Lung Cancer (AAG) Flashcards
(106 cards)
1
Q
How common is lung cancer worldwide, compared to other cases?
A
Most common cancer worldwide
2
Q
How common is lung cancer in the UK compared to other cancers?
A
Second most common cancer
3
Q
What % of cases of lung cancer are in people over 65?
A
87%
4
Q
At what age is the highest incidence of lung cancer?
A
Between 80 and 84 years
5
Q
What demographic shift has occurred with lung cancer?
A
The incidence and mortality rates are falling in males and rising in females
6
Q
How does mortality from lung cancer compare to other cancers?
A
It is the biggest cause of cancer deaths in the UK and USA
7
Q
What is the most significant risk factor for lung cancer?
A
Smoking, including passive smoking
8
Q
What % of cases of lung cancer are associated with smoking?
A
80-90%
9
Q
What is the risk of lung cancer from smoking proportional to?
A
- The person’s pack years
- Age they started smoking
- Type of cigarettes smoked
10
Q
How is pack years calculated?
A
Packs smoked per day x years smoked
11
Q
What are the other risk factors for lung cancer?
A
- Previous radiotherapy to the chest
- Occupational exposure to chemicals
12
Q
Exposure to which chemicals increases the risk of lung cancer?
A
- Asbestos
- Acetaldehyde
- Beryllium
- Cadmium
- Chromium
- Formaldehyde
- Polycyclic aromatic hydrocarbons
- Nickel
- Inorganic arsenic compounds
13
Q
By how much does a significant family history increase the risk of lung cancer?
A
2.5x
14
Q
What genetic mutation can increase the risk of lung cancer?
A
Germline mutations in genes such as Rb TP53
15
Q
What are the main categories of lung cancer?
A
- Small cell lung cancer
- Non-small cell lung cancer
16
Q
What % of lung cancers are small cell lung cancers?
A
20%
17
Q
Where does SCLC arise?
A
In the larger airways - tends to be a more central tumour
18
Q
How do most patients with SCLC present?
A
Systemic disease
19
Q
Does SCLC frequently metastasise?
A
Yes
20
Q
How does SCLC metastasise?
A
Via haematogenous spread
21
Q
Where does SCLC metastasise to?
A
- Liver
- Skeleton
- Bone marrow
- Brain
- Adrenal glands
22
Q
What do the small cells in SCLC contain?
A
Dense neurosecretory granules
23
Q
What can the dense neurosecretory granules in SCLC produce?
A
Ectopic biological substances such as ACTH and ADH
24
Q
What can ectopic production of ACTH by SCLC cause?
A
Cushing’s syndrome
25
What can ectopic production of ADH by SCLC cause?
SIAD
26
What genetic abnormalities are common in SCLC?
- Mutations in RB1 and TP53
| - Abnormal DNA methylation of the cyclin D2 gene
27
What % of cases of SCLC have mutations in RB1 and TP53?
80%
28
What % of lung cancers are non-small cell lung cancers?
80%
29
Where do NSCLC arise from?
The epithelial cells of the lung, from the central bronchi to the terminal alveoli
30
What types can NSCLC be divided into?
- Squamous cell carcinoma
- Adenocarcinoma
- Large cell carcinoma
31
What % of lung cancers are squamous cell carcinomas?
50%
32
How do lung squamous cell carcinomas often present?
As an obstructive lesion of the bronchus, causing infection
33
How might lung squamous cell carcinomas appear on the CXR?
Cavitation
34
Describe the course of lung squamous cell carcinomas?
They tend to grow slowly, spread locally, and disseminate late
35
What % of lung cancers are adenocarcinomas?
15%
36
Where do lung adenocarcinomas arise from?
The bronchial mucosal glands - tend to arise in the periphery
37
What is the result of lung adenocarcinomas tending to occur at the periphery?
The presentation can represent a metastasis from a distant site, so careful patient assessment is required
38
How do the risk factors for lung adenocarcinomas differ from other lung tumours?
There is less of an association with smoking with adneocarcinomas
39
What can lung adenocarcinomas arise in?
Scar tissue
40
Do lung adenocarcinomas metastasise?
Yes, they have a high risk of metastatic spread
41
Where do lung adenocarcinomas often metastasise to?
- Mediastinal lymph nodes
| - Pleura
42
What does lung adenocarcinoma metastasising to the pleural produce?
Effusion
43
What % of lung cancers are large cell carcinomas?
10%
44
How do large cell carcinomas often present?
As a large peripheral mass on a chest radiograph
45
How might large cell carcinomas produce paraneoplastic features?
They can have neurosecretory elements producing paraneoplastic features
46
Describe the features of large cell carcinomas?
- Tend to be poorly differentiated
- Can grow rapidly
- Metastasise early
47
What is the most common presentation of lung cancer?
Cough
48
What % of patients with lung cancer present with a cough?
41%
49
What are the other symptoms of lung cancer?
- Chest pain
- Haemoptysis
- Breathlessness
- Recurrent chest infections
Patients can be asymptomatic
50
In which type of lung cancer is finger clubbing particularly common?
NSCLC
51
What symptoms can local spread of lung cancer result in?
- Lymphadenopathy
- Dysphagia
- Hoarseness of the voice
- Shoulder pain
52
How can local spread of lung cancer cause hoarseness of voice?
Recurrent laryngeal nerve involvement
53
How can metastases from lung cancer present?
- Bone pain
- Liver discomfort
- Neurological signs due to CNS involvement
54
What are the extra-thoracic symptoms of lung cancer?
- Anorexia
- Weight loss
- Malaise
- Lethargy
55
What paraneoplastic syndromes are associated with lung caner?
- Dematomyositis
- Acanthosis nigricans
- Lambert-Eaton myasthenic syndrome (LEMS)
- Ectopic production of ACTH, ADH, and PTHrP
56
What should be looked for on facial examination in lung cancer?
- Conjunctival pallor
- Jaundice
- Horner's syndrome
- Cushingoid features
57
What lymph nodes should be examined in lung cancer?
- Neck
- Supraclavicular
- Axillary
58
What should be looked for on examination of the hand in lung cancer?
- Clubbing
- Signs of smoking
- Pallor
- Wasting of small muscles
59
What causes wasting of small muscles in lung cancer?
T1 root compression
60
What should be looked for on cardiovascular examination in lung cancer?
- SVC obstruction
- Atrial fibrillation
- Pericardial effusion
61
What should be looked for on respiratory examination in lung cancer?
- Tachypnoea
- Stridor
- Consolidation
- Pleural effusion
62
What should be looked for on abdominal examination in lung cancer?
- Abdominal distention
- Ascites
- Hepatomegaly
63
What should be looked for on neurological examination in lung cancer?
- Confusion
- Focal neurological signs
- Sensory deficit
- Spinal cord compression
- Memory deficit
- Personality change
- Hallucinations
64
What should be looked for on skeletal survey for lung cancer?
- Focal bone tenderness
- Pathological fractures
- Wrist tenderness and ankle tenderness
65
What is wrist and ankle tenderness a sign of in lung cancer?
Hypertrophic osteopathy
66
What is the aim of investigation in lung cancer?
- Gain histological diagnosis
| - Determine extent of spread (stage)
67
What should investigation in lung cancer include?
- Chest x-ray
- FBC
- Liver function tests
- Serum calcium
68
What is the problem with sputum cytology in lung cancer?
It can be unreliable
69
What is CT imaging used for in lung cancer?
- Assess tumour size and spread
- Assess lymph node involvement
- Identify chest wall invasion or metastasis to other sites
70
How is tissue for diagnostic testing usually obtained in lung cancer?
During a bronchoscopy
71
What other ways of obtaining tissue for diagnostic testing may be considered in lung cancer?
- FNA of involved lymph nodes
| - CT guided biopsy
72
What fluid might be used for fluid cytology in lung cancer?
From any pleural effusion
73
What investigations should be done if bone pain is present in lung cancer?
- X rays
| - Bone scan imaging
74
What is PET/CT used for in lung cancer?
Increasingly used as an alternative to invasive mediastinoscopy to determine the operability of the patient
75
What treatment is required in SCLC?
Chemotherapy
76
What chemotherapy agent is used in SCLC?
Etoposide combined with carboplatin or cisplatin
77
What chemotherapy regime is used in SCLC?
Chemotherapy delivered at 3 weekly-intervals for 4-6 cycles
78
What is the response rate of SCLC to chemotherapy?
80-90% for limited stage, 60-90% for extensive stage
79
What is the limitation of chemotherapy in SCLC?
Most patients relapse, and medial survival is only improved by about 14 months
80
Describe the use of radiotherapy in SCLC?
- Can be used as concurrent therapy with curative intent
- Pallitation
- Proprohylactic cranial irradiation
81
Why is radiotherapy useful for pallitation in SCLC?
As 60% of relapses occur within the thorax
82
Who might receive prophylactic cranial irradiation in SCLC?
Those being treated with curative intent
83
What is the purpose of prophylactic cranial irradiation in SCLC?
Reduce risk of CNS metastasis
84
What is NSCLC treatment dependant on?
- Patient
| - Type and stage of cancer
85
What offers the best curative option for stage 1, 2, and some 3a NSCLC patients?
Complete surgical excision
86
What is complete surgical excision often followed by in NSCLC?
Adjuvant chemotherapy
87
What is the aim of surgery in NSCLC?
Remove the primary tumour with all locoregional lymph nodes
88
What do patients require to be able to undergo surgery for NSCLC?
Sufficient fitness and respiratory function
89
How is stage 3b or 4 NSCLC managed?
Chemotherapy
90
What is the purpose of chemotherapy in stage 3b/4 NSCLC?
Improvement in symptoms and disease control
91
What chemotherapy regime is used in NSCLC?
4-6 cycles using a combination carboplatin or cisplatin with gemcitabine or vinorelbine
92
What % of patients with NSCLC respond to chemotherapy?
40%
93
What is the problem with chemotherapy in NSCLC?
There are limited survival gains of 6-7 weeks
94
What is the second line chemotherapy agent in NSCLC?
Docetaxel
95
What therapy can be offered to patients with NSCLC with ECGFR mutations?
EGFR tyrosine kinase inhibitors
96
What is the application of radiotherapy in NSCLC?
Can be used in a radical or palliative setting
97
How can high-dose curative radiotherapy be given for NSCLC?
Using a schedule of continuous hyperfractionated accelerated radiotherapy (CHART)
98
How is continuous hyperfractionated accelerated radiotherapy (CHART) delivered ?
3 fractions per day for 12 days
99
Over what time period is palliative radiotherapy given for NSCLC?
6 weeks
100
Which patients are suitable for palliative radiotherapy in NSCLC?
- Symptomatic disease
- No metastatic spread
- Good performance status
101
What can palliative radiotherapy be useful for in NSCLC?
Symptom control, in particular to improve pain, haemoptysis, breathlessness, and cough
102
What intervention should patients with SVC obstruction be considered for?
Stent insertion or radiotherapy
103
What % of patients with SVC obstruction will have SCLC?
50%
104
What is the result of 50% of patients with SVC obstruction having SCLC?
Prompt responses to chemotherapy are common
105
How are paraneoplastic syndromes due to production of hormones managed?
The syndrome features will improve if treatment for the underlying cancer is successful
106
What should be done if the features of paraneoplastic syndromes return after treatment of the underlying cancer?
It should be considered as a possible relapse, and investigated accordingly
