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Medicine Y3 TCD 13-24 > 17. Lung Cancer > Flashcards

17. Lung Cancer Flashcards

1
Q

What is the most common disease that you would see in the apex of a CXR

A

TB

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2
Q

How would you calculate the risk of someone having lung cancer

A

use a bayesian calculator or use Brock calculator (on medical it is called solitary pulmonary nodule SPN)

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3
Q

The SPIKES model is used for breaking bad news

what does SPIKES stand for

A
  • 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
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4
Q

What are the two main categories of lung cancer

A

none small cell lung cancer which includes;
- squamous cell carcinoma (35%)
- adenocarcinoma (25%)
Small cell lung cancer (20%)

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5
Q

which of the lung cancers tend to release neuroendocrine hormones

A

small cell lung cancer

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6
Q

what are the signs and symptoms of lung cancer

A 
SOB
cough 
Haemoptysis (coughing up blood)
finger clubbing 
recurrent pneumonia 
weight loss 
lympathadenopathy- often supraclavicular nodes
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7
Q

What findings on a CXR would be suggestive of lung cancer

A

Hilar enlargement
“Peripheral opacity” – a visible lesion in the lung field
Pleural effusion – usually unilateral in cancer
Collapse

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8
Q

What and Why would you use a PET-CT

A

inject a radioactive tracer (usually attached to glucose molecules) and take images
metabolically active areas are identified and so this could indicate cancer

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9
Q

Why is a bronchoscopy with end-brachial ultrasound (EBUS) used

A

allows detailed assessment of the tumour and ultrasound guided biopsy

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10
Q

Which kind of lung cancer would be offered surgery as first line

A

non-small cell lung cancer

note that radiotherapy can also be used to treat this kind of cancer when early enough

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11
Q

what is the treatment of small cell lung cancer

A

chemotherapy and radiotherapy

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12
Q

prognosis is generally worse for which kind of patient

A

the ones with small cell lung cancer

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13
Q

What endobronchial treatments can be used as part of palliative treatment to relieve bronchial obstruction caused by lung cancer

A

stents or debulking

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14
Q

Extra-pulmonary manifestations and paraneoplastic syndromes:
- why would you get a hoarse voice

A

recurrent laryngeal nerve palsy as cancer is pressing one it as it moves through the mediastinum

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15
Q

Extra-pulmonary manifestations and paraneoplastic syndromes:
- why would you get SOB

A

phrenic nerve palsy due to nerve compression so diaphragm weakness

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16
Q

Extra-pulmonary manifestations and paraneoplastic syndromes:
-why would someone present with facial swelling and distended veins in neck and upper chest

A

superior vena cava obstruction

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17
Q

Extra-pulmonary manifestations and paraneoplastic syndromes:
- why would someone get corners syndrome (partial ptosis, anhydrous and myosis)

A

Pancoast tumour (tumour in pulmonary apex) pressing on the sympathetic ganglion

18
Q

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

A

ectopic ADH secretion by a small cell lung cancer and presents with hyponatraemia

19
Q

Extra-pulmonary manifestations and paraneoplastic syndromes:
- if the small cell lung cancer releases ectopic ACTH then what condition can this cause

A

Cushings

20
Q

Extra-pulmonary manifestations and paraneoplastic syndromes:
- Hypercalcaemia is caused by ectopic parathyroid hormone released from which kind of lung cancer

A

squamous cell carcinoma

21
Q

Extra-pulmonary manifestations and paraneoplastic syndromes:
- can cause limbic encephalitis. What is it

A

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

22
Q

What is Lambert-eaton myasthenia syndrome

A

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

23
Q

What is mesothelioma

A

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

24
Q

what is a carcinoma

A

begins in the skin or the tissue that covers the surface of internal organs and glands

25
Q

what are the common primary sites for secondary lung cancers

A

breast
kidney
bladder
testis

26
Q

what are the 2 types of primary lung cancers

A

small cell

non small cell - Squamous and adenocarcinoma

27
Q

what is an adenocarcinoma

A

cancer that begins in the glandular cells

28
Q

Name some other differentials to lung cancer which also show CXR changes

A 
TB
pneumonia 
lung metastases from other primary cancers 
benign lung tumours 
rarities eg Wegeners granulomatosis
29
Q

Name some criteria for which lung cancer is no operable

A 
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
30
Q

What drug is licensed to treat lung cancer if there is a epidermal growth factor receptor (EGFR) mutation

A

Gefitinib

31
Q

In the cell cycle what protein is the guardian of the genome which controls the cell cycle by blocking cell cycle progression

A

P53 gene

32
Q

what is the role of the p21 proteins

A

inhibit CDK

33
Q

Complications of lung cancer:

- what does non small cell lung cancer produce which causes for increased calcium

A

parathyroid related protein

34
Q

complications with lung cancer;

- what kind of hormones can a small cell lung cancer release and what problems do these cause

A

ADH which increase blood pressure and can lead to low potassium
ACTH will increase corticosteroids so reduce immune function

35
Q

what is the commonest cause of high calcium

A

malignancy

36
Q

which gland helps to regulate calcium ions

A

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

37
Q

tumour cells from which cancers can release parathyroid related proteins which leads to an increase in calcium

A

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)

38
Q

What are the main treatments for high calcium

A

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

39
Q

What CXR finding is suggestive of exposure to asbestos and name some other problems with asbestos inhalation

A

thickening/pleural plaques

  • Lung fibrosis
  • Pleural thickening and pleural plaques
  • Adenocarcinoma
  • Mesothelioma
40
Q

What is asbestosis

A

lung fibrosis related to inhalation of asbestos

Medicine Y3 TCD 13-24 (32 decks)

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