspnoea +/- dysphagia
Swollen oedematous facies and arms
Raised JVP
Dilated veins in upper chest and arms


Name 2 clinical features that can be caused by pancoast tumours

Hoarse voice: recurrent laryngeal nerve compression
Klumpke's paralysis (C8/T1): claw hand
Horner's syndrome: anhidrosis, ptosis, miosis


What cancer is known to secrete PTH-rp?

Squamous cell lung cancer


What cancer is known to secrete ADH and ACTH?

Small cell lung cancer


What paraneoplastic syndromes are associated with small cell lung cancer?

Cushing's syndrome from ACTH secretion
SIADH from ADH secretion
Eaton-Lambert syndrome


What paraneoplastic syndrome is associated with squamous cell lung cancer?

Hypercalcaemia from PTHrP secretion


What sign is associated with metastatic lung cancer originating from the kidneys?

Cannonball metastases


Where do primary lung cancers often metastasise?

Mediastinal, cervical, axillary, intra-abdominal lymph

Liver: anorexia, nausea, weight loss, epigastric pain
Bone: bony pain, pathological fractures, spinal cord collapse*
Adrenal glands: usually asymptomatic
Brain: raised intracranial pressure
Malignant pleural effusion: dyspnoea and pleurisy


Name 5 non-metastatic extra-pulmonary manifestations of lung cancer

Weight loss, lethargy, anorexia
Clubbing (30%)
Small cell: SIADH, Cushing's
Squamous cell: Hypercalcaemia
Neuro: encephalitis, motor neurone disease, peripheral sensorimotor neuropathy, Eaton-Lambert syndrome


What tests should be ordered for lung cancer?

FBC, U&E, LFTs, INR, calcium
Staging contrast CT of chest, liver and adrenal glands
MRI spine: assess if at risk of cord compression
PET scan: detect mediastinal nodes and small mets

Bronchoscopy + biopsy


How is spinal cord compression secondary to lung cancer treated?

High dose steroids
Surgical decompression


What CXR findings may be seen with lung cancer?

Mass lesion if >1cm diameter
Pleural effusion: associated pleurisy
Lymphadenopathy or mediastinal widening
Slow-resolving consolidation: post-obstructive pneumonia
Lung collapse: endoluminal tumour
Reticular shadowing: lymphatic involvement

Normal: if confined to central airways and mediastinum


What must be done prior to commencing treatment of lung cancer?

WHO performance status: fitness for treatment
0-1: tolerate all forms of treatment
2: applicable for curative chemotherapy
3+: palliative care


Summarise the management of non-small cell lung cancer

Applicable for non-small cell lung cancer*

Ipsilateral tumour + good performance score: surgery
Good staging + performance score: chemotherapy

Stage I/II: curative surgery
Stage IIIa: surgery + adjuvant chemotherapy
Stage III/IV: curative chemo if performance score 0-2

Curative radiotherapy if unfit for surgery or curative chemotherapy

Palliative care
Watch and wait


What system is used to stage lung cancer?



Why is small-cell lung cancer generally unfit for curative surgery? How is this managed?

Rapid growth and early metastases

Curative: cisplatin chemotherapy
-Adjuvant radiotherapy given in limited disease
Palliative: radiotherapy

Combined chemo improves survival from 4-12wk to 6-15 months.


Outline the WHO performance status

0: Fully active, able to carry out predisease performance without restriction

1: Restricted in physically strenuous activity, but ambulatory and able to carry out work in a light or sedentary nature.

2: Ambulatory and capable of all self-care. Unable to carry out any work activities. Up and about more than 50% of waking hours.

3: Capable of only limited self-care. Confined to bed or chair more than 50% of waking hours.

4: Completely disabled. Cannot carry on any self-care. Totally confined to bed or chair.

5: Death