17. Lung Cancer Flashcards
What is the most common disease that you would see in the apex of a CXR
TB
How would you calculate the risk of someone having lung cancer
use a bayesian calculator or use Brock calculator (on medical it is called solitary pulmonary nodule SPN)
The SPIKES model is used for breaking bad news
what does SPIKES stand for
- Setting
- Patients perception
- invitation to continue with the explanation
- knowledge in small chunks
- empathy for the shock or other emotions
- strategy what you and the patient are going to do
What are the two main categories of lung cancer
none small cell lung cancer which includes;
- squamous cell carcinoma (35%)
- adenocarcinoma (25%)
Small cell lung cancer (20%)
which of the lung cancers tend to release neuroendocrine hormones
small cell lung cancer
what are the signs and symptoms of lung cancer
SOB cough Haemoptysis (coughing up blood) finger clubbing recurrent pneumonia weight loss lympathadenopathy- often supraclavicular nodes
What findings on a CXR would be suggestive of lung cancer
Hilar enlargement
“Peripheral opacity” – a visible lesion in the lung field
Pleural effusion – usually unilateral in cancer
Collapse
What and Why would you use a PET-CT
inject a radioactive tracer (usually attached to glucose molecules) and take images
metabolically active areas are identified and so this could indicate cancer
Why is a bronchoscopy with end-brachial ultrasound (EBUS) used
allows detailed assessment of the tumour and ultrasound guided biopsy
Which kind of lung cancer would be offered surgery as first line
non-small cell lung cancer
note that radiotherapy can also be used to treat this kind of cancer when early enough
what is the treatment of small cell lung cancer
chemotherapy and radiotherapy
prognosis is generally worse for which kind of patient
the ones with small cell lung cancer
What endobronchial treatments can be used as part of palliative treatment to relieve bronchial obstruction caused by lung cancer
stents or debulking
Extra-pulmonary manifestations and paraneoplastic syndromes:
- why would you get a hoarse voice
recurrent laryngeal nerve palsy as cancer is pressing one it as it moves through the mediastinum
Extra-pulmonary manifestations and paraneoplastic syndromes:
- why would you get SOB
phrenic nerve palsy due to nerve compression so diaphragm weakness
Extra-pulmonary manifestations and paraneoplastic syndromes:
-why would someone present with facial swelling and distended veins in neck and upper chest
superior vena cava obstruction
Extra-pulmonary manifestations and paraneoplastic syndromes:
- why would someone get corners syndrome (partial ptosis, anhydrous and myosis)
Pancoast tumour (tumour in pulmonary apex) pressing on the sympathetic ganglion
Extra-pulmonary manifestations and paraneoplastic syndromes:
- if the tumour is causing syndrome of inappropriate ADH (SIADH) then what does this cause and what kind of lung cancer do they have
ectopic ADH secretion by a small cell lung cancer and presents with hyponatraemia
Extra-pulmonary manifestations and paraneoplastic syndromes:
- if the small cell lung cancer releases ectopic ACTH then what condition can this cause
Cushings
Extra-pulmonary manifestations and paraneoplastic syndromes:
- Hypercalcaemia is caused by ectopic parathyroid hormone released from which kind of lung cancer
squamous cell carcinoma
Extra-pulmonary manifestations and paraneoplastic syndromes:
- can cause limbic encephalitis. What is it
small cell lung cancer causes immune system to make antibiotics to tissues in the brain (limbic system) causing inflammation
results in short term memory impairment, hallucinations, confusion and seizures
associated with anti-Hu antibodies
What is Lambert-eaton myasthenia syndrome
result of antibodies produced against small cell lung cancer cells
also target and damage VG calcium channels on motor neurones
leads to weakness in proximal muscles but also intraocular muscle, elevator muscles and pharyngeal muscles so symptoms similar to myasthenia gravis
What is mesothelioma
lung malignancy affecting mesothelial cells of the pleura
strongly linked to asbestos
huge latency period with very poor prognosis
chemo can improve survival but is essentially palliative
what is a carcinoma
begins in the skin or the tissue that covers the surface of internal organs and glands
what are the common primary sites for secondary lung cancers
breast
kidney
bladder
testis
what are the 2 types of primary lung cancers
small cell
non small cell - Squamous and adenocarcinoma
what is an adenocarcinoma
cancer that begins in the glandular cells
Name some other differentials to lung cancer which also show CXR changes
TB pneumonia lung metastases from other primary cancers benign lung tumours rarities eg Wegeners granulomatosis
Name some criteria for which lung cancer is no operable
o There is distant metastasis o Mediastinal spead eg recurrent laryngeal nerve palsy o Phrenic nerve palsy o Poor pulmonary function o Frequent angina/heart failure o Psychological failure
What drug is licensed to treat lung cancer if there is a epidermal growth factor receptor (EGFR) mutation
Gefitinib
In the cell cycle what protein is the guardian of the genome which controls the cell cycle by blocking cell cycle progression
P53 gene
what is the role of the p21 proteins
inhibit CDK
Complications of lung cancer:
- what does non small cell lung cancer produce which causes for increased calcium
parathyroid related protein
complications with lung cancer;
- what kind of hormones can a small cell lung cancer release and what problems do these cause
ADH which increase blood pressure and can lead to low potassium
ACTH will increase corticosteroids so reduce immune function
what is the commonest cause of high calcium
malignancy
which gland helps to regulate calcium ions
parathyroid gland by releasing parathyroid hormone which increases calcium
In kidney cause tubules in nephron to increase reabsorption of calcium
In bones it stimulates osteoblasts to release RANKL and then this stimulates osteoclasts which break down bone into calcium in the blood stream
Stimulates gut to increase absorption of calcium
tumour cells from which cancers can release parathyroid related proteins which leads to an increase in calcium
o Anxiety, depression, cognitive changes, lethargy (neurones)
o Cramping of muscles, N/V and GI symptoms(smooth muscles)
o Sinus arrythmias or ventricular arrythmias (cardiac)
What are the main treatments for high calcium
there are many different options but some main ones include Iv fluids and diuretics but can also consider bisphosphonates if the high calcium is due to cancer
What CXR finding is suggestive of exposure to asbestos and name some other problems with asbestos inhalation
thickening/pleural plaques
- Lung fibrosis
- Pleural thickening and pleural plaques
- Adenocarcinoma
- Mesothelioma
What is asbestosis
lung fibrosis related to inhalation of asbestos
