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1st Year - Clinical Respiratory > Lung cancer > Flashcards

Lung cancer Flashcards

1
Q

What percentage of lung cancers are caused by smoking

A

85%

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2
Q

What percentage of smokers get lung cancer

A

10%

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3
Q

What are the causative agents of lung cancer

A

Asbestos
Radon
Air Pollution
Diesel Exhaust

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4
Q

Is there more lung cancer in males or females

A

Males but females are more succepitable

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5
Q

What are the presenting symptoms of lung cancer (x9)

A 
Chronic cough (>3 weeks) 
Haemoptosis 
Wheeze
Chest and Bone pain 
Difficulty swallowing 
Raspy hoarse voice
S.O.B
Nail Clubbing 
Unexplained weight loss
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6
Q

What are the clinical signs of lung cancer (x6)

A 
Clubbing of fingers 
Lymphadenopathy 
Horners syndrome 
Pancoast tumour
Superior Vena Cava obstruction from lymph glands
Hepatomegaly and skin nodules
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7
Q

What is Horners syndrome

A

Horner’s syndrome is a rare condition characterized by miosis (constriction of the pupil), ptosis (drooping of the upper eyelid), and anhidrosis (absence of sweating of the face). It is caused by damage to the sympathetic nerves of the face.

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8
Q

What are the three indicators of finger nail clubbing

A
  1. The base of the nail (nail bed) becomes soft and the skin next to the nail bed becomes shiny. 2. The nails then curve more than normal when looked at from the side (this is called Scarmouth’s sign)
  2. The ends of the fingers may then get larger (when they are called drumstick fingers)
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9
Q

What is a Pancoast tumour?

A

A tumour of the pulmonary apex

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10
Q

If you suspect lung cancer then whats the first investigation you should carry out

A

Chest X-ray

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11
Q

After chest X-ray what further investigations can the GP perform when suspecting lung cancer

A 
Full Blood count 
Renal and liver functions 
Calcium 
Clotting screening 
Pulmonary function (Spirometry)
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12
Q

What techniques can be used to diagnose a piece of tissue suspected to be lung cancer or metastasis.

A

Bronchoscopy (just looks)
EBUS (common) - bronchoscopy but sample is taken
Image guided lung biopsy
Image guided liver biopsy (for metastasis)
Fine needle aspiration of neck node or skin metastasis

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13
Q

What do you look for on a chest Xray when diagnosing lung cancer

A 
No widening of the mediastinum 
The hilar vascular structures are crisply defined (left should be higher) 
The trachea should be central 
Pleural effusion 
phrenic nerve palsy
Collapsed lobe/lung
Shadowed local opacity
Metastatic disease
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14
Q

If a lesion is found by the Xray, what investigations should be done next?

A

CT scan and tissue sample

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15
Q

How do you stage a lung neoplasm?

A

TNM staging

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16
Q

What is TNM staging

A

T - the size of the cancer tumor and whether or not it has grown into nearby tissue (T1–T4)
N - whether cancer is in the lymph nodes N0-N3)
M - if the cancer has metastasised to other organs (Mx-M1)

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17
Q

If the lesion is not Lung cancer, what else could it be?

A

Pulmonary mass - an opacity in the lung over 3cm with no mediastinal adenopathy or atelectosis

Pulmonary Nodule - less than 3cm with no mediastinal adenopathy or atelectosis

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18
Q

What is a PET scan and what area of the body can you not use it on

A

A positron emission tomography (PET) scan is an imaging test that helps reveal how your tissues and organs are functioning. A PET scan uses a radioactive drug (tracer) to show this activity. This scan can sometimes detect disease before it shows up on other imaging tests.

Cant use for brain metastasis

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19
Q

What are the 4 main types of lung carcinoma and how common are they (%)

A

Adenocarcinoma 41%
Squamous cell carcinoma 40%
Small cell carcinoma 15%
Large cell carcinoma 4%

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20
Q

What are the two categories of lung cancers and how common is each (in %)

A

Small Cell lung Cancer (SCLC) 15%

None small cell lung cancer (NSCLC) 85%

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21
Q

What the survival rate for a NSCLC

A

10-25%

22
Q

What the survival rate for a SCLC

A

4%

23
Q

What lung cancer is most commonly caused by smoking

A

Squamous cell carcinoma

24
Q

Why are Squamous cell carcinomas difficult to treat

A

Very few addictive Oncogenes

25
Q

What mechanism is used to attempt to treat Squamous cell carcinomas

A

inactivating mutations in tumour suppressor genes.

26
Q

What is the name for genes that mutate and cause adenocarcinomas

A

Addictive oncogenes

27
Q

What is the adenocarcinoma oncogene that is induced by smoking

A

Kras

28
Q

What are the adenocarcinoma oncogenes that are not induced by smoking

A 
EGRF
BRAF
HER2
ALK rearrangements
ROS 1
29
Q

A tumour in the lung might not be lung cancer. What else could it be

A

Carcinoid tumour
Tumour in bronchial glands (v rare)
lymphoma
sarcoma

30
Q

What are the local effects of lung cancer

A

Bronchial obstruction

  • —Lung collapse
  • –Infection or abcess in lung
  • –Endogenous lipid pneumonia
  • –Bronchiectasis

Plural inflammation
Direct invasion of chest well, nerves and mediastinum

31
Q

What nerves can be damaged in lung cancer and what are the effects

A

Phrenic - diaphragm paralysis
L-reccurant laryngeal - Bovine cough
Brachial Plexus - Pancoast T1 damage
Cervical sympathetic - Horner’s syndrome

32
Q

What are the distant effects of lung cancer

A

Distant metastasis

pretty much everything gets affected

33
Q

What is a common endocrine effect of SCLC and NSCLC

A

SCLC - ACTH and to much antidiuretic hormone

NSCLC - increased parathyroid hormone production

34
Q

What treatments are available for lung cancer?

A

Surgery
Radiotherapy
Chemotherapy
Palliative management

35
Q

Why would you use an MRI in lung cancer investigations

A

to assess the degree of vascular and neurological involvement in pancoast tumours

36
Q

Why would you use an echocardiograph in lung cancer investigations

A

To look for pericardial effusion

37
Q

What tests need to be done to decide if the patient is fit for surgery

A 
Cardiovascular tests (is heart working ok) 
Respiratory tests (post operative FEV1) 
Psychological tests (mental illness)
38
Q

What is the name of the gold standard lung surgery procedure

A

Lobectomy

39
Q

What is the doubling time for NSCLC

A

129 days

40
Q

What is the doubling time for SCLC

A

29 days

41
Q

Why is the patient at higher risk of MI after lobectomy

A

More resistance as the same amount of blood has to go through less lung.

42
Q

In NSCLC what is the 5 year survival rate after surgery

A

40%

43
Q

Define adjuvent and Neo-adjuvent therapy

A

Adjuvent - after surgery

Neo-Adjuvent - delivered before main treatment.

44
Q

In NSCLC should use use chemo adjuvently

A

Yes

45
Q

In NSCLC should you use chemo neoadjuvently

A

Yes if stage 3 (locally advanced) but not if stage 1 or 2

46
Q

What is the staging of SCLC

A

Limited disease

Extensive disease

47
Q

What treatment is best for SCLC limited disease

A

Chemotherapy

48
Q

What treatment is best for SCLC extensive disease

A

Radiotherapy

49
Q

What are side effects with chemo therapy

A

Marrow supression
nausea
Neuropathy
Hairloss

50
Q

What are side effects with radio therapy

A

Lethargy

Pneumonitis

51
Q

What is immunotherapy for lung cancers

A

Immunotherapy, or immune-oncology (IO) as it is sometimes referred, is a type of treatment for non-small cell lung cancer (NSCLC). It works by helping the body’s immune system to recognise and destroy cancer cells.

52
Q

What therapy do you give to stage 4 lung cancer patients

A

Radiotherapy to reduce negative symptoms
Chemo to help survive longer
BUT ITS INCURABLE AND PALLIATIVE

1st Year - Clinical Respiratory (11 decks)

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