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Oncology + Palliative > Lung Cancer > Flashcards

Flashcards in Lung Cancer Deck (34):
1

Staging for NSCLC

Use TNM

T1 = 1-3cm

T2 = 3-5cm 

T3 = 5-7cm 

T4 = >7cm 

N1 = lung or hilar lymph nodes

N2 = ipsilateral mediastinum lymph nodes or under carina

N3 = lymph nodes contralateral to affected side, in supraclavicular fossa or at apex of lung

2

Staging for SCLC

Limited = 1 lung

Extensive = both lungs 

3

5 types of NSCLC

Squamous cell

Adenocarcinoma

Large cell

Carcinoid tumours

Bronchoalveolar

4

What is the prevalence + characteristics of squamous cell cancer?

42% of NSCLC

Large lesion centrally (bronchus), leading to infection

Closely linked with smoking

Can secrete PTH relate peptide - leading to malignancy related hypercalcaemia

5

What is the prevalence + characteristics of adenocarcinoma?

30% of NSCLC

Contains mucus cells 

Often brain + bone mets

Seen in non-smokers, associated with asbestos

Arises in peripheral areas of the lung

More frequent in women

Associated with activating mutations in EGFR + ALK

6

What is the prevalence + characteristics of large cell lung cancer?

8% of NSCLC

Mets early

Less differentiated

Generally small tumours, in people under 40

7

What are the characteristics of carcinoid tumours?

Most indolent type - unrelated to smoking

Can metastasize

Secrete serotonin which increases peristalsis + causes diarrhoea + can cause bronchoconstriction

8

What do broncoalveolar cell cancers look like?

Peripheral solidary nodule or diffuse nodular lesions

9

What is the prevalence + characteristics + management of small cell carcinomas?

20% of lung cancer

Strong link to smoking + uranium mining

Arise from Kulchitsky cells

Rapidly growing + highly malignant

Chemotherapy often only option. No role for radiotherapy due to pneumonitis

Associated with paraneoplastic syndromes, causing SIADH, Cushings, Lambert Eaton Myesthaenic syndrome (LEMS)

10

What are the characteristics of mesotheliomas?

Cancer of pleura

Extremely asbestos related

Recurrent pleural effusions

11

Epidemiology - what % of cancers are lung, how many deaths are caused 

13% of cancers + 22% of cancer deaths

Bronchial carcinoma = 95% of all lung cancers

M:F = 3:1

1 in every 13 men

1 in every 15 women

12

RF

Smoking

Increasing age

COPD

Epidermal growth factor receptor

Genetics

13

Symptoms

Cough, haemoptysis, dyspnoea, chest pain, recurrent pneumonia, lethargy, anorexia, weight loss

14

Signs

Cachexia, anaemia, clubbing, HPOA (hypertrophic pulmonary osteoarthropathy causing wrist pain)

Supraclavicular nodes, Horner's syndrome

Consolidation, collapse, pleural effusion

Paraneoplastic symptoms

15

Paraneoplastic symptoms

Most often due to SCLC but can also be due to NSCLC

Hypercalcemia due to parathyroid-like hormone production occurs most commonly in patients with SCCs

Clubbing and hypertrophic pulmonary osteoarthropathy and Trousseau syndrome of hypercoagulability are caused more frequently by adenocarcinomas

The syndrome of inappropriate antidiuretic hormone production (SIADH) is more common in SCLC but can also occur in NSCLC.

Cushing syndrome from ectopic adrenocorticotropic hormone (ACTH) production is more likely to occur in SCLC or bronchial carcinoid

Lambert Eaton syndrome – autoimmune against the neuromuscular junction usually SCLC

16

Common mets

Lymph nodes, brain, bones, liver, adrenal glands

17

Other types of tumour

Bronchial adenoma (rare, slow growing, 90% carcinoid, 10% cylindromas)

Hamartoma (rare, benign, CT lobulated mass with flecks of calcification)

Mesothelioma (cancer of pleura)

18

Investigations for staging

CXR Cytology (sputum + pleural fluid)

CT to stage tumour

Bronchoscopy for histology +- endobronchial

US PET scan to check distant mets

Tumour markers = NSE + LDH

Pulmonary function tests

19

Findings on CXR of lung cancer

Peripheral nodule, hilar enlargement, consolidation, lung collapse, pleural effusion, bony secondaries

20

Staging assessment - bloods + imaging

Serum lactate dehydrogenase, LFTs + serum sodium

CT of chest, liver + adrenal glands

21

10 year overall + 5 year survival rates for NSCLC/ SCLC based on stages 1 or 4

10 year = 5.5%

NSCLC = 92% for stage 1 to 1% for stage 4 

SCLC = 31% stage 1 to 2% stage 4

22

Treatment of NSCLC by stage

Stage 1/2 = excision, adjuvant chemo + RT.

Curative RT if not suitable for surgery

Stage 3 = lobectomy/ pneumonectomy + adjuvant chemo/ radiotherapy

Stage 4 = chemo +- radiotherapy - may involve immunotherapy

23

SCLC treatment

Palliative chemo (cisplatin)

Limited stage = radical RT + chemo

Surgery not an option

Denosumab for bone mets

24

Local complications of lung cancer

Recurrent laryngeal nerve palsy

SVC obstruction

Horners syndrome

Rib erosion Pericarditis AF MSCC

25

How to place a chest drain

Triangle of safety

Anterior border = lateral edge of pec major

Lateral border = lateral edge of latissimus dorsi I

nferior border = line of 5th IC space

Typical depth = 10cm

Don't drain more than 500ml at a time

26

Apical tumours cause what specific symptoms?

Invade brachial plexus = Horner's syndrome or Pancoast's syndrome (pain in nerve roots)

27

What specific histology/ cancer is associated with: Clubbing Sputum production

Clubbing = squamous cell

Sputum = bronchio-alveolar

28

Prognosis for SCLC with + without treatment

2-4 months no treatment

6-12 months with chemo

29

Prognostic factors

Extent of disease

Number of met sites

Performance status

Degree of weight loss

Biochemical abnormalities (high LDH, low sodium/ albumin)

30

What type of RT is used in NSCLC + how often is it given?

Continuous hyperfractionated accelerated RT (CHART)

3X a day for 12 days

31

What is targeted chemo in NSCLC?

Adenocarcinoma tested for EGFR + ALK mutations

If positive, TKIs used for EGFR mutatuins + Crizotinib for ALK

32

Immunotherapy use in NSCLC

Pembrolizumab

When high PDL1 expression - used before or after chemo

33

When is prophylactic cranial RT used?

SCLC that has responded to chemo 

34

What is SABR?

Stereotactic Ablative Body RT 

Used for early NSCLC - used to give small number of large doses to a small area