#passmed 2022 > Lung Cancer > Flashcards

Lung Cancer Flashcards

(54 cards)

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1
Q

What is Lung cancer epidemiology? (2 things)

A
  1. 3rd most common cancer in da UK
  2. 1st in cancer related deaths in da UK
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2
Q

What are the causes of Lung Cancer? (2 things)

A
  1. Smoking (80-90% of cases)
  2. Asbestos
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3
Q

What are the divisions of Lung cancer? (2 things)

A

Non-Small Cell Lung Cancer (80%)

  • Adenocarcinoma (40%)
  • Squamous Cell Carcinoma (20%)
  • Large Cell Carcinoma (10%)

Small Cell Lung Cancer (20%) (most dangerous)

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4
Q

Where in the lungs does Adenocarcinoma occur?

A

Mucus secreting cells of Lung peripheries

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5
Q

Which type of Lung cancer is a non-smoker most likely to have?

A

Adenocarcinoma

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6
Q

What is the most common type of Lung cancer?

A

Adenocarcinoma (Non-Small Cell)

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7
Q

Where in the lung does Squamous cell carcinoma occur?

A

Central part of lungs

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8
Q

How does Squamous cell carcinoma present? (apart from normal lung cancer CF)?

A

Pneumonia (2ndary to obstructed bronchus)

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9
Q

Does metastases occur EARLY or LATE in Squamous cell carcinoma?

A

Late

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10
Q

What is the epidemiology of Large cell carcinoma?

A

5% of lung cancers

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11
Q

Does metastases occur EARLY or LATE in Large cell carcinoma?

A

EARLY

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12
Q

What is the pathophysiology of Small Cell Lung Cancer? (2 things)

A
  1. Uncontrolled prolif of APUD cells (small immature Neuroendocrine cells in lungs)
  2. Cells contrain Neurosecretory granules –> release Neuroendocrine hormones –> cause Paraneoplastic Syndromes
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13
Q

Where does Small Cell Lung Cancer usually arise?

A

Centrally: in larger airways

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14
Q

What is special about Small Cell Lung Cancer?

A

Exclusive to smokers

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15
Q

What are the CF of Lung Cancer? (12 things)

A
  1. Cough (80%)
  2. Haemoptysis (70%)
  3. SOB (60%)
  4. Chest pain (40%)
  5. Fever n Malaise
  6. Hoarseness (bc recurrent laryngeal nerve clarted)
  7. Stridor
  8. Wheeze
  9. Lymphadenopathy (supraclavicular nodes 1st)
  10. Clubbing
  11. Weight loss
  12. Paraneoplastic Features (mainly in Small Cell)
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16
Q

What are the Extra-Pulmonary manifestations of Lung Cancer? (4 things)

A
  1. Recurrent Laryngeal Nerve Palsy
  2. Phrenic Nerve Palsy
  3. Superior Vena Cava obst
  4. Horner’s Syndrome
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17
Q

What is Recurrent Laryngeal Nerve Palsy?

What does it cause?

A

Cancer presses on Recurrent Laryngeal Nerve (as it passes thru mediastinum)

Causes –> Hoarse voice

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18
Q

What is Phrenic Nerve Palsy?

What does it cause? (2 things)

A

Cancer presses on Phrenic Nerve

Causes:

  1. Diaphrahm weakness
  2. SOB
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19
Q

What is Superior Vena Cava Obstruction?

What does it cause? (4 things)

A

Cancer presses on SVC

Causes:

  1. Facial + Arm swelling
  2. SOB
  3. Distended veins in Neck + Upper chest
  4. Pemberton’s Sign
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20
Q

What is Pemberton’s Sign? (3 things)

A
  1. Sign of Superior Vena Cava Obst
  2. When you raise hands over head –> Facial congestion + Cyanosis
  3. MEDICAL EMERGENCY
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21
Q

What is Horner’s Syndrome?

What are it’s CF? (3 things)

A

Pancoast tumour (Pulmonary apex tumour, usually a Squamous Cell Carcinoma) pressing on Sympathetic ganglion

Triad of

  1. Anhidrosis (loss of sweating on face)
  2. Partial Ptosis (upper eyelid dropping)
  3. Miosis (small pupil)
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22
Q

What type of Lung Cancer are Paraneoplastic Syndromes mainly caused by?

Study These Flashcards
A

Small Cell Lung Cancer

23
Q

What are the Paraneoplastic Syndromes? (5 things)

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A
  1. Hypercalcaemia
  2. SIADH
  3. Cushing’s syndrome
  4. Lambert-Eaton syndrome
  5. Hypertrophic osteoarthropathy
24
Q

What causes the Paraenoplastic Syndrome of Hypercalcaemia? (2 things)

Study These Flashcards
A
  1. Bony metastasis
  2. Ectopic Parathyroid Hormone secretion (Squamous Cell Carcinoma)
25
What are the CF of the Paraenoplastic Syndrome of Hypercalcaemia? (5 things)
1. Stones = Renal calculi 2. Bones = Bone pain 3. Groans = Abd pain 4. Bol = Polyuria 5. Psychiatric Moans = Alt mental status
26
How common is Hypercalcaemia in each type of Lung Cancer?
Squamous cell carcinoma = 50% Adenocarcinoma = 20% Small Cell Lung Cancer = 15%
27
What causes the Paraenoplastic Syndrome of SIADH?
Ectopic ADH secretion by Small Cell Lung Cancer
28
What are the CF of the Paraenoplastic Syndrome of SIADH? (2 things)
1. Hyponatraemia 2. Cerebral oedema (extreme cases)
29
What causes the Paraenoplastic Syndrome of Cushing's Syndrome?
Ectopic ACTH --\> Increase in Glucocorticoids --\> Cushing's
30
What are the CF of the Paraenoplastic Syndrome of Cushing's Syndrome? (5 things)
1. Moon face 2. Buffalo Hump (fat pad on upper back) (buffalo shouldaaa) 3. Proximal limb muscle wasting 4. Central Obesity 5. Abdominal striae
31
What causes the CF of the Paraenoplastic Syndrome of Lambert-Eaton syndrome? (2 things)
1. Antibodies prod against Small Cell Lung Cancere 2. These iGs damage Voltage Gated Calcium Channels (on pre-synaptic terminals in motor neurones)
32
What are the CF of the Paraenoplastic Syndrome of Lambert-Eaton syndrome? (4 things)
1. Proximal muscle weakness 2. Ocular muscle weakness (--\> diplopia) 3. Levator muscle weakness (--\> ptosis) 4. Pharyngeal muscle weakness (--\> slurred speech + dysphagia) POLP
33
What are the CF of the Paraenoplastic Syndrome of Hypertrophic Pulmonary Osteoarthropathy (HPOA)? (3 things)
1. Clubbing 2. Periostitis (inflamm periosteum aka layer around bone) 3. Symmetrical Painful arthropathy (in distal joints)
34
What investigations should you do for sus Lung Cancer? (5 things)
1. CXR (first line) 2. Staging CT 3. PET 4. Bronchoscopy w EndoBronchial Ultrasound (EBUS) 5. Biopsy (via Bronchoscopy / Percutaneously (thru skin)
35
What is the FIRST LINE investigation for sus Lung Cancer?
CXR
36
What may you see in a CXR of Lung Cancer? (4 things)
1. Visible lesion (peripheral opacity) 2. Hilar enlargement 3. Pleural effusion (usually unilater in lung cancer) 4. Collapse
37
What does Hilar Enlargement on sus Lung Cancer CXR show?
Lymphadenopathy
38
What does Unilateral Pleural Effusion on sus Lung Cancer CXR show?
Stage 4 cancer
39
Who should get a CT scan for sus Lung Cancer? (2 things)
1. Significant suspicion 2. Sus CXR
40
What should the CT scan you do for sus Lung Cancer be? (2 things)
1. CT: Chest Abd Pelvis 2. Contrast enhanced
41
What will the CT scan for sus Lung Cancer tell you? (3 things)
1. Stage 2. Lymph node involvment 3. Metastasis
42
What will you typically see in a CT scan of Lung Cancer? (3 things)
1. Solitary pulmonary nodule (with spikes maybe) 2. Lymph node involvment (maybe) 3. Metastasis (maybe)
43
What is the staging system used for Non-Small Cell Lung Cancer?
TNM
44
What is the staging system used for Small Cell Lung Cancer? Why is it better than TNM for Small?
VALSG Staging Simple 2 stage system, reflects limited treatment opportunities
45
What are the 2 stages of VALSG staging for Small Cell Lung Cancer?
1. Limited Disease 2. Extensive Disease
46
What are the features of a LIMITED Small Cell Lung Cancer in the VALSG staging system? (2 things)
1. No spread beyond Hemithorax (aka to other side of lung) 2. Regional nodes (can be treated w single Radiotherapy field)
47
What are the features of an EXTENSIVE Small Cell Lung Cancer in the VALSG staging system? (4 things)
1. Spread beyond Hemithorax (aka to other side of lung) 2. Distant metastasis 3. Malignant pleural effusions OR 4. Contralateral hilar / supraclavicular involvment
48
What are the management options for Lung Cancer? (4 things)
1. Surgery 2. Radiotherapy 3. Chemo 4. Endobronchial treatment (stents / debulking)
49
Who is offered Surgery as first line treatment?
Non-small cell lung cancer w cancer isolated to 1 area
50
What is the Surgery types for lung cancer? (3 things)
1. Lobectomy (FIRST LINE) 2. Segmentectomy 3. Wedge Resection
51
Can Radiotherapy be curative for Non-Small Cell Lung Cancer?
Yes, if early
52
Who is Chemotherapy offered to? (3 things)
1. Adjuvant chemo (w Surgery / Radio) to improve outcome 2. Palliative Treatmement (to improve survival + Quality of life) (late stage Non-Small) 3. Palliative for Small Cell (w Radio)
53
What is the management for Small Cell Lung Cancer?
Chemo + Radio (bad prognosis)
54
What is Endobronchial treatment? (2 things)
1. Stents / Debulking to relieve bronchial obst (caused by cancer) 2. Palliative
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