Flashcards in Respiratory: Lung Cancer Deck (20):
What is the epidemiology of lung cancer?
Has the highest cancer related deaths in the world - also the most prevalent cancer. 20% 5yr survival rate
35,000 deaths per year in the UK
How does the incidence of lung cancer differ between socioeconomic groups?
Higher incidence in lower socioeconomic groups due to higher incidence of smoking, and less likely to access healthcare.
What is the most common age of presentation of lung cancer?
What are the risk factors for lung cancer other than smoking?
- radon from rocks
- occupational carcinogens
- genetic factors
Why is there not screening for lung cancer?
Doesn't lead to a decrease in disease specific mortality so screening does not fulfil criteria
Why is it important to stage lung cancer?
To look at prognosis and what treatments are suitable
What does lung cancer have such a poor prognosis?
80% of pts present non inoperable
Lots of pts have other co-morbidities caused by smoking which limits treatment options
What are the common sites for lung cancer to spread to?
Local spread: draining lymph nodes, pericardium, pleura
Distant spread: brain, liver, adrenals, bone
In the rapid access lung clinic all pts have CT from head to adrenals
What imaging techniques are used for diagnosis and staging of the disease?
CT scan - shows only physical presence
PET scan - shows increased activity in tissues which is important in lymph nodes. Often picks up metastasis that CT doesnt
What are the common methods used to obtain material for histological diagnosis?
USS guided liver biopsy
CT biopsy - of lung and pleura
Pleural fluid aspiration
What are some of the symptoms of lung cancer?
Primary tumour: cough, dyspnoea, wheezing, haemoptysis, lung infection, malaise, weight loss, asymptomatic most common
Regional metastases: hoarseness, dysphagia, chest pain
Distant metastases: bone pain, headache
What are the different types of lung cancer?
Non small cell carcinoma (80%)
Includes squamous cell, large cell and adenocarcinoma which is most common in non smokers
Small cell carcinoma (15%)
How does small cell carcinoma present and what is the prognosis?
60% present when already metastasised
Tumours tend to be located around the hilium
Involve neuroendocrine cells which produce hormones
How does non small cell carcinoma present?
Adenocarcinoma make up half of all non small cell carcinomas - Located near the periphery of the lung and involve glands
Squamous cell located near the main bronchus and can compress the airways
Large cell grow rapidly
What is performance status?
A measure of the activity level of the individual - the cut off for radical treatment is 2 which means the pt is symptomatic but it is in a bed or chair for less than half a day.
What is the best chance of cure for lung cancer?
Surgery, This is mostly used for non small cell carcinomas (20% when operable)
What are the uses of radiotherapy?
Radical radiotherapy has curative intent and may cure small cell carcinomas
Low dose radiotherapy can be used palliatively for symptomatic control
What is neoadjuvant and adjuvant chemotherapy?
Neoadjuvant chemotherapy is before surgery to downstage the tumour and size
Adjuvent chemotherapy is after surgery
What is the role of chemotherapy?
Generally slows cancer rather than cures
- potentially curative for small cell in the minority
- modest survival increase with non small cell