Bronchial Carcinoma Flashcards
What are the main risk factors?
SMOKING Asbestos Chromium Arsenic Nickel Iron oxide Radiation (radon) gases Atmospheric pollustion Genetics
What are the two histological types of lung cancer?
Small cell
Non-small cell
What are the different types of non-small cell lung cancer?
Squamous cell carcinoma (SCC)
Adenocarcinoma (AC)
What are the general features of cancer?
Malignant growth
Uncontrolled replication
Local invasion
Metastasis
How can cancer spread?
Lymphatic
Blood stream
Serous cavities
What are paraneoplastic symptoms
Molecules released from tumour cells can mimic effects of naturally occurring hormones
What is the prognosis of bronchial carcinoma?
90% incurable at time of diagnosis
50% not alive 6 months after diagnosis
What is neoplasia?
Uncontrolled cell growth (abnormal)
Which components of tobacco smoke can contribute to lung cancer?
Polycyclic hydrocarbons Aromatic amines Phenols Nickel Cyanates
What distinguishes squamous carcinoma?
Keratinising
What distinguishes adenocarcinoma?
Gland forming
Which histological type of bronchial carcinoma is the “worst”?
Small cell
____ is the most sensitive to chemotherapy?
Small cell
Adenocarcinomas express?
Thyroid transcription factor 1
Squamous cell carcinoma express?
Nuclear antigen p63 and high molecular weight cytokeratins
What is p53?
Tumour suppressor gene
What do point mutations do?
Make epidermal growth factor gene active in the absence of a ligand
How are point mutations identified?
DNA
Cytology
Biopsy
Tumours respond to ______ inhibitors
tyrosine kinase
Which oncogene identifies target for treatment? Which drug targets it?
EML4-ALK fusion oncogene
Crizotinib
What makes up bronchial epithelium?
Ciliated
Mucous
Neuroendocrine
Reserve
What makes up bronchioles / alveoli epithelium?
Clara cells - type 1 and 2 alveolar lining cells
What is hyperplasia?
Increase in tissue (rate of reproduction)
What is metaplasia?
Change in nature of tissue
What is dysplasia?
Enlargement of tissue
What is Eaton Lambert syndrome?
Paraneoplastic/autoimmune change
Problem with transmission of nerves to muscle, muscles can’t contract properly
What are features of Eaton-Lambert syndrome?
Muscle weakness
Reduced autonomic activity
How can you test for Eaton-lambert syndrome?
Anti P/Q type VGCC antibodies are positive in 85%
What is Horner’s syndrome?
Damage to the sympathetic chain affecting innervation of the face
What are clinical features of Horner’s syndrome?
Ptosis (drooping upper eyelid)
Anhydrosis (loss of sweating)
Miosis (pupil constriction)
What is a pan coast tumour?
Apical lung carcinoma invades the sympathetic plexus in the neck - brachial plexus; recurrent laryngeal nerve
What are the symptoms of a pan coast tumour?
Arm pain Weakness Hoarse voice Cough Some signs of ipsilateral Horner's
What are sites of local invasion?
Recurrent laryngeal nerve Pericardium Oesophagus Brachial plexus Pleural cavity SVC
What is the effect of local invasion of the recurrent laryngeal nerve?
Hoarse voice
What is the effect of local invasion of the pericardium?
Breathless
AF
Pericardial effusion
What is the effect of local invasion of the oesophagus?
Dysphagia
How does a pan coast tumour cause its symptoms? (be specific)
T1 root infiltration by cancer in apex of lung
What is the effect of local invasion of the SVC?
Obstructs drainage of blood from arms and head
= Distended external jugular vein, distended veins, anastomoses (made to IVC to avoid obstructed SVC)
Common sites of metastases?
Liver Bone Adrenal Skin Lung Cerebral
How does a metastases to the liver present?
LFTs - alkaline phosphates abnormal
How does a metastases to the bone present?
Localised pain (midshaft)
Worse at night
Pathological fracture
How does a metastases to the brain present?
Insidious onset Weakness Visual disturbance headache Fits (if invaded the cortex)
What are paraneoplastic symptoms?
High calcium Finger clubbing HPOA Thrombophelbitis Hyponatraemia (substance mimics ADH which leads to low sodium) Weakness (Eaton-Lambert syndrome)
What is HPOA?
Hypertrophic pulmonary osteoarthritis
Periosteal reaction involving the diaphysis and metadiaphysis of the long bones of distal extremities without an underlying bone lesion.
What are clinical features?
Haemoptysis Recurrent pneumonia Affected lung - loss volume, gets smaller as cancer grows Stridor Hoarseness Weight loss
What is stridor?
Wheeze on inspiration
What investigations/tests can be carried out?
FBC Coagulation screen Na, K, Ca, Alk Phos Spirometry - FEV1 CXR CT PET Bronchoscopy EBUS Fluid aspiration
What is EBUS?
Endobronchial Ultrasound
What are treatment options?
Surgery (non-small cell - if no mets)
Radiotherapy (radical > surgery if respiratory reserve is poor) (non-small cell)
Chemotherapy (small-cell)
Palliative care
One of the systemic effects of lung cancer is production of ectopic hormones. Which hormones do squamous cancers produce? Small cell cancer?
Squamous cancer = PTH
Small cell = ACTH
Which oncogenes can be drug targeted in SCLC?
myc
Which tumour suppressor genes can be drug targeted in SCLC?
p53 1q 3p 9p 11p Rb
NSCLC express PD-L1 which binds to PD-receptor on_______. What effect does this have?
T-lymphocytes
Inactivating the cytotoxic immune response
