Lung Cancer Flashcards Preview

Year 3 - CR > Lung Cancer > Flashcards

Flashcards in Lung Cancer Deck (40)
Loading flashcards...

What increases the risk of lung cancer

- Smoking
- Asbestos
- Radiation (environmental radon)
- Arsenic
- Chromium
- Coal tar and oils
- Iron oxides
- Recent study: pollution


What is the increase in passive smoking on lung cancer

- passive smokers have a 1.5 fold increased risk
- but this depends on the quantity inhaled


how much lung cancers occurs in non-smokers

15% of lung cancers occurs in non-smokers


if you stop smoking what happens to the risk of lung cancer

- stopping smoking does not lower the risk back down to non-smoking levels - but it does increase life expectancy


What are the genetic mechanisms of lung cancer

- Activation of oncogenes e.g. KRAS, myc family of oncogenes. EGFR and ALK mutations
- Inactivation of tumour suppressor genes e.g. p53
- Autocrine growth factors e.g. derivatives of nicotine found in smoke
- Inherited predisposition (details not fully known)


what are the types of lung cancer

- Small cell (oat cell) lung cancer (SCLC) 10%
- Non small cell lung cancer (NSCLC)


Name the types of non small cell lung cancer

- Squamous cell carcinoma 20-30%
- Adenocarcinoma 40-50%
- Large cell carcinoma 10-15%


What are the features of small cell carcinoma

- Aggressive, early spread, usually inoperable as spreads easily
- May respond to chemotherapy due to rapidly dividing cells
- Endocrine cells: hormones produced


who is squamous cell carcinoma tend to be in

- often cavities


describe large cell carcinomas

- Undifferentiated
- Early metastasis


Name an example of large cell carcinoma

- bronchoalveolar cell (adenocarcinoma in situ)


what does a bronchoalveolar cell (adenocarcinoma in situ) resemble

- may resemble a pneumonia


What are the indications that call for an urgent CXR if you suspect lung cell carcinoma

- haemoptysis

Any of the following for greater than 3 weeks unexplained:
- cough
- chest/shoulder pain
- dyspnoea
- weight loss
- chest signs

Other things
- hoarseness - tumour in left side compressing recurrent laryngeal nerve
- clubbing
- features of mets
- Supraclavicular / Cervical lymphadenopathy


What are chest signs of lung cancer

- Visible swelling
- Facial swelling
- Distended veins - superior vena cava disrupted syndrome
- Reduced expansion
- Dullness, ↓TVF and VR
- Wheeze – esp. unilateral
- Reduced breath sounds


what paraneoplastic syndromes can be caused by small cell lung cancer

- Cushing’s syndrome (ectopic ACTH)
- Lambert Eaton myasthenic syndrome
- Limbic encephalitis
- Cerebellar syndrome

Any – but more common in SCLC
- Dermatomyositis


What paraneoplastic syndrome is in squamous cell carcinoma

- parathyroid hormone-related protein (PTH-rp) secretion causing hypercalcaemia
- clubbing
- hypertrophic pulmonary osteoarthropathy (HPOA)
hyperthyroidism due to ectopic TSH


what should cause a 2 week wait referral for lung cancer

If the CXR or CT scan suggests lung cancer including:
- pleural effusion
- slowly resolving consolidation

If the CXR (or CT) is normal, but there is a high clinical suspicion of lung cancer, the patient should be referred


When should patients be referred whilst having to wait for a CXR

Patients should be referred whilst awaiting a CXR in the presence of:
- Persistent haemoptysis in smokers/ex-smokers older than 40 years
- signs of superior vena caval obstruction (swelling of the face/neck with fixed elevation of jugular venous pressure)
- Stridor

Emergency referral should be considered for patients with superior vena cava obstruction or stridor.


What investigations do you use to stage and diagnose lung cancer

- CT of chest
- bronchoscopy
- CT guided biopsy
- PET scan
- MRI scan for pancoast tumours not used so much for lung cancer
- blood tests - urea and electrolytes for IV contrast which can be dangerous for people in renal impairment


What does staging involved when using a CT scan

“Staging” CT of chest – includes upper abdomen to cover liver, adrenals and kidneys


What are the other staging investigations can be used

- Transbronchial “blind” FNA
- EBUS guided FNA - can look at lymph nodes or tumours that are sitting near the bronchi, can put a fine needle and take samples
- EUS guided FNA
- Mediastinoscopy
- Bone scan
- Brain CT/MRI


Describe the TNM staging for lung cancer

T – based on size and location of tumour.
- T1 is a small peripheral tumour which may be removed surgically (Stage 1 or 2)
- T4 is an advanced large tumour invading e.g. heart (Stage 3)

N – depends on which lymph nodes are involved
- N1 – hilar (Stage 2),
- N2 – mediastinal
- N3 – contralateral (Stage 3)

M – if metastases are present: M1 (Stage 4)
- Common sites: liver, lungs, adrenals, brain, bones


What is the only curative treatment for lung cancer

- Surgery


describe what lung cancers can be surgically treated

- For localised tumours that are not invading other organs e.g. heart, bones
- No signs of spread – have to perform a PET scan
- It is the only chance of a “cure”
- 5 – 10% are suitable


What is the survival rate for lung cancer

70% 5 year survival with successful surgery and a small tumour


name other treatments for lung cancer

- Radical radiotherapy
- palliative radiotherapy
- chemotherapy
- immunotherapy
- adjuvant chemotherapy
- Neo-adjuvant chemotherapy


Describe radical radiotherapy

May be useful in squamous cell carcinoma where surgery not possible (lymph nodes involved, patient declines or not fit)


What are the complications of radical radiotherapy

- Pneumonitis (early)
- fibrosis (late)
- oespheogitis


what is palliative radiotherapy used for

To relieve pain, haemoptysis, neurological problems (brain or spinal metastases


describe chemotherapy use in lung cancer

- Cisplatin, pemetrexed, gemcitabine
- Oral therapy: EGFR antagonists like gefitinib, erlotinib
- ALK (anaplastic lymphoma kinase) mutation: Crizotinib, ceritinib, alectinib
- Newer agents: atezolizumab, durvalumab
- T790M mutation: osimertinib