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2: Carcinoma of the bronchus Flashcards

1
Q

Define carcinoma of the bronchus

A

Malignant neoplasm arising from epithelium of bronchioles or bronchus

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2
Q

What are two types of bronchial carcinoma

A

Small cell lung cancer

Non small cell lung cancer

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3
Q

What is most common type of bronchial carcinoma

A

Non small cell lung cancer (85%)

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4
Q

What % of bronchial carcinomas are small cell lung cancer

A

15%

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5
Q

what are the three types of non small cell lung cancer

A
  • Squamous Cell Lung Cancer
  • Adenocarcinoma
  • Large cell carcinoma
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6
Q

What is the most common type of non small cell lung cancer

A

Squamous cell lung cancer (35%)

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7
Q

Where to small cell lung cancers arise

A

Arise from neuroendocrine - Kluchitsky cells

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8
Q

What does small cell lung cancers arising from Kluchitsky cells mean

A

Most paraneoplastic syndromes are associated with small cell lung cancer

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9
Q

What % of small cell lung cancers have metastasised at presentation

A

70%

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10
Q

What two cancers arise from central part of the lung

A

2S’s:

Squamous cell lung-cancer
Small cell lung cancer

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11
Q

What is squamous cell lung cancer strongly associated with

A

Smoking

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12
Q

Where does squamous cell lung cancer arise

A

Larger central airways adjacent to the hilum

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13
Q

How do squamous cell lung cancers develop

A

Metaplasia- Dysplasia- Carcinoma sequence

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14
Q

What is squamous cell lung cancer strongly associated with

A

Clubbing

Hypertrophic osteoarthropathy

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15
Q

what is the most common type of lung cancer in non-smokers

A

Adenocarcinoma

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16
Q

what is adenocarcinoma a type of

A

Non small-cell lung cancer

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17
Q

where do adenocarcinomas arise

A

Smaller peripheral airways

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18
Q

what is most common lung-cancer type in women

A

Adenocarcinoma

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19
Q

what is the precursor for adenocarcinoma

A

atypical adenomatous hyperplasia

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20
Q

what is a large cell carcinoma

A

cancer that cannot be histologically classified into other types

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21
Q

where do large cell carcinomas usually arise

A

peripheries

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22
Q

what can large cell carcinomas secrete

A

bHCG

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23
Q

what cancers have strongest association with smoking

A

small cell lung cancer

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24
Q

where do small cell lung cancers arise

A

central airways

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25
explain grading of small cell lung cancers
all small cell lung cancers are highly aggressive and therefore by definition are all high-grade
26
what is the second most common cancer in the uk
lung cancer
27
which gender is bronchial carcinoma more common it and what cancer is an exception to this rule
- Men. Except adenocarcinoma which is more common in women (6:1)
28
what are 5 RF for bronchial carcinoma
- Smoking (90%) - FH - Radiation - Asbestos - Heavy metals
29
what is the most common presenting symptom of bronchial carcinoma
Cough (90%)
30
what are three symptoms of bronchial carcinoma
Cough Haemoptysis Dyspneoa
31
what are systemic symptoms of bronchial carcinoma
- Fever - Weight loss - Anorexia
32
What cause stridor in lung cancer
Obstruction larger airways (SCLC, SCC)
33
What does chest pain in lung cancer indicate
Chest wall involvement
34
What does pain in arm or shoulder in bronchial carcinoma indicate
Pancoast tumour
35
What does ptosis, miosis and anhydrosis in bronchial carcinoma indicate
Horner's syndrome - compression sympathetic trunk
36
what does hoarse voice or bovine cough in bronchial carcinoma indicate
Compression recurrent laryngeal nerve
37
what can bronchial carcinoma (mainly SCLC and squamous cell lung cancer) cause
superior vena cava syndrome
38
what causes dysphagia in bronchial carcinoma
lymph nodes can compress oesophagus
39
what is a nail sign of lung cancer
clubbing
40
what are two other pulmonary sequelae of lung cancer
- Pleural effusion | - Pnuemonia
41
what is SVC syndrome
tumour compresses SVC - impeding venous return from upper extremities presenting as dyspneoa and facial oedema
42
what is a paraneoplastic syndrome
substance secreted by tumour that acts at a distance site
43
what paraneoplastic syndromes are associated with squamous cell carcinoma
PTHrp
44
what is the action of PTHrp
Increases bone reabsorption causing Hypercalcaemia
45
what 3 paraneoplastic syndromes are associated with small cell carcinoma
- SIADH - ACTH - Lambert-Eaton Myasthenia
46
what does SIADH cause
Increases water absorption - results in low serum sodium
47
what will patients with SIADH present with and why
Confusion, tiredness and drowsiness - due to cerebral oedema caused by fluid retention
48
what does ectopic ACTH cause
Bilateral adrenal enlargement - and excess adrenal hormone secretion
49
how can ectopic ACTH be differentiated
Bilateral enlargement of adrenal glands
50
how does ectopic ACTH usually present
Polyuria and polydipsia (due to excess aldosterone). Symptoms due to increase cortisol are rare
51
what causes LEMS syndrome
small cell carcinoma
52
what antibodies are released in LEMS syndrome
antibodies to pre-synaptic voltage-gated calcium channels
53
how does LEMS present
repeated contraction causes increased strength
54
what is a pancoast tumour
peripheral lung cancer located in superior sulcus involves cervical nerves and brachial plexus (C8, T1, T2)
55
what does a pan coast tumour cause
- Horner syndrome | - Shoulder pain that radiates down the arm
56
what is the clinical presentation of Horner syndrome
Miosis Anhydrosis Endopathalmos
57
what is pre-cursor to adenocarcinoma
atypical adenomatous hyperplasia
58
where does squamous cell carcinoma originate
metaplasia-dysplasia-carcinoma
59
explain metaplasia-dysplasia-carcinoma sequence of SCC
- Columnar glandular epithelium undergoes metaplasia to form squamous epithelium - Squamous epithelium undergoes dysplasia to form carcinoma in situ - Carcinoma in situ transforms to SCC
60
what are indications for referring under 2W pathway
- Over 40 with: haemoptysis, cough, dyspneoa, recurrent chest infections, fatigue, weight loss - Abnormal findings on CXR
61
what will be seen on CXR
Solitary nodule
62
what is performed after CXR for lung-cancer
CT Neck, Thorax, Abdomen
63
what is CT neck, thorax, abdomen used for
Stage lung cancer
64
what are peripheral lung cancers
large cell | adenocarcinoma
65
if a peripheral lung cancer is present and nodes less than 10mm what is ordered
``` PET-CT Endobronchial US (US-guided transbronchial biopsy) ```
66
if a central lung cancer or peripheral lesion with nodes more than 10mm what is performed
- Biopsy of nodes | - Flexible bronchoscopy
67
if evidence of bone metastases what is performed
- X-ray
68
if x-ray is negative, but individual has bone pain what is performed
MRI
69
what is offered for high-stage lung cancers
CT Head
70
in summary what is ordered to stage lung cancer
CT Neck, Thorax, Abdomen
71
what is ordered to biopsy following a. central lesions b. peripheral lesions
a. Bronchoscopy | b. US guided transbronchial biopsy
72
what is offered for small cell lung cancer
platinum based chemoradiotherapy
73
what may be offered in small cell lung cancer
prophylactic cranial irradiation
74
what is problem with non-small cell lung cancer
poor response to chemotherapy
75
what is offered for low stage non-small cell lung cancer
surgery
76
what should be done before surgery in non-SCLC
mediastinoscopy - to view mediastinal lymph nodes
77
what is offered for N-SCLC
radiotherapy

Respiratory (19 decks)

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