Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

oncoloy > lung cancer > Flashcards

lung cancer Flashcards

(46 cards)

Start Studying
1
Q

how common in lung cancer and who is it most common in?

A

1/3 most common cancer

most common in men after 75 yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

where do the majority of lung cancers arise from?

A

95% are bronchial carcinomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

which tumours metastasise to the lung?

A

GIT
breast, prostate, kidney
bone
cervix and ovaries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

how can we classify lung cancers?

A 
small cell 
non small cell - majority
   - adenocarcinoma - most common
   - squamous cell carcinoma
   - large cell 
   - carcinoid tumour 
   - bronchioalveolar cell tumour
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

where do non-small cell lung cancers arise from?

A

non small cell mainly arise from smaller airways.

squamous cell have a central location

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

where do small cell lung cancers arise from?

A

arise from APUD cell (high amine precursor uptake, high decarboxylase)
arise from larger airways and tend to be central tumours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the risk factors for lung cancer?

A 
smoking
lung disease - TB, COPD, pulmonary fibrosis 
FHx
toxins - radon, asbestos, arsenic
HIV 
age
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is the 2WW CXR referral guidelines?

A

urgent CXR 2ww referral for those >40 and 2 of the following symptoms or 1 symptom + smoker:

  • cough
  • SoB
  • chest pain
  • fatigue
  • loss of appetite
  • weight loss

urgent 2ww for >40 and one of symptoms:

  • persistent recurrent chest infections
  • finger clubbing
  • supraclavicular/ cervical lymphadenopathy
  • chest signs consistent with lung cancer
  • thrombocytosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is the 2ww for cancer MDT referral criteria?

A

CXR finding suggestive of cancer

>40yrs and unexplained haemoptysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

how do squamous cell lung cancers mainly present?

A

obstruction of bronchus leading to infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

how do squamous cell lung cancers mainly spread?

A

local spread is common but wide spread metastasis is rare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is the most common bronchial tumour associated with asbestos and most common in non-smokers?

A

adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

do large cell lung cancer metastasise early or late?

A

less differentiated and metastasise early

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

describe the growth pattern of small cell lung cancer? what does this mean about the prognosis?

A

rapid growth and highly malignant
small primary tumour and lots of nodes involved.
almost always inoperable at time of presentation
respond well to chemo but poor prognosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what investigations would you need in someone you suspect has lung cancer?

A 
bloods - FBC, LFTs (mets and baseline before drugs) , bone profile, UEs, CRP (rule out infection),  serum calcium, INR, tumour markers. 
CXR
CT - chest abdomen pelvis 
F-deoxyglucose PET scan 
CT head/ MRI brain 
radionucleotide bone scan
USS of liver 
biopsy 
sputum culture and cytology 
thoracentesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the tumour markers?

A 
CEA 
CA19-9
PSA
AFP
CA125 
B-hCG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what might be seen on CXR in lung cancer?

A 
peripheral circular opacity / consolidation 
hilar enlargement / lymphadenopathy
pleural effusion 
collapse 
bony metastasis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is the role of a PET scan?

A

F deoxyglucose is given and taken up by active tumour cells.

the scan will detect the emission from this positron emitting radionucleotide to show up active lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are the different methods of biopsying in lung cancer?

Study These Flashcards
A 
bronchoscopy 
Neck USS guided FNA of nodes 
CT guided tumour biopsy 
surgical biopsy if other methods fail
thoracentesis and cytology of pleural fluid
20
Q

what is a biopsy needed for?

Study These Flashcards
A

gold standard diagnosis to confirm it is a tumour
test for mutations e.g. EGFR, PD1, ALK , KRAS
helps predict prognosis and aid treatment.

21
Q

what is the WHO performance status scoring?

Study These Flashcards
A

0 - normal no restrictions
1 - restricted in strenuous physical exercise
2 - incapable of carrying out work
3 - 50% bed/chair bound of waking hours, limited self care
4 - always in bed/ chair , completely disabled
5 - dead

number one predictor of prognosis in any cancer

22
Q

how do lung cancer patients present?

Study These Flashcards
A

specific to the lung cancer:

  • cough (most common presentation, but not specific so often missed)
  • dyspnoea, chest pain, haemoptysis
  • slow resolving pneumonia

from obstruction:

  • Pancoast syndrome
  • dysphagia, stridor, wheeze

local spread:
- rib erosions, pericarditis, AF

systemic upset:
- fever, malaise, weight loss, weakness, lethargy, signs of dehydration and finger clubbing

paraneoplastic syndromes
metastatic presentation

23
Q

what is Pancoast syndrome?

Study These Flashcards
A

apical tumours can cause obstructive problems and present as the following:

  • Horners syndrome (miosis, partial ptosis, and anhidrosis and enopthalmos) due to compression of sympathetic nerves
  • Brachial plexus compression - arm and should pain, weakness in hand muscles, paraesthesia in T1/C8 and wasting of hand muscles
  • compression of vessels - arm oedema
  • SVC obstruction
  • recurrent laryngeal nerve palsy - hoarseness of voice
  • phrenic nerve involvement
  • ipsilateral reflex sympathetic dystrophy of arm (CRPS) - with enhanced sensitivity and skin changes
24
Q

what type of lung cancer are majority of Pancoast tumours?

Study These Flashcards
A

adenocarcinoma - 1/2

squamous cell carcinoma - 1/2

25
what paraneoplastic syndromes are seen in lung cancer?
``` anaemia - pale conjunctiva, pallor DIC, thrombocytosis small cell: - ADH - SiADH - hyponatraemia - ACTH - cushings syndrome, bilateral adrenal hyperplasia and hyperkalaemic acidosis - acanthosis nigricans - dermatomyositis - lambert eaton syndrome ``` squamous cell carcinoma: - PTH - high Ca - hyperthyroid - hypertrophic pulmonary osteoarthropathy (HPOA) adenocarcinoma - gynaecomastia others: hypoglycaemia, mononeuritis multiplex, encephalomyelitis, MND, nephrotic syndrome, glomerulonephritis, polymyopathy, subacute sensory neuropathy. subcut: erythema multiforme, thrombophlebitis migrans, pruritic and urticaria
26
how can lambert eaten syndrome and dermatomyositis present?
can present after lung cancer or can actually precede the cancer. thus anyone presenting with these syndromes should be screened regularly. ``` lambert eaton (auto Ab to VG Ca channels) - myasthenia like syndrome dermatomyositis - muscle weakness and skin changes ```
27
how does metastatic lung cancer present?
supraclavicular/ cervical/ axillary lymphadenopathy bone - pain, pathological fractures, hypercalcaemia spinal mets - peripheral neuropathy liver - hepatomegaly, ascites adrenals - Addison's brain - headaches, N&V, focal neurology, visual changes, personality changes, cerebellar syndrome, seizures
28
describe the TNM staging for non-small cell lung cancer.
Tx - positive cytology but no lesion seen T0 - no evidence of primary tumour T1 - diameter = 3cm, surrounded by lung/ pleura. T1a <2cm, T1b 2-3cm T2 - 3-7cm diameter, involves main bronchus, >2 cm from carina, associated with atelectasis/ obstructive pneumonitis that extends to hilar but doesn't involve whole lung. T2a 3-5cm, T2b 5-7cm T3 - >7cm diameter, directly invades chest wall, diaphragm, phrenic nerve, mediastinal pleura or parietal pericardium. <2cm from carina but no involvement. associated with atelectasis/ pneumonitis that involves entire lung T4 - invasion of mediastinal organs (oesophagus, bronchus, great vessels, heart, vertebral body). malignant pleural effusion. separate ipsilateral nodes, recurrent laryngeal nerve involvement. N0 - no nodes N1 - ipsilateral bronchopulmonary or hilar nodes N2 - ipsilateral mediastinal/ subcarinal nodes N3 - contralateral mediastinal , hilar or supraclavicular nodes M0 - no mets M1 - distant med, includes nodules in different lobes (M1a)
29
describe the clinical staging for lung cancer (non small cell)
``` IA - T1 IB - T2 IIA - T1N1 IIb - T2N1 or T3 IIIA - T1-3, N2 or T3 N1 IIIB - any T4 or any N3 IV - M1 ```
30
based on staging, which cancers are curative and which are not for non-small cell lung cancer?
stage 1 to 3 are curative | stage 3b and 4 are inoperable and chemo used to improve symptoms and control disease
31
what is the management for non small cell lung cancer?
encourage to stop smoking - improves outcome and post surgical complication surgery: - lobar resection. during resection also sample the hilar/ mediastinal nodes radiotherapy: (CHART) - offered to all patients 1- 3 which are not suitable for surgery and radical radiotherapy if WHO performance score is good. - can also be used in palliative care chemotherapy: - offered to all patients with III or IV with good performance status. e.g. cisplatin or docetaxel - adjuvant chemo for those who have had complete resection and good performance status and good post op recovery.
32
what can be done Pre op for lung cancer surgery?
assessment and throacoscore to calculate the risk of death lung function tests CVS risk assessed
33
what are the contraindications to lobectomy?
FEV1 <1.5 stage III or IV SVCO vocal cord paralysis
34
what investigations do you need before lung radiotherapy?
Pulmonary function tests, must be adequate to continue.
35
what is CHART?
continuous hyperfractionated accelerated radiotherapy can be used for radical or palliative care 3 fractions / day for 12 days
36
which type of non-small cell lung cancer is highly responsive to chemo?
squamous cell
37
how is stage 3b/ 4 non small cell lung cancer treated?
chemoradiotherapy radical RT palliative chemo palliative RT immunotherapy, targeted therapies
38
what determines what treatment for lung cancer is used?
``` type and stage expression of markers lung function comorbidities WHO performance patients wishes ```
39
describe specific mutations seen in non small cell lung cancer and how they are treated?
EGFR tyrosine kinase mutations - targeted therapies against tyrosine kinase (tyrosine kinase inhibitors) - these are very specific to certain tyrosine kinase molecules PDL1 mutations - pembrolizumab - monoclonal Ab against PDL1 to allow immune system to recognise tumour cells and kill them (PDL1 is expressed to appear as self to T cells which have PDL1 receptor). this is known as immunotherapy as it enhances immunity
40
how does the mutational status differ between non-smokers and smokers?
non smokers get very specific single mutations which drive the tumour to grow e.g. EMRF-ALK translocation smokers - have multiple mutations (tumour mutational burden) that together drive the tumour to grow. PDL1 mutations are most commonly associated with smokers.
41
how are small cell lung cancers staged?
limited stage disease: - confined to one hemithorax - involves ipsilateral hilar nodes - involves ipsilateral/ contralateral supraclavicular/ mediastinal nodes extensive disease: - metastatic lesions in contralateral lung - distant metastasis
42
how are small cell lung cancers managed?
stop smoking if less than or equal to 5cm can consider surgical removal (if good performance status and no lymph node involvement). then give adjuvant chemo. otherwise chemoradiotherapy consider prophylactic cranial RT relapse - best supportive care/ chemo/ immunotherapy
43
how do small cell lung cancers respond to chemo?
very well | but relapse rates are high
44
what is the prognosis for small cell lung cancer?
limited - 18-30 months | extensive - 7-12 months
45
discuss different methods for supportive/ palliative care for lung cancer..
breathlessness - opioids, fan on face, breathing techniques bronchial obstruction - external beam radiotherapy, debulking bronchoscopic proceedures, stents pleural effusion - pleural aspiration, drainage, pleurodesis cough / pain - codeine/ morphine, radiotherapy SVCO - chemo/radiotherapy, stent bone pain - analgesia cerebral mets - steroids, radiotherapy spinal cord compression - steroids and emergency radiotherapy/ surgery
46
how is lung cancer prevented?
discourage smoking smoking caessation services prevent occupational exposure to carcinogens.

oncoloy (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions