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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
Q

What is dysplasia?

A

Enlargement of tissue

26
Q

What is Eaton Lambert syndrome?

A

Paraneoplastic/autoimmune change

Problem with transmission of nerves to muscle, muscles can’t contract properly

27
Q

What are features of Eaton-Lambert syndrome?

A

Muscle weakness

Reduced autonomic activity

28
Q

How can you test for Eaton-lambert syndrome?

A

Anti P/Q type VGCC antibodies are positive in 85%

29
Q

What is Horner’s syndrome?

A

Damage to the sympathetic chain affecting innervation of the face

30
Q

What are clinical features of Horner’s syndrome?

A

Ptosis (drooping upper eyelid)
Anhydrosis (loss of sweating)
Miosis (pupil constriction)

31
Q

What is a pan coast tumour?

A

Apical lung carcinoma invades the sympathetic plexus in the neck - brachial plexus; recurrent laryngeal nerve

32
Q

What are the symptoms of a pan coast tumour?

A 
Arm pain
Weakness
Hoarse voice
Cough 
Some signs of ipsilateral Horner's
33
Q

What are sites of local invasion?

A 
Recurrent laryngeal nerve
Pericardium
Oesophagus
Brachial plexus
Pleural cavity
SVC
34
Q

What is the effect of local invasion of the recurrent laryngeal nerve?

A

Hoarse voice

35
Q

What is the effect of local invasion of the pericardium?

A

Breathless
AF
Pericardial effusion

36
Q

What is the effect of local invasion of the oesophagus?

A

Dysphagia

37
Q

How does a pan coast tumour cause its symptoms? (be specific)

A

T1 root infiltration by cancer in apex of lung

38
Q

What is the effect of local invasion of the SVC?

A

Obstructs drainage of blood from arms and head

= Distended external jugular vein, distended veins, anastomoses (made to IVC to avoid obstructed SVC)

39
Q

Common sites of metastases?

A 
Liver 
Bone 
Adrenal
Skin
Lung 
Cerebral
40
Q

How does a metastases to the liver present?

A

LFTs - alkaline phosphates abnormal

41
Q

How does a metastases to the bone present?

A

Localised pain (midshaft)
Worse at night
Pathological fracture

42
Q

How does a metastases to the brain present?

A 
Insidious onset
Weakness
Visual disturbance 
headache 
Fits (if invaded the cortex)
43
Q

What are paraneoplastic symptoms?

A 
High calcium
Finger clubbing 
HPOA 
Thrombophelbitis
Hyponatraemia (substance mimics ADH which leads to low sodium) 
Weakness (Eaton-Lambert syndrome)
44
Q

What is HPOA?

A

Hypertrophic pulmonary osteoarthritis

Periosteal reaction involving the diaphysis and metadiaphysis of the long bones of distal extremities without an underlying bone lesion.

45
Q

What are clinical features?

A 
Haemoptysis 
Recurrent pneumonia 
Affected lung - loss volume, gets smaller as cancer grows 
Stridor
Hoarseness
Weight loss
46
Q

What is stridor?

A

Wheeze on inspiration

47
Q

What investigations/tests can be carried out?

A 
FBC
Coagulation screen
Na, K, Ca, Alk Phos
Spirometry - FEV1
CXR
CT
PET 
Bronchoscopy
EBUS 
Fluid aspiration
48
Q

What is EBUS?

A

Endobronchial Ultrasound

49
Q

What are treatment options?

A

Surgery (non-small cell - if no mets)
Radiotherapy (radical > surgery if respiratory reserve is poor) (non-small cell)
Chemotherapy (small-cell)
Palliative care

50
Q

One of the systemic effects of lung cancer is production of ectopic hormones. Which hormones do squamous cancers produce? Small cell cancer?

A

Squamous cancer = PTH

Small cell = ACTH

51
Q

Which oncogenes can be drug targeted in SCLC?

A

myc

52
Q

Which tumour suppressor genes can be drug targeted in SCLC?

A 
p53
1q
3p
9p
11p
Rb
53
Q

NSCLC express PD-L1 which binds to PD-receptor on_______. What effect does this have?

A

T-lymphocytes

Inactivating the cytotoxic immune response

Respiratory Conditions (JBR) (26 decks)

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