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Respiratory Conditions (JBR) > Bronchial Carcinoma > Flashcards

Bronchial Carcinoma Flashcards

1
Q

What are the main risk factors?

A 
SMOKING 
Asbestos 
Chromium
Arsenic
Nickel
Iron oxide
Radiation (radon) gases
Atmospheric pollustion
Genetics
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2
Q

What are the two histological types of lung cancer?

A

Small cell

Non-small cell

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3
Q

What are the different types of non-small cell lung cancer?

A

Squamous cell carcinoma (SCC)

Adenocarcinoma (AC)

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4
Q

What are the general features of cancer?

A

Malignant growth
Uncontrolled replication
Local invasion
Metastasis

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5
Q

How can cancer spread?

A

Lymphatic
Blood stream
Serous cavities

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6
Q

What are paraneoplastic symptoms

A

Molecules released from tumour cells can mimic effects of naturally occurring hormones

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7
Q

What is the prognosis of bronchial carcinoma?

A

90% incurable at time of diagnosis

50% not alive 6 months after diagnosis

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8
Q

What is neoplasia?

A

Uncontrolled cell growth (abnormal)

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9
Q

Which components of tobacco smoke can contribute to lung cancer?

A 
Polycyclic hydrocarbons 
Aromatic amines 
Phenols 
Nickel
Cyanates
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10
Q

What distinguishes squamous carcinoma?

A

Keratinising

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11
Q

What distinguishes adenocarcinoma?

A

Gland forming

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12
Q

Which histological type of bronchial carcinoma is the “worst”?

A

Small cell

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13
Q

____ is the most sensitive to chemotherapy?

A

Small cell

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14
Q

Adenocarcinomas express?

A

Thyroid transcription factor 1

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15
Q

Squamous cell carcinoma express?

A

Nuclear antigen p63 and high molecular weight cytokeratins

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16
Q

What is p53?

A

Tumour suppressor gene

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17
Q

What do point mutations do?

A

Make epidermal growth factor gene active in the absence of a ligand

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18
Q

How are point mutations identified?

A

DNA
Cytology
Biopsy

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19
Q

Tumours respond to ______ inhibitors

A

tyrosine kinase

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20
Q

Which oncogene identifies target for treatment? Which drug targets it?

A

EML4-ALK fusion oncogene

Crizotinib

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21
Q

What makes up bronchial epithelium?

A

Ciliated
Mucous
Neuroendocrine
Reserve

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22
Q

What makes up bronchioles / alveoli epithelium?

A

Clara cells - type 1 and 2 alveolar lining cells

23
Q

What is hyperplasia?

A

Increase in tissue (rate of reproduction)

24
Q

What is metaplasia?

A

Change in nature of tissue

25
What is dysplasia?
Enlargement of tissue
26
What is Eaton Lambert syndrome?
Paraneoplastic/autoimmune change | Problem with transmission of nerves to muscle, muscles can't contract properly
27
What are features of Eaton-Lambert syndrome?
Muscle weakness | Reduced autonomic activity
28
How can you test for Eaton-lambert syndrome?
Anti P/Q type VGCC antibodies are positive in 85%
29
What is Horner's syndrome?
Damage to the sympathetic chain affecting innervation of the face
30
What are clinical features of Horner's syndrome?
Ptosis (drooping upper eyelid) Anhydrosis (loss of sweating) Miosis (pupil constriction)
31
What is a pan coast tumour?
Apical lung carcinoma invades the sympathetic plexus in the neck - brachial plexus; recurrent laryngeal nerve
32
What are the symptoms of a pan coast tumour?
``` Arm pain Weakness Hoarse voice Cough Some signs of ipsilateral Horner's ```
33
What are sites of local invasion?
``` Recurrent laryngeal nerve Pericardium Oesophagus Brachial plexus Pleural cavity SVC ```
34
What is the effect of local invasion of the recurrent laryngeal nerve?
Hoarse voice
35
What is the effect of local invasion of the pericardium?
Breathless AF Pericardial effusion
36
What is the effect of local invasion of the oesophagus?
Dysphagia
37
How does a pan coast tumour cause its symptoms? (be specific)
T1 root infiltration by cancer in apex of lung
38
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)
39
Common sites of metastases?
``` Liver Bone Adrenal Skin Lung Cerebral ```
40
How does a metastases to the liver present?
LFTs - alkaline phosphates abnormal
41
How does a metastases to the bone present?
Localised pain (midshaft) Worse at night Pathological fracture
42
How does a metastases to the brain present?
``` Insidious onset Weakness Visual disturbance headache Fits (if invaded the cortex) ```
43
What are paraneoplastic symptoms?
``` High calcium Finger clubbing HPOA Thrombophelbitis Hyponatraemia (substance mimics ADH which leads to low sodium) Weakness (Eaton-Lambert syndrome) ```
44
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.
45
What are clinical features?
``` Haemoptysis Recurrent pneumonia Affected lung - loss volume, gets smaller as cancer grows Stridor Hoarseness Weight loss ```
46
What is stridor?
Wheeze on inspiration
47
What investigations/tests can be carried out?
``` FBC Coagulation screen Na, K, Ca, Alk Phos Spirometry - FEV1 CXR CT PET Bronchoscopy EBUS Fluid aspiration ```
48
What is EBUS?
Endobronchial Ultrasound
49
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
50
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
51
Which oncogenes can be drug targeted in SCLC?
myc
52
Which tumour suppressor genes can be drug targeted in SCLC?
``` p53 1q 3p 9p 11p Rb ```
53
NSCLC express PD-L1 which binds to PD-receptor on_______. What effect does this have?
T-lymphocytes | Inactivating the cytotoxic immune response

Respiratory Conditions (JBR) (26 decks)

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