Flashcards in Respiratory Deck (350)
How common is lung cancer compared to other cancers in the UK?
- Thirst most common - Behind breast (first) and prostate (second)
What is by far the biggest cause of lung cancer?
Smoking - 80% of lung cancer believed to be preventable
What are the two main histological types of lung cancer?
- Non-small cell lung cancer (NSCLC)- Small cell lung cancer (SCLC)
Which is the most prevalent histological form of lung cancer?
- Non-small cell lung cancer (NSCLC); 80%- Small cell lung cancer (SCLC); 20%
What are the two subtype of Non-small cell lung cancer (NSCLC)?
- Squamous cell carcinoma (35%)- Adenocarcinoma (25%)
Why are small-cell lung cancers (SCLC) responsible for many paraneoplastic syndrome?
Small cell lung cancer cells contain neurosecretory granules that may release neuroendocrine hormones
Outline the signs and symptoms of lung cancer?
- SOB- Cough - Haemoptysis - Finger clubbing - Recurrent pneumonia- Unexplained weight loss- Lymphadenopathy; often in the supraclavicular nodes
What is the first line investigation in suspected lung cancer?
What findings may be present on CXR in a patient with lung cancer?
- Hilar enlargement - Peripheral opacity; visual lesion in the lung field(s)- Pleural effision; usually unilateral in cancer - Lung collapse
Once lung cancer has been diagnosed on CXR, what further investigations are required?
- Staging CT Scan; contrast enhanced, checking for lymph node involvement and metastasis- PET-CT; useful in identifying metastasis through ares of increased metabolic activity - Bronchoscopy with endobronchial ultrasound (EBUS); useful for detailed assessment of the tumour and US-guided biopsy- Histololgical diagnosis; using biopsy obtained from EBUS or percutaneously
How are treatment options identified in lung cancers
Must be discussed at lung MDT meeting
What are the broad options for lung cancer treatment?
- Surgery; lobectomy or segmentectomy/wedge ressection - Radiotherapy; curative in NSCLC- Chemotherapy; adjuvant or palliative- Endobronchial treatments; stents or debulking, palliative
What is the first line treatment offered in NSLC if the disease is confined to a single area?
Surgery- Lobectomy; first line - Segmentectomy or wedge resection; secondary option
What medical treatment can be given in patients with NSCLC?
- Radiotherapy; can be curative - Chemotherapy; used as an adjuvant to radiotherapy or as palliative treatment to improve survival/quality of life
Outline the treatment options in SCLC?
Usually a combination therapy of both radiotherapy and chemotherapy
Which kind of lung cancer has the worse prognosis?
Outline the extrapulmonary manifestations/paraneoplastic syndromes associated with lung cancer?
- Recurrent laryngeal nerve palsy- Phrenic nerve palsy- Superior vena cava (SVC) obstruction- Syndrome of innappropriate ADH (SIADH) - Cushing's syndrome - Hypercalcaemia - Limbic encephalitis - Lambert-Eaton Myasthenic Syndrome (LEMS)
How can lung cancer cause recurrent laryngeal nerve palsy?
Tumour may compress the recurrent laryngeal nerve as it passes through the mediastinum, resulting in a hoarse voice
How can lung cancer cause phrenic nerve palsy?
Tumour may compress the phrenic nerve, resulting in shortness of breath
How does lung cancer sometimes cause SVC obstruction?
Direct compression of the SVC by the tumour
How does SVC compression present in patients?
- Swelling of the face- Difficulty breathing- Distended neck veins - Pemberton's sign; raising the hands over the head causes facial congestion and cyanosis
How does Horner's syndrome present?
- Ptosis- Miosis- Anhydrosis
What kinds of lung cancers cause Horner's syndrome?
Pancoast tumours of pulmonary apex; compresses the cervical sympathetic chain
Why can lung cancer trigger SIADH?
Some SCLCs are neuroendocrine tumours that secrete peptide hormones that mimic the action of ADH
How does SIADH present?
Why can lung cancer trigger Cushing's syndrome?
Some SCLC are neuroendocrine tumours that secrete peptide hormones that mimic the action of ACTH and raise the circulating cortisol levels
Why can lung cancer trigger hypercalcaemia?
Some SCLCs are neuroendocrine tumours that secrete peptide hormones that mimic the action of PTH and raise circulating calcium levels
How can some SCLCs result in limbic encephalitis?
Some SCLCs cause the immune system to make antibodies to tissues in the limbic system, causing inflammation. This causes symptoms such as short term memory impairment, hallucinations, confusion and seizures. It is associated with anti-Hu antibodies
What is Lambert-Eaton Myasthenic Syndrome (LEMS)?
- Result of antibodies against voltage-gated Ca2+ channels in presynaptic terminals of motor neurones- Similar to myasthenia gravis