Lung cancer Flashcards
(42 cards)
Survival rate of lung cancer
Very low, 1 and 5 year survival.
Due to patients presenting late with advanced stages.
Symptoms are also very similar to those who already smoke.
Causes of lung cancer
90% caused by smoking.
Lung cancer deaths in women increasing despite those in men decreasing.
General Symptoms
Usually in smoker >20 years
Respiratory: Cough Haemoptysis (red flag) Dyspnoea Wheeze Chest pain (more advanced stage) Hoarseness
Common systemic and metastatic symptoms
Weight loss
Anorexia, nausea
Malaise
Fatigue
Secondary site: CNS, bone and skin (i.e pain and masses).
Paraneoplastic syndromes
Hyponatremia
Hypercalcaemia
Less commonly: itching, gynaecomastia.
Sub-types of lung cancer
Non-small cell:
Squamous- central, cavitation, hypercalcaemia.
Adenocarcinoma: peripheral lung, more common in non-smokers.
Small cell:
central
early lymphatic spread.
Common signs of lung cancer seen in examination
Clubbing
Cachexia- muscle wasting
Supraclavicular/ cervical lymphadenopathy
Stridor
Lung collapse/ pleural effusion.
Investigations to confirm diagnosis and determine tumour type/ extent
CT
Biopsy:
- Bronchoscopy.
- Endobronchial ultrasound- needle aspiration.
- Percutaneous CT thorax
- P eripheral lymph node/liver
Complete staging:
PET scanning- glucose analogue shows areas of high uptake, locates cancer.
Staging in lung cancer
Takes into account:
- Tumour size
- Involvement of any local structures and invasion
- Lymph/ blood metastases.
TNM staging
T- size and invasion
N- nodal stage
M- metastasis
Surgery non small cell lung cancer
Considered in all patients with stage 1/2
Lobectomy or even pneumonectomy (whole lung removal)
Radical radiotherapy with or without chemotherapy- given to stage 1/2 who are not fit enough/ unwilling to do surgery.
Palliative radiotherapy- in NSCLC
Relieves symptoms like: - haemoptysis - Intractable cough - Dyspnoea but not expected to cure.
Small cell lung cancer treatment
Chemotherapy is primary- more effective than in NSCLC
Controls symptoms and can induce remission
Prolongs survival by months
Small cell carcinoma
Accounts for 10-15% of lung cancers.
Present very darkly in microscope as they are mainly nucleus.
Little cytoplasm
Salt and pepper chromatin in nuclei.
Squamous cell carcinoma
Central origin
Cigarette smoke stimulates squamous metaplasia then dysplasia of bronchial epithelium.
Accounts for 20-30% of NSCC- second most common type
Adenocarcinoma
Most common type of non-small cell carcinoma- around glands
Typically happen at periphery of the lung.
Fibrotic: the cells make fibrotic protein
Tissues can be stained to look for specific proteins: TTF1 most typical.
Mutations targeted in adenocarcinoma
Key mutations in adenocarcinoma:
EGFR
ALK
PD1/ PD-L1
These mutations are targeted with specific agent.
New treatment that can be used to treat adenocarcinomas.
Spread of lung cancer
Local and direct:
Adjacent lung
Pleura and pleural cavity.
Lymphatic:
Pulmonary lymphatics
Lymph nodes- hilar and mediastinal.
Systemic: Liver Bone Brain Adrenal
Erlotinib
Tyrosine kinase inhibiting agent that targets epidermal growth factor receptor mutations (EGFR)
Gefitinib
Tyrosine kinase inhibiting agent that targets epidermal growth factor receptor mutations (EGFR)
Why are survival rates for lung cancer so poor?
Patients present late with advanced stage lung cancer
Due to early symptoms being similar to those who smoke.
Hyponatraemia
Increased retention of sodium in the blood.
This is a paraneoplastic syndrome in small cell carcinoma due to SIADH- increased secretion of ADH.
Hypercalcaemia
Too much calcium in the blood.
A paraneoplastic symptom in in sqaumous cell carcinoma.
Caused by an increase in Parathyroid hormone activity.
Associations linked to lung cancer
Smoking
Fibrosing alveolitis
Ionising radiation
Air pollution
Chromium
Iron oxide
Nickel
Mesothelioma
Surgical considerations for lung cancer
The operative mortality
Cardiovascular morbidity
Effect on lung function
Post-op quality of life
Post-op radiotherapy?
Chemotherapy?
The actual surgical approach?
