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Block 13 - The Development of Cardiorespiratory Disease > ALS Lecture 2 - Intrathoracic Malignancy DONE > Flashcards

ALS Lecture 2 - Intrathoracic Malignancy DONE Flashcards

1
Q

2 main types of primary intrathoracic malignancy

A

lung carcinoma, pleura malignant mesothelioma

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2
Q

leading cause of cancer mortality in men and women

A

lung

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3
Q

90% of lung cancer cases are caused by

A

smoking

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4
Q

> 90% of lung cancer cases are in people

A

over 40

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5
Q

changes in lung cancer incidence and mortality have paralleled past trends in

A

cigarette smoking

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6
Q

marked increase in incidence and mortality of lung carcinoma in the 20th century followed the introduction of

A

manufactured cigarettes with addictive properties

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7
Q

risk of lung cancer progressively declines following

A

smoking cessation

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8
Q

cigarette smoke contains at least __ known carcinogens

A

43

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9
Q

other causes of lung carcinoma (5)

A

occupational carcinogens, environmental radon, air pollution, chronic lung disease, FH

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10
Q

radon once inhaled continues to

A

decay and emit alpha particles

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11
Q

occupations associated with radon higher risk (3)

A

air crew, nuclear fuel plant, power station workers

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12
Q

asbestos workers increased risk of cancer

A

5 fold

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13
Q

asbestos workers increased risk of smokers

A

11 fold

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14
Q

asbestos workers who are also smokers increased risk of cancer

A

53 fold

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15
Q

driver mutations

A

genetic factor of lung carcinoma, essential for tumour cell survival

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16
Q

common genetic mutations in adenocarcinoma in non-smokers

A

EGFR, ALK, RET, ROS1

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17
Q

common genetic mutations in adenocarcinoma in smokers

A

KRAS, BRAF

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18
Q

targeted drug for EGFR mutations

A

EGFR tyrosine kinase inhibitor

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19
Q

targeted drug for ALK mutations

A

ALK inhibitor

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20
Q

squamous cell carcinoma of the lung genetic mutation steps

A
  1. LOH of 3p and 9p 2. Oncogene OSX2 amplification in 3q
  2. TP53 inactivation
  3. LOH of 8p and 5q
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21
Q

which genes are ALWAYS inactivated in squamous cell carcinoma of the lung?

A

TP53, RB1

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22
Q

RB1 mutation is a hallmark of

A

small cell carcinoma

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23
Q

other genes involved in small cell carcinoma of the lung

A

PTEN, FGFR1, SOX2, SLIT, EPHA7

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24
Q

carcinoma of the lung symptoms (7)(9)

A

progressive SOB, cough, weight loss, chest pain, hoarseness, sputum, haemoptysis

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25
Q

symptoms related to lung carcinoma clinical features caused by tumour obstruction of airway (3)

A

pneumonia, abscess, lobar collapse

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26
Q

symptom related to lung carcinoma clinical features caused by tumour spread to pleura

A

pleural effusion

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27
Q

symptom related to lung carcinoma clinical features caused by tumour invasion of recurrent laryngeal nerve

A

hoarseness

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28
Q

symptom related to lung carcinoma clinical features caused by tumour invasion of oesophagus

A

dysphagia

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29
Q

symptom related to lung carcinoma clinical features caused by tumour invasion of phrenic nerve

A

diaphragm paralysis

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30
Q

symptom related to lung carcinoma clinical features caused by tumour invasion of chest wall

A

rib destruction

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31
Q

symptom related to lung carcinoma clinical features caused by tumour compressing SVC

A

superior vena cava syndrome

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32
Q

symptom related to lung carcinoma clinical features caused by apical tumour invasion of sympathetic ganglia

A

horner’s syndrome

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33
Q

symptoms related to lung carcinoma clinical features caused by pericardial involvement (2)

A

pericarditis, cardiac tamponade

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34
Q

common metastatic sites of lung carcinoma (6)

A

regional lymph nodes, bone, brain, liver, skin, adrenal glands

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35
Q

syndrome caused by ADH production by lung cancer cells

A

hyponatraemia

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36
Q

syndrome caused by ACTH production by lung cancer cells

A

Cushing syndrome

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37
Q

syndrome caused by parathyroid hormone production by lung cancer cells

A

hypercalcaemia

38
Q

syndrome caused by calcitonin production by lung cancer cells

A

hypocalcaemia

39
Q

syndrome caused by gonadotropins production by lung cancer cells

A

gynaecomastia

40
Q

syndrome caused by serotonin and bradykinin production by lung cancer cells

A

carcinoid syndrome

41
Q

syndrome caused by auto-antibodies against neuronal calcium channels production by lung cancer cells

A

Lambert-Eaton myaesthenic syndrome

42
Q

other syndromes caused by lung cancer cells (4)

A

peripheral sensory neuropathy, acanthosis nigricans, Trousseau syndrome, finger clubing

43
Q

diagnostic tools for lung carcinoma

A

CXR, CT, PET, MRI, bronchoscopy, cytology, biopsy, surgery

44
Q

surgeries for lung cancer (2)

A

lobectomy, pneumonectomy

45
Q

WHO classification of lung tumours

A

primary, benign and malignant, metastatic

46
Q

main histological types of epithelial tumours (2)

A

non-small cell carcinoma, small cell carcinoma

47
Q

types of non-small cell carcinoma (5)

A

adenocarcinoma, squamous cell, large cell, carcinoid, sarcoma

48
Q

label the histological diagrams of carcinomas

49
Q

atypical adenomatous hyperplasia histology

A

alveoli lined by atypical cuboidal epithelial cells

50
Q

normal respiratory tract-type epithelium histology (3)

A

pseudostratified, columnar-shaped, ciliated

51
Q

squamous metaplasia histology (1)

A

replacement of bronchial epithelium by mature squamous epithelium

52
Q

dysplasia and carcinoma in situ histology (4)

A

disordered growth, loss of architecture and uniformity, pleomorphic, hyperchromatic nuclei

53
Q

dysplasia and carcinoma in situ and cancer

A

precedes cancer, doesn’t always lead to it

54
Q

squamous cell carcinoma cytology (3)

A

normal, metaplastic and highly atypical squamous epithelia, exfoliated cells in sputum

55
Q

squamous cell carcinoma histology (4)

A

excessive growth of abnormal squamous cells, levels of differentiation (well, moderate, poor), intercellular bridges, keratinisation

56
Q

small cell carcinoma histology (3)

A

small round blue cell tumour, high mitotic count, neurosecretory granules

57
Q

choice of treatment for carcinoma of the lung depends on (2)

A

histological subtype, TNM stage

58
Q

types of treatment for lung carcinoma (4)

A

surgery, chemo, radiotherapy, targeted and immunotherapy

59
Q

TNM stages stand for

A

tumour, node, metastasis

60
Q

T stage of TNM

A

1 - 4, 1 is small, 4 large

61
Q

N stage of TNM

A

0-3, 0 no nodes involved, 3 lots

62
Q

M stage of TNM

A

0 no mets, 1 mets

63
Q

number stages cancer

A

1 - small, contained
2 - larger (in some cancers lymph nodes)
3 - larger, in nodes/nearby tissue
4 - mets

64
Q

treatment for non-small cell lung cancer in stage 1-2 (2)

A

resection, radical radiotherapy (if unfit/refuse surgery)

65
Q

prognosis for non-small cell lung cancer in stage 1-2

A

5 year survival 23-60%

66
Q

treatment for non-small cell lung cancer in stage 3-4

A

palliative chemo/radiotherapy

67
Q

prognosis for non-small cell lung cancer in stage 3-4

A

5 year survival <1%

68
Q

treatment for small cell lung cancer, limited disease

A

radical chemo, radiotherapy

69
Q

prognosis for small cell lung cancer, limited disease (3)

A

median survival 18months, <20% cured, 5 year survival 25%

70
Q

treatment for small cell lung cancer, extensive disease

A

palliative chemo, radiotherapy

71
Q

prognosis for small cell lung cancer, extensive disease

A

median survival 9 months

72
Q

in non-small cell carcinomas with EGFR mutation we can use

A

tyrosine kinase inhibitors (e.g. erlotinib, gefitinib, osimertinib)

73
Q

in non-small cell carcinomas with ALK translocation we can use

A

inhibit ALK (e.g. crizonitinib, ceritinib, alectinib, brigatinib, lorlatinib)

74
Q

in non-small cell carcinomas with ROS1 translocation we can use (names)

A

crizonitib, ceritinib, entrectinib

75
Q

if a cell carries PDL-1 it is

A

our own cell, so won’t attack it

76
Q

some cancers develop PDL-1 to

A

trick our T-cells

77
Q

some cancer drugs target the tumour’s fake ligand (PDL-1) or the T-cell receptor, e.g. (4)

A

pembrolizumab, nivolumab, atezolizumab, durvalumab,

78
Q

malignant mesothelioma is a cancer of the

79
Q

> 90% of cases of malignant mesothelioma are associated with previous

A

exposure to asbestos

80
Q

latent period between exposure to asbestos and detection of malignant mesothelioma tumour

A

up to 50 years

81
Q

with asbestos, the ____ ___ is more important than the ____ __ _____

A

cumulative dose, duration of exposure

82
Q

Incidence of malignant mesothelioma in the UK is expected to peak in what year and why?

A

2020, asbestos banned 50 years ago

83
Q

malignant mesothelioma usual age group

A

older adults

84
Q

malignant mesothelioma gender

A

M > F, occupational exposure

85
Q

malignant mesothelioma symptoms (11)

A

SOB, cough, chest pain, weakness, fatigue, weight loss, chest fullness, fever, sweating, pleurisy, pleural effusion

86
Q

WHO classification of tumours of the pleura

A

primary (mesothelial, mesenchymal, lymphoproliferative), malignant, metastatic

87
Q

main malignant mesothelioma histological types (4)

A

epitheloid, sarcomatoid, biphasic, desmoplastic

88
Q

malignant mesothelioma locations can be (2)

A

localised, diffuse

89
Q

possible surgery for malignant mesothelioma (2)

A

pneumonectomy, pleurectomy (not curative)

90
Q

malignant mesothelioma prognosis

A

1 year survival, rarely >2 years

91
Q

malignant mesothelioma compensation (2)

A

state, previous employer

Block 13 - The Development of Cardiorespiratory Disease (14 decks)

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