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RESPIRATORY > BRONCHIAL CARCINOMA > Flashcards

BRONCHIAL CARCINOMA Flashcards

1
Q

What % of primary lung tumours?

A

95%

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2
Q

What % of cases are SCLCs?

A

15%

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3
Q

What type of cells in SCLCs?

A

• Arise from Kulchitsky cells – part of amine precursor uptake and decarboxylation (APUD) endocrine system

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4
Q

What prognosis of SCLC?

A

Highly malignant, usually inoperable at presentation

Poor prognosis

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5
Q

What is SCLC also called?

A

Oat-cell carcinoma

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6
Q

What % are NSCLCs?

A

85%

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7
Q

What 5 types of NSCLCs?

A
  1. Squamous
  2. Adenocarcinoma
  3. Large-cell
  4. Carcinoid tumours
  5. Bronchialveolar cell
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8
Q

Describe squamous NSCLC

A

o Obstructive lesions of bronchus

o Local spread common, widespread metastases occur late

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9
Q

Describe adenocarcinoma NSCLC

A

o Arises from mucous cells in bronchus epithelium
o Invasion of leura and mediastinal lymph nodes common
o Often metastasises to brain and bones

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10
Q

Describe large-cell NSCLC

A

o Less differentiated forms of squamous cell and adenocarcinomas
o Metastasise early

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11
Q

Describe carcinoid tumours NSCLC

A

o Neuroendocrine tumours

o Arise predominantly from Kulchitsky cells

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12
Q

Describe bronchoalveolar cell NSCLC

A

o Occurs as peripheral solitary nodule or as diffuse nodular lesions

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13
Q

How long does it take to develop from initial malignant change to presentation of adenocarcinoma?

A

15

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14
Q

How long does it take to develop from initial malignant change to presentation of squamous carcinoma?

A

8

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15
Q

How long does it take to develop from initial malignant change to presentation of SCLC?

A

3

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16
Q

What other tumours can you get which are benign?

Which one is…

  • very poor prognosis
  • slow-growing
  • benign?
A

Tracheal, bronchial, hamartoma

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17
Q

Describe mesothelioma?

A

usually occurs in pleura, rarely metastasises, associated with asbestos

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18
Q

Where do secondary tumours normally originate?

A

common, often asymptomatic, common primary sites include kidney, prostate, breast, bone, GI, cervix, ovary

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19
Q

What is the biggest risk factor?

A

Smokers

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20
Q

Which age group is it more prominent?

A

Older people

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21
Q

Is it more common in women or men?

A

Men

22
Q

How common it is?

A

Most common malignant tumour world-wide with 1.3 million death/year.
3rd most common death after heart disease and pneumonia in UK.
In UK 32,000 die/year.

23
Q

What are other risk factors?

A

EGFR-TK mutation
Hx of cancer
Age
Occupational risk: Arsenic, Coal tar/ combustion processes, asbestos, chromium, radiation, iron oxide

24
Q

What are the symptoms?

A
  • Cough (80%)
  • Haemoptysis (70%)
  • Dyspnoea (60%)
  • Chest pain (40%)
  • Recurrent or slowly resolving pneumonia
  • Lethargy
  • Anorexia
  • Weight loss
  • Hoarseness – due to recurrent laryngeal nerve involvement
  • Finger clubbing
  • Bone pain - metastasis
25
Q

What are the signs?

A
  • Cachexia
  • Anaemia
  • Clubbing
  • HPOA (hypertrophic pulmonary osteoarthropathy) - Causes wrist pain; combines clubbing and periostitis of small hand joints; especially associated with NSCLCs
  • Supraclavicular or axillary nodes
  • Bone tenderness - metastasis
  • Hepatomegaly - metastasis
  • Confusion/fits/focal CNS signs/cerbeallar syndrome - metastasis
  • Proximal myopathy/peripheral neuropathy - metastasis
26
Q

What investigations would you do?

A 
Cytology
CXR
(PET)-CT
Bronchoscopy
Bone scan
Bloods
Lung function tests
27
Q

Why do you do cytology?

A

Sputum and pleural fluid - send at least 20mls. Test cells

28
Q

Why do you of CXR?

A
  • If cancer is causing symptoms, it will be visible on CXR
  • Asymptomatic tumour visible if >1cm diameter
  • Lateral views used to assess hilum and behind heart
  • May cause 2° pneumonia (consolidation), pleural effusions and collapsed lobes
  • peripheral nodule, hilar enlargement, consolidation, lung collapse, pleural effusion, bony secondary’s
29
Q

Why do you do CT?

A
  • Detecting small tumours esp of the mediastinum
  • Staging the tumour – done by contrast-enhanced CT; done using TNM for NSCLCs; two stage system used for SCLCs
  • Scanning should also include liver, brain and adrenal glands for mets
  • MRI is not useful
30
Q

Why do you do bronchoscopy?

A
  • to give histology and assess operability
  • To define anatomy, obtain biopsy and cytological samples
  • To assess operability - if tumour involves first 2cm of either main bronchus then it is inoperable
  • Widening and loss of sharp angle of carina suggests enlarged mediastinal lymph nodes
31
Q

Why do you do bone scan?

A

If you suspect mets

32
Q

Why do you do Peripheral aspiration and biopsy?

A

• For peripheral lung lesions that can not be seen by bronchoscopy

33
Q

What bloods would you do?

A
  • FBC (anaemia)
  • LFT (liver mets)
  • U+E (hypercalcaemia, hyponatraemia) – hypercalcaemia due to decreased bone resorption; hypernatraemia due to consequential changes in calcium excretion in kidneys which affects Na
34
Q

Why would you do lung function tests?

A

to assess suitability for lobectomy

35
Q

What is the biggest management interventions?

A

Quit smoking

36
Q

Describe the treatment options for Stages 1-4?

A

Surgical resection – for stage I or II tumours; lobar resection is treatment of choice
Radiotherapy – for stage I-III unsuitable for surgery
Chemotherapy – for stage III-IV

37
Q

When would you use Erlotinib?

A

second line treatment after chemotherapy fails

38
Q

When would you use Gefinitb?

A

first line treatment for those with EGFR-TK mutations

39
Q

When would you use multidrug regimes??

A

first line treatment for SCLCs; cisplatin-based combination chemotherapy; second-line chemotherapy offered only if first line was responded to but failed; thoracic irradiation after that

40
Q

What palliative care options are there?

A

opiates; symptomatic pleural drainage/pleurodesis; radiotherapy, steroids, brochodilators

41
Q

What is Endobronchial therapy?

A
  • Tracheal stenting
  • Cryotherapy
  • Laser
  • Brachytherapy – radioactive source placed close to tumour
42
Q

How do you treat non-small cell tumours?

A
  • Excision if stage ½
  • Curative radiotherapy = alternative if resp reserve is poor
  • Chemo +/- radio for more advanced disease
  • Regimes may be platinum based eg with monoclonal Ab targeting epidermal GF receptor (cetuximab)
43
Q

How do you treat small-cell tumours?

A
  • Nearly always disseminated at presentation
  • May respond to chemo but invariably relapse
  • (cyclophosphamide + doxorubicin + vincristine + etoposide; OR cisplatin + radio if limited disease)
44
Q

When do you do pleural drainage?

A

For symptomatic pleural effusions

45
Q

What other drugs might you consider?

A
  • Analgesia
  • Steroids
  • Antiemetics
  • Cough linctus (codeine)
  • Bronchodilators
  • Antidepressants
46
Q

What are the differentials?

A
  • Secondary malignancy
  • Arteriovenous malformation
  • Pulmonary hamartoma – rare benign tumour
  • Bronchial adenoma – rare slow-growing tumour; majority carcinoids
  • Abscess
  • Granuloma
  • Encysted effusion – fluid, blood, pus
  • Cyst
  • Foreign body
  • Pneumonia
  • TB
47
Q

What are the complications?

A 
Local
•	Recurrent laryngeal nerve palsy
•	Phrenic nerve palsy
•	SVC obstruction
•	Horner’s syndrome (Pancoast’s tumour) – tumour of pulmonary apex; involvement of sympathetic ganglion
•	Rib erosion
•	Pericarditis
•	AF
Metastatic
•	Brain
•	Bone --> bone pain, hypercalcaemia, anaemia
•	Liver
•	Adrenals --> addison’s
Endocrine
•	Ectopic hormone secretion
o	SIADH and ACTH by small cell
o	PTH by squamous cell
Non-metastatic neurological
•	Confusion
•	Fits
•	Cerebellar syndrome
•	Proximal myopathy
•	Neuropathy
•	Polymyositis
•	Lambert-Eaton syndrome
Other
•	Clubbing
•	HPOA
•	Dermatomyositis
•	Acanthosis Nigricans – hyperpigmentation of the skin
•	Thrombophlebitis migrans – phlebitis related to a thrombus
48
Q

What is the general prognosis?

A

20% alive at 1 year after diagnosis; 6-8% after 5 years (NB 50% for breast and cervix).

49
Q

What is the prognosis for NSCLC?

A

50% 2yr survival without mets, with mets 10%.

50
Q

What is the prognosis for SCLC?

A

Median survival = 3 months untreated, 1-1.5yrs treated.

RESPIRATORY (8 decks)

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