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Year 4 Cancer Care and Haem > Thoracic Cancers > Flashcards

Thoracic Cancers Flashcards

(85 cards)

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1
Q

Lung cancer is the second most common cancer in the UK. Name four linked aetiologies

A

Cigarette smoking (particularly unfiltered and high nicotine)
Passive smoking
Asbestos
Chest Radiotherapy

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2
Q

Discuss screening and prevention of Lung Cancer

A

Screening with CXR and sputum cytology doesn’t reduce mortality

Trial with Spiral CT in smokers

2007 smoking ban in public places will reduce rates in future

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3
Q

Describe the histological subtypes of Lung Cancer

A

Small Cell Carcinoma (15-20%)

Non Small Cell Carcinoma (Squamous 30%, Adenocarcinoma 40%, Large Cell, Adenosquamous)

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4
Q

How does Small Cell Carcinoma present on histology?

A

Small Purple Cells

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5
Q

Describe the characteristics of Small Cell Carcinoma of the Lung

A 
Derived from Neuroendocrine cells (normally in the large airways)
Very aggressive (90% metastasise)
Associated with paraneoplastic syndromes
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6
Q

Describe the characteristics of Adenocarcinomas of the Lung

A

Usually peripheral but even small tumours metastasise

Commonly metastasising to: Liver, Adrenals, Other Lung, Pleura, Bone

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7
Q

Describe the characteristics of Squamous Cell Carcinoma of the Lung

A

Arise in proximal bronchi and grow slowly, disseminating in late course

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8
Q

What can a Pancoast Tumour compress?

A 
Braciocephalic Vein
Subclavian
Phrenic Nerve
Vagus Nerve
RLN
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9
Q

How does a Pancoast Tumour present?

A

Hoarse Voice
Bovine Cough
SVCO
Hand muscle wasting

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10
Q

Give four genetic mutations that are potentially associated with Lung Cancer

A 
EGFR Overexpression (Oncogene)
p53 Inhibition (Tumour Supressor)
Increased VEGF (Angiogenesis)
Telomerase Activation
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11
Q

Lung Cancer normally presents late as symptoms are often attributed to smoking. Give 5 symptoms

A 
Persistent Cough (>3 weeks)
Haemoptysis
Recurrent Chest Infections
Chest Pain
Hoarse Voice
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12
Q

What is the criteria for a 2ww referral along the lung cancer pathway?

A

CXR showing Lung Cancer or Mesothelioma
OR
Over 40 with unexplained haemoptysis

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13
Q

Describe some different referral criterias for a 2ww CXR for Lung Cancer

A

Over 40 with: Recurrent chest infection/Finger Clubbing/Cervical LN/Consistent Chest Signs/Thrombocytosis

Over 40 and never smoked with atleast two/used to smoke with atleast one of: Fatigue, Cough, Dyspnoea, Weight Loss, Chest Pain

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14
Q

What are the three main investigations for suspected Lung Cancer?

A

CXR
CT Staging with Contrast
Biopsy (If central then ideally via bronchoscopy, then if not via sputum, peripheral via needle biopsy)

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15
Q

Give four potential features seen on CXR of Lung Cancer

A

Circular Opacity
Hilar Enlargement
Consolidation
Pleural Effusion

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16
Q

Describe the WHO Performance Status

A 
0 - Asymptomatic
1 - Symptomatic but ambulatory
2 - In bed < 50% but unable to work
3 - In bed > 50%, no self care
4 - Bedridden
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17
Q

Who is involved in the MDT Lung Cancer team?

A 
Physician
Specialist Nurse
Radiologist
Thoracic Surgeon
Oncologist
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18
Q

What investigation can be done to specifically look for Liver and Bone metastases from the Lung?

A

FDG PET CT

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19
Q

Lung Cancer is staged via TNM. Describe Tx - T2

A 
Tx - Positive malignant cytology, no lesion
T0 - No evidence of primary tumour 
T1a - <2cm
T1b -2 to 3 cm
T2a - 3 to 5cm
T2b - 5 to 7cm
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20
Q

Lung Cancer is staged via TNM. Describe T3 - T4

A

T3 - >7cm invading, assoicated atelectasis, separate nodules in same lobe

T4 - Invasion of mediastinal organs, malignant effusion, RLN

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21
Q

How is suitability for surgical management of Lung Cancer assessed?

A

Thoracoscore

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22
Q

What are the surgical options for management of Lung Cancer?

A

Lobectomy
Pneumonectomy
Wedge resection for small tumours

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23
Q

Patients post op from surgical Lung Cancer management are managed in ICU/HDU, what are further treatment options?

A

Adjuvant Cis Platin if good performance score

Radiotherapy if incomplete resection

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24
Q

Give two early and two late complications of surgical management of Lung Cancer?

A

Early - Haemorrhage, Resp Failure

Late - Post Thoracotomy Pain, Late Bronchopulmonary FIstula

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25
Name a biological treatment option for Lung Cancer
Afatinib (eGFR Tyrosine Kinase Inhibitors)
26
Name an immunotherapy treatment option for Lung Cancer
Pembidizumab (prevents inhibition of T cell response)
27
What is the preferred Chemotherapy regime for Adenocarcinoma of the lung?
Pemetrexed Cisplatin (also a radiosensitiser) Carboplatin
28
Lung Cancer can also be managed by radical radiotherapy if unsuitable for surgery. Give three disadvantages of this
``` Frequent hospital attendance Acute toxicities (oesophagitis) Late toxicities (lung fibrosis) ```
29
Lung Cancer can also be managed by radical radiotherapy if unsuitable for surgery. Describe the CHART regimen
54Gy in 36 fractions over 12 days (8am, 12pm, 8pm)
30
Give three prognostic factors of Small Cell Carcinoma of the Lung
Performance Status LDH Na+ (SIADH = poor prognosis)
31
Small Cell Carcinoma of the Lung is staged slightly differently. Describe it
Limited Stage - confined to one hermithorax, ipsilateral hilar LN, supraclavicular and mediastinal nodes Extensive Stage - Metastatic lesions in contralateral lung, distant metastatic involvment
32
Surgery is generally not recommended in Small Cell Carcinoma of the lung, describe the use of chemotherapy
Limited Stage: 4-6 cycles of cisplatin combination Extensive Stage: Maximum 6 cycles of above
33
Surgery is generally not recommended in Small Cell Carcinoma of the lung, describe the use of radiotherapy
Limited: Thoracic irratiation alonside/after chemotherapy Extensive: Offered if complete response at distant sites and good response in thorax
34
Give two local complications of Lung Cancer
Horners Syndrome | RLN Palsy
35
Give two metastatic complications of Lung Cancer
Confusion | Bone Pain
36
Give two non metastatic complications of Lung Cancer
SIADH | Lambert Eaton Syndrome
37
What is Lambert Eaton Syndrome?
Autoimmune targeting of voltage gated sodium channels causing muscular weakness Associated with Small Cell Carcinoma
38
Define Mesothelioma
Aggressive tumour arising from serosal lining of chest Strong association with asbestos exposure
39
Describe the pathology of Mesotheliomas
Grows diffusely in pleural space Associated with pleural effusion 3 histological subtypes (epithelioid, sarcomatous, mixed)
40
What is seen on CXR of Mesothelioma?
Pleural effusion/thickening
41
What is seen on CT and MRI of Mesothelioma?
CT - Pleural mass and effusion encasing lung | MRI - definition of tissue planes
42
How is Histology taken for suspected Mesothelioma?
US/CT guided biopsy OR Thoracoscopy and Biopsy (risk of seeding into chest wall)
43
How are Mesotheliomas staged?
Brigham staging I - One side of the pleura II - Intrapleural adenopathy III - Extension into chest wall/ribs/spine/peritoneum/pericardium IV - Distant metastatic disease
44
Surgical management is ideal for Mesothelioma, but only applicable in certain cases, such as:
Stage I if medically fit Stage II and III as part of multimodal therapy Extrapleural pneumonectomy
45
Describe the use of Radiotherapy/Chemotherapy for Mesothelioma
Radiotherapy - short course for painful chests Chemotherapy - Pemetrexed in combination with Cisplatin/Carboplatin
46
What is different about the management and paperwork of Mesotheliomas as opposed to other cancers?
Patients are entitiled to compensation All deaths must be notified to coroner
47
How does the incidence of Breast Cancer increase with age?
Incidence doubles every decade until menopause After 50y there is a slower increase
48
Give 5 risk factors for Breast Cancer
``` Early Menarche and Late Menopaus Exogenous Oestrogens (COCP, HRT) Obesity Previous breast surgery (eg augmentation) Radiation ```
49
How should a family history of breast cancer be managed?
- 45-65% of those who inherit BRCA1/2 will get breast cancer before the age of 70 - Prophylactic mastectomy (+/- Oophorectomy) - Annual MRI for BRCA1/2 carriers (aged 30-50)
50
What is the most common type of Breast Cancer?
Ductal Carcinoma More common in left breast
51
Define DCIS
- Atypical proliferation of ductal epithelium that eventually plugs ducts with neoplasm - Remains within basement membrane - Progression to invasive disease is 30-50%
52
How does DCIS present on mammography?
Microcalcification
53
How is LCIS different from DCIS?
Neither palpable nor showing microcalcifcations on mammography
54
Invasive Ductal Carcinoma accounts for 75% of breast cancers , and is graded from I-III. How is the grade calculated?
Tubule Formation Nuclear Pleomorphisms Mitotic Frequency
55
Name two prognostic markers of Breast Cancer and a score
ER receptor status HER2 receptor status Nottingham Prognostic Score
56
What is a 'Triple Negative' Breast Cancer?
ER, PR and HER2 negative 15% of breast cancers
57
What is Paget's Disease?
Ductal carcinoma with involvement of nipple skin and areola (presents like nipple eczema)
58
What are Breast Cysts?
Epithelial lined fluid filled cavities formed when lobules become distended due to blockage Normally affects perimenopausal age group
59
How are Breast Cysts investigated?
``` Mammography (classic halo shape) Needle Aspiration (cytology) ```
60
What is Mammary Duct Ectasia?
Dilation and shortening of the lactiferous ducts | Common in the peri-menopausal age group
61
How does Mammary Duct Ectasia present?
Green/Yellow nipple discharge Palpable mass Retracted nipple
62
How is Mammary Duct Ectasia investigated?
Mammography (dilated calcified ducts) | Biopsy (multiple plasma cells)
63
Name 5 types of benign breast lumps
``` Fibroadenoma Adenoma Papilloma Lipoma Phyllodes ```
64
How does a Papilloma present?
Typically in sub-areolar region | Clear/bloody nipple discharge
65
What are Phyllodes tumours?
Rare fibroepithelial tumours that grow rapidly | Should be excised as a 1/3 have malignant potential
66
Give five presentations of Breast Cancer
``` Breast Lump Axillary Lump Breast Skin Changes (dimpling, puckering, erythema) Nipple Changes (inversion, discharge) Abnormal mammogram ```
67
Name four possible criteria for a 2ww Breast Cancer referral
- Any age with discrete hard lump that is fixated - >30 with lump persisting after period - Unilateral eczematous changes unresponsive to steroids - Persistent axillary swelling
68
Name three possible criteria for a routine Breast referral
<30y with a lump (no other concerning features) <50y with intermittent nipple discharge (non bloody) Mastalgia and no palpable abnormality
69
What is a Triple Assessment for Breast Cancer
Examination Imaging Biopsy
70
What is the radiographical choice for Breast Cancer?
Mammography if over 35y (two views - caudiocranial, mediolateral) USS in younger patients (due to denser tissue)
71
When would you use an MRI to image breasts?
Familial Cancer Screening | Breast Implants
72
What is involved in the clinical examination of suspicious Breasts?
Calliper measurement of any lumps Assessment of fixicity Lymphadenopathy
73
Describe the biopsy options for Breast Cancer
Impalpable Lesions use US guided FNA (quicker and less painful) Ideally use Core Biopsy (allows more information about tumour grade and receptor sensitivity)
74
What is a Sentinel Node Biopsy?
Removing the first lymph node that the breast tissue drains to, found by injecting radioactive blue dye
75
Name three adverse effects of Axillary Clearance
Lymphoedema Arm Pain Stiff Shoulder
76
Describe the T of TNM Breast Cancer Staging
``` T0 - in situ T1 - <2cm T2 - 2-5cm T3 - >5cm T4a - Involvement of chest wall T4b - Involvement of skin T4c - Involvement of chest wall and skin T4d - Inflammatory ```
77
What are the management options for In Situ Breast Cancer?
Mastectomy Wide Excision Alone Wide Excision and whole Breast Irradiation
78
What is the role of Adjuvant Hormone Therapy in Breast Cancer?
Aims to eradicate micrometastatic disease Generally given for 10y Premenopausal - Tamoxifen Post menopausal - Anastrazole
79
Adjuvant chemotherapy for Breast Cancer has a good response in Pre-Menopausal Women. Describe a typical regime
Doxorubicin Fluorouracil Cyclophosphamide
80
What are the key treatments for Advanced Breast Cancer?
``` Endocrine therapy (if ER positive) Chemotherapy ```
81
Give a benefit and disadvantage to immediate breast reconstruction in Breast Cancer
Preserves native skin so more symmetrical outcome Can delay adjuvant therapy if any post op complications
82
Give a benefit and disadvantage to delayed breast reconstruction in Breast Cancer
Allows focus on cancer treatment Extra skin needs to be gathered from other site or donor
83
Give three reconstructive options post Mastectomy
Lat Dorsi - for smaller breasts, can be free or pedicled TRAM - Transverse Rectus Abdominus Muscle DIEP - Deep Inferior Epigastric Perforator
84
Give an advantage and disadvantage to adjuvant treatment in Breast Cancer
Immediate surgical removal of disease Can't assess full efficacy of treatment
85
Give an advantage and disadvantage to neoadjuvant treatment in Breast Cancer
Allows visualisation of tumour response Risk of over treatment

Year 4 Cancer Care and Haem (16 decks)

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