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Respiratory YR3 > Lung cancer and pleural disease lecture > Flashcards

Lung cancer and pleural disease lecture Flashcards

1
Q

How common is lung cancer?

A
  • One of most common cancers in UK
  • Commenest cause of cancer deaths
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2
Q

Assessing x-ray RIP

A
  • Patient name and DOB
  • AP/PA?
  • Date
  • Is it Rotated? - clavicles equidistant from spinous process
  • Is there adequate Inspiration - 6 anterior ribs/8-10 posterior ribs?
  • Is there adequate Penetration - can you see vertebrae through heart?
    RIP
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3
Q

Areas which lung cancer metastasises to?

A
  • Liver
  • Brain
  • Bones
  • Adrenals (sometimes kidney)
  • Skin mets
  • Splenic
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4
Q

Language for CT interpretation

A
  • Attenuation
  • Lower attenuaton = darker
  • Higher attenuation = brighter
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5
Q

Language for MRI interpretation

A
  • High signal = bright
  • Low signal = dark
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6
Q

Language for PET scan interpretation

A
  • High FDG avidity - bright
  • Low FDG avidity - dark
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7
Q

What time do lung cancers often present?

A

Late - tumours have to get quite large before causing symptoms

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8
Q

Tumour doubling time lung cancer

A

30-100 days - tumour sometimes doubles while waiting for diagnosis

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9
Q

Intrathoracic presentation symptoms/signs of lung cancer

A
  • Peristent cough that has changed recently
  • Haemoptysis
  • Monophonic wheeze - one sound, partial blockage of one section of airway at one level
  • Increasing breathlessness
  • Infection - eg consolidation on CXR or sometimes lobar collapse
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10
Q

Extrapulmonary signs/symptoms of lung cancer

A
  • Hoarseness voice - L RLN nerve compression
  • SVCO - headache, faint, breathless
  • Dysphagia
  • Palpitations - pericardium involved?
  • Shoulder/inner arm pain - brachial plexus impinged or bone mets
  • Chest pain
  • Poor appetite
  • Weight loss
  • Enlarged lymph nodes
  • Clubbing
  • Cushings syndrome?
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11
Q

What 2 things are important to ask about in history (apart from presenting complaint) for lung cancer?

A
  • Smoking history
  • Occupation history
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12
Q

How to ask smoking history?

A
  • Do you smoke now?
  • If yes, how much and for how long and has this changed recently?
  • If no, have you ever smoked?
  • Do you smoke anything else?
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13
Q

How to ask occupation history?

A
  • What was the nature of exposure? (eg asbestos powder?)
  • When were you exposed until when?
  • Who was your employer?
  • Was there protective gear provided?
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14
Q

Death certificates if mesothelioma or if someone has received a war pension?

A

Goes to coroner - they determine cause of death

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15
Q

Assessing suitability for management of lung cancer?

A

WHO performance status

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16
Q

How to deliver to someone that their scans may show cancer?

A
  • I can’t be certain what this is yet
  • Possibilities include infection, TB, inflammation and another possibility, something I need to make sure I rule out is a growth in the lung, possible even a lung cancer
  • But all we can be sure of at the moment are the pictures of your scans
  • Offer contact details of cancer nurse specialists
17
Q

Inv for lung cancer - bloods

A
  • U&E
  • LFT
  • Calcium
  • FBC
  • Clotting - esp if thinking of biopsy
18
Q

Imaging for lung cancer suspect

A
  • CXR
  • Staging CT - contrast from neck to adrenals
  • +/- CT head, PET-CT (with FDG radioactive glucose)
19
Q

Special tests for suspected lung cancer

A
  • Spirometry and transfer factor (DLCO diffusing capacity carbon monoxide)
  • = Ability of lungs to transfer inhaled gas to bloodstream
  • ECHO
20
Q

What can areas of high avidity be on PET scan?

A
  • Abscess
  • Infection eg TB
  • Cavitating tumour?
  • Cancer
  • General inflammation
21
Q

When can we biopsy lung cancers?

A

If closer to pleura

22
Q

Ways of biopsying lung cancers?

A
  • bronchoscopy
  • EBUS - endobronchial US - can use bronchoscope + US to see lymph node masses nearby just outside airway wall, can then biopsy these
  • Image guided biopsy - eg from outside pt
23
Q

Types of lung cancer

A
  • Small cell - neuroendocrine, aggressive
  • Non-small cell - squamous, large cell, adenocarcinoma
24
Q

Squamous cell sub divisions

A

PD-L1

25
Q

Adenocarcinoma subdivisions

A
  • PD-L1
  • EGFR
  • ALK
  • ROS1
26
Q

Treatment dependent on…

A
  • Performance score
  • Co-morbidities
  • Stage
27
Q

Treatment options for lung cancer

A
  • Surgical resecreion (or SABR) - sterotactic ablative radiotherapy
  • Radical or palliative radiotherapy
  • Systemic anti cancer - chemotherapy plus immunotherapy
28
Q

Median survival of lung cancer time

A

1yr - 40%
320days

29
Q

Screening programme lung cancer UK

A
  • low dose CT scan
  • Aged 55-74 who recorded smoking history on GP record
  • Assessed and determined if high risk (20 pack years) - if they are, they get low dose CT scan and offered smoking cessation advice
  • Have every 2 years
30
Q

Asbestos related diseases

A
  • Mesothelioma
  • Benign pleural thickening
  • Asbestosis - ILD
  • Lung cancer - increased RF
31
Q

What 3 things can accumulate in pleura?

A
  • Fluid
  • Air
  • Tumour
32
Q
A

Respiratory YR3 (14 decks)

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