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Cardio-Resp > Lung cancer > Flashcards

Lung cancer Flashcards

1
Q

Describe the epidemiology of lung cancer

A

3rd commonest cancer in the UK
Largest cause of cancer-related mortality in UK and worldwide. 5-year survival is only 13%.
3rd commonest cause of death after CAD and CVD
85% occur in smoker or ex-smokers
44% are diagnosed aged 75 and older
Higher incidence in urban areas

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2
Q

Name 5 risk factors for lung cancer

A

Smoking*
Increasing age
FHx

Environmental: radon gas, asbestos, radiation and chemicals, air pollution

Host: pre-existing lung disease, previous radiation therapy, HIV, immunosuppression, genetics

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3
Q

Categorise the different types of primary lung cancer

A 
Small cell lung cancer (12%)
Non-small cell lung cancer (87%)
-Adenocarcinoma: commonest
-Squamous cell carcinoma
-Large cell carcinoma
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4
Q

Name 3 cancers related to the lungs

A

Pancoast tumours: pulmonary apex
Mesothelioma: pleura
Metastatic lung cancer

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5
Q

Where does metastatic lung cancer commonly originate from?

A 
Breast
Bowel
Kidney: cannonball metastases
Testicle
Bladder
Melanoma
Bone
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6
Q

Describe the features of small cell lung cancer

A 
Accounts for 12% of lung cancers
Arises from neuroendocrine cells
10% paraneoplastic: ACTH (Cushing's), ADH (SIADH)
Often arises centrally
Metastasises early
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7
Q

Describe the features of squamous cell carcinoma

A

Arises from epithelial cells
Associated with keratin production
May secrete PTHrP (hypercalcaemia)
Occasional cavitation with central necrosis
Obstructing lesions of bronchus with infection
Local spread common
Metastasise relatively late

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8
Q

Describe the features of adenocarcinoma

A 
Commonest lung cancer in UK
Originate from mucus-secreting glandular cells
Most common type in non-smokers
Often peripheral lesions on CXR/CT
Subtype: bronchoalveolar cell carcinoma
Commonly metastasises
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9
Q

Describe the features of large cell carcinoma

A

Often poorly differentiated

Metastasises relatively early

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10
Q

Name 5 local effects of lung cancer

A

Lung cancer is often asymptomatic, and presents late.

Cough*: 3-week cough merits CXR
Dyspnoea
Haemoptysis
Monophonic wheeze: partial obstruction

Chest pain:
-pleuritic: invasion of chest wall or pleura
-dull central ache: large-volume mediastinal nodes
Recurrent infection: post-obstructive pneumonia

Hoarse voice: recurrent laryngeal nerve compression
Nerve compression: pancoast tumour
-Klumpke’s paralysis (C8/T1): claw hand
-Horner’s syndrome: anhidrosis, ptosis, miosis
Direct invasion of phrenic nerve

SVC obstruction
Tracheal tumour: progressive dyspnoea and stridor

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11
Q

How does superior vena cava obstruction present?

A

Dyspnoea +/- dysphagia
Swollen oedematous facies and arms
Raised JVP
Dilated veins in upper chest and arms

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12
Q

Name 2 clinical features that can be caused by pancoast tumours

A

Hoarse voice: recurrent laryngeal nerve compression
Klumpke’s paralysis (C8/T1): claw hand
Horner’s syndrome: anhidrosis, ptosis, miosis

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13
Q

What cancer is known to secrete PTH-rp?

A

Squamous cell lung cancer

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14
Q

What cancer is known to secrete ADH and ACTH?

A

Small cell lung cancer

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15
Q

What paraneoplastic syndromes are associated with small cell lung cancer?

A

Cushing’s syndrome from ACTH secretion
SIADH from ADH secretion
Eaton-Lambert syndrome

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16
Q

What paraneoplastic syndrome is associated with squamous cell lung cancer?

A

Hypercalcaemia from PTHrP secretion

17
Q

What sign is associated with metastatic lung cancer originating from the kidneys?

A

Cannonball metastases

18
Q

Where do primary lung cancers often metastasise?

A

Mediastinal, cervical, axillary, intra-abdominal lymph

Liver: anorexia, nausea, weight loss, epigastric pain
Bone: bony pain, pathological fractures, spinal cord collapse*
Adrenal glands: usually asymptomatic
Brain: raised intracranial pressure
Malignant pleural effusion: dyspnoea and pleurisy

19
Q

Name 5 non-metastatic extra-pulmonary manifestations of lung cancer

A 
Weight loss, lethargy, anorexia
Clubbing (30%)
Small cell: SIADH, Cushing's
Squamous cell: Hypercalcaemia
Neuro: encephalitis, motor neurone disease, peripheral sensorimotor neuropathy, Eaton-Lambert syndrome
20
Q

What tests should be ordered for lung cancer?

A

FBC, U&E, LFTs, INR, calcium
CXR
Staging contrast CT of chest, liver and adrenal glands
MRI spine: assess if at risk of cord compression
PET scan: detect mediastinal nodes and small mets

Bronchoscopy + biopsy

21
Q

How is spinal cord compression secondary to lung cancer treated?

A

High dose steroids
Radiotherapy
Surgical decompression

22
Q

What CXR findings may be seen with lung cancer?

A

Mass lesion if >1cm diameter
Pleural effusion: associated pleurisy
Lymphadenopathy or mediastinal widening
Slow-resolving consolidation: post-obstructive pneumonia
Lung collapse: endoluminal tumour
Reticular shadowing: lymphatic involvement

Normal: if confined to central airways and mediastinum

23
Q

What must be done prior to commencing treatment of lung cancer?

A

WHO performance status: fitness for treatment
0-1: tolerate all forms of treatment
2: applicable for curative chemotherapy
3+: palliative care

24
Q

Summarise the management of non-small cell lung cancer

A

Applicable for non-small cell lung cancer*

Ipsilateral tumour + good performance score: surgery
Good staging + performance score: chemotherapy

Stage I/II: curative surgery
Stage IIIa: surgery + adjuvant chemotherapy
Stage III/IV: curative chemo if performance score 0-2

Curative radiotherapy if unfit for surgery or curative chemotherapy

Palliative care
Watch and wait

25
Q

What system is used to stage lung cancer?

A

TNM

26
Q

Why is small-cell lung cancer generally unfit for curative surgery? How is this managed?

A

Rapid growth and early metastases

Curative: cisplatin chemotherapy
-Adjuvant radiotherapy given in limited disease
Palliative: radiotherapy

Combined chemo improves survival from 4-12wk to 6-15 months.

27
Q

Outline the WHO performance status

A

0: Fully active, able to carry out predisease performance without restriction
1: Restricted in physically strenuous activity, but ambulatory and able to carry out work in a light or sedentary nature.
2: Ambulatory and capable of all self-care. Unable to carry out any work activities. Up and about more than 50% of waking hours.
3: Capable of only limited self-care. Confined to bed or chair more than 50% of waking hours.
4: Completely disabled. Cannot carry on any self-care. Totally confined to bed or chair.
5: Death

Cardio-Resp (26 decks)

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