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Resp JL > Bronchial Carcinoma > Flashcards

Bronchial Carcinoma Flashcards

1
Q

What can recurrent episodes of pneumonia in the same lobe of the lung be a sign of?

A

Primary lung cancer

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2
Q

What happens to the affected lung in lung cancer over time?

A

It loses volume and gets smaller as the cancer grows

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3
Q

When looking at a lung cancer chest x-ray, which lung big or small, is likely to be the diseased one?

A

Small

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4
Q

What is stridor usually accompained by?

A

A course aurdible wheeze during inspiration

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5
Q

Name 6 anatomical places where local invastion of a cancer can occur?

A
  1. Recurrent laryngeal nerve
  2. Pericardium
  3. Oesophagus
  4. Bronchial plexus
  5. Pleural cavity
  6. Superior vena cava
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6
Q

What is a clinical feature of recurrent laryngeal nerve palsy?

A

Hoarse voice

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7
Q

What aspect of lung cancer can lead to atrial fibrilation?

A

Local invasion of the pericardium, accompanied by pericardial effusion

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8
Q

What clinical feature is a pointer for a tumour in the oesophagus?

A

Dysphagia

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9
Q

What is wasting of the small muscles in the hand due to?

A

T1 root infiltration by a primary lung cancer in the apex of the lung

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10
Q

What is a pancoast tumour and what can its local invasoin be?

A

Tumour of the pulmonary apex - brachial plexus invasion

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11
Q

What clinical sign occurs when the primary tumour invades the pleural space?

A

Pleural effusion

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12
Q

What can a symptom of pleural effusion be?

A

Breathlessness

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13
Q

What does local invasion of the SVC obstruct?

A

Drainage of blood from arms and head

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14
Q

What clinical features can local invasion of the SVC obstrucing drainage of blood from arms and head cause?

A

Puffy eyelids and headache

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15
Q

What could distended veins visible on the abdomen and thorax mean?

A

Blood flow is bypassing the obstructed SVC by opening up anastomoses with the IVC tributeries

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16
Q

What invasion can be described by localised chest wall pain, worse with movement and pain which is worse at night?

A

Chest wall invasion by lung cancer

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17
Q

What are 6 common sites for metastases from primary lung cancer?

A
  1. Liver
  2. Brain
  3. Bone
  4. Adrenal
  5. Skin
  6. Lung
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18
Q

What metastases has insidious onset, can lead to weakness, visual disturbance, headaches and is worse in the morning, not photophobic?

A

Cerebral metastases

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19
Q

What is the headache due to in cerebral metastases?

A

Increased intracranial pressure

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20
Q

If a cerebral metastases involves the cortex, what could the presenting feature be?

A

Epileptic fit

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21
Q

With liver metastases - what can be said about the LFVTs?

A

Abnormal, particularly alkaline phophatase

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22
Q

What are two clinical features of bone metastases?

A
  1. Localised pain which is worse at night

2. Pathalogical fracture - bone may fracture follwoin a trivial mechanical stress

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23
Q

What investigation can be used to investigate bone metastases?

A

Isotope bone scan

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24
Q

What 7 cloinical features are a result of a primary tumour but dont indicate metastatic disease?

A
  1. Finger clubbing
  2. Hypertrophic pulmonary osteoarthropathy (HPOA)
  3. Weight loss
  4. Thrombophlebitis
  5. Hypercalcaemia
  6. Hyponatraemia (SIADH)
  7. Weakness - Eaton Lambert syndrome
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25
Q

Give 4 features of hypercalcaemia?

A

Headaches
Confusion
Thirst
Constipation

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26
Q

What can hypercalcaemia result from?

A

Tumour producing a substance which mimics the effects of parathyroid hormone

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27
Q

What can hyponatraemia result from?

A

Production of a substance which mimics Anti-Diuretic-Hormone

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28
Q

What is the main symptom of Hypoatraemia?

A

Confusion

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29
Q

What does Eaton Lambert Syndrome mimic?

A

Myaesthenia gravis

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30
Q

What clinical feature do these diseases all have in common: liver disease, chronic hepatitis C, congenital cyanotic heart disease, bacterial endocarditis, bronchioectasis?

A

Finger clubbing

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31
Q

What clinical featrue can elevation of the periosteum away from bone surface result in?

A

Symptoms of pain and tenderness of the long bones near the adjacent joints

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32
Q

What investigation would you not do for lung cancer?

A

Sputum cytology

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33
Q

What 4 radiological investigations might you do for lung cancer?

A

CXR
CT scan of thorax
PET scan
Endobronchial ultrasound

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34
Q

What is another invasive investigation you might do for lung cancer?

A

Bronchoscopy

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35
Q

What 4 non-invasive tests might you do to investigate lung cancer?

A

FBC
Coagulation screen
Na, K, Ca, Alk Phos
Spirometry FEV1

36
Q

What are the 4 common ways to make a tissue diagnosis of lung cancer?

A
  1. Bronchoscopy
  2. CT guided biopsy
  3. Lymph node aspirate
  4. Aspiration of pleural fluid
37
Q

What does endobronchial ultrasound enable visualisation of?

A

Hilar and mediastinal structures

38
Q

Name 6 differential diagnosis other than lung cancer for a patient presenting with Smoking, haemoptysis and abnormal CXR?

A
  1. TB
  2. Vasculitis
  3. PE
  4. Secondary cancer
  5. Lymphoma
  6. Bronchiectasis
39
Q

Name a clinical feature that is direct consequence of the primary tumour?

A

Haemoptysis

40
Q

What are smoking, asbestosis, nickel, chromates, radiation, atmospheric pollution and genetics all risk factors for?

A

Lung cancer

41
Q

Give two examples of ectopic hormone production in lung cancer?

A

PTH (SQUAMOUS CANCER)

ACTH (SMALL CELL CANCER)

42
Q

Name the 4 common smoking-associated types of lung tumours?

A
  1. Adenocarcinoma (35%)
  2. Squamous carcinoma (30%)
  3. Small cell carcinoma (25%)
  4. Large cell carcinoma (10%)
43
Q

What is the most common lung tumour?

A

Adenocarcinoma

44
Q

Other than smoking-associated types of tumour, what are the other two classifications?

A

Neuroendocrine tumours

Bronchial gland tumours

45
Q

What process does squamous carcinoma do?

A

Keratinising

46
Q

What process does adenocarcinoma do?

A

Gland forming

47
Q

What is expressed most characteristically in small cell and adenocarcinoma?

A

TTF-1 (Thyroid Transcription Factor)

48
Q

What is expressed in squamous cell carcinoma?

A

P63

49
Q

What type of tumour has the worst survivial time?

A

Small cell

50
Q

What type of cancer tumour, other than small cell, is worse than squamous or adenocarcinoma?

A

Large cell

51
Q

Which lung tumour type is known to be chemosensitive but with rapidly emerging resistance?

A

Small cell

52
Q

What is the treatment of choice for lung tumours, other than small cell?

A

Surgery

53
Q

What is the most simple classification of lung cancer?

A

Small cell lung cancer

Non-small cell lung cancer

54
Q

In small cell lung cancer, name the potential oncogene therapeutic target?

A

myc

55
Q

In small cell lung cancer, name the three potential tumour suppressor genes for therapeutic targeting?

A

p53
Rb
3p

56
Q

In non-small cell lung cancer, name the 3 oncogene potential therapeutic targets?

A

myc
K-ras
EGFR

57
Q

In non-small cell lung cancer, name the 6 potential therapeutic targets (tumour suppressor genes)?

A 
p53
1q
3p
9p
11p
Rb
58
Q

Most adenocarcinomas are smoking related and often show what?

A

K-ras mutation + wild-type EGFR

59
Q

Name a tyrosine kinase inhibitor which shows activity in some NSCLC patients?

A

Gefitinib

60
Q

What type of tumours are sensitive?

A

Adenocarcinomas

61
Q

Tumours with what present are the only ones that respond?

A

Epidermal growth factor receptor (EGFR)

62
Q

What is essential to do before prescribing treatment for lung cancer?

A

Molecular testing of tumour tissue

63
Q

What are 4 features of bronchial (large airway) tumours?

A
  1. Squamous metaplasia
  2. Dysplasia
  3. Carcinoma in situ
  4. Invasive malignancy
64
Q

What two features do peripheral adenocarcinomas have?

A
  1. Atypical adenomatous hyperplasia

2. Spread of neoplastic cells along alveolar walls (bronchioloalveolar carcinoma)

65
Q

What are two prognostic indicators in lung cancer?

A

Tumour stage

Tumour histological subtype

66
Q

What are carcinoid lung neoplasms?

A

Neuroendocrine neoplasms of low grade malignancy

67
Q

Where are bronchial gland neoplasms often seen?

A

In salivary glands

68
Q

Name two bronchial gland neoplasms?

A

Adenoid cystic carcinoma

Mucoepidermoid carcinoma

69
Q

What is the median survival for lung cancer?

A

5.8 months

70
Q

What type of lung cancer is a rapidly progressive disease, early metastases and is rarely suitable for surgery but has a good initial response to chemotherapy?

A

Small cell

71
Q

What two types of tumours are included in the non-small cell catagory?

A

Squamous and adenocarcinomas

72
Q

What type of lung cancer is sometimes cured by surgery or radical radiotherapy, and less responsive to chemotherapy - as well as accounting for the majority of lung cancer?

A

Non-small cell

73
Q

What is the median survival for non-small cell cancer?

A

7.7 months

74
Q

What is the median survivial for small cell cancer?

A

5.9 months

75
Q

What are the 4 treatment choices for lung cancer?

A

Surgery
Rdiotherapy
Chemotherapy
Palliative care

76
Q

When staging for surgery, what 3 things is the surgeon looking for with bronchoscopy?

A
  1. Vocal cord palsy
  2. Proximety to carina
  3. Cell type
77
Q

When staging for surgery - what is the surgeon looking for with a mediastinoscopy?

A

Lymph nodes

78
Q

When staging for surgery, what is the surgeon looking for with a CT scan of the brain?

A

Metastases

79
Q

When staging for surgery, what is the surgeon looking for with a CT scan of thorax?

A

Tumour size
Lymph nodes
Metastases
Local invasion

80
Q

What are the two types of surgery for lung cancer?

A

Pneumonectomy or lobectomy

81
Q

What does cytotoxic chemotherapy have a better response in?

A

Small cell lung cancer

82
Q

How often are IV infusions needed when performing cytotoxic chemotherapy?

A

3-4 weeks

83
Q

What are 4 side effects of chemotherapy?

A 
Nausea and vomiting
Tiredness
Bone marrow suppression - opportunistic infection, anaemia
Hair loss
Pulmonary fibrosis
84
Q

What kind of therapy involves ionising radiation?

A

Radiotherapy

85
Q

What are 3 disadvangtages relating to radiotherapy?

A
  1. Maximum cumulative dose
  2. Collateral damage - spinal cord, oesophagus, adjacent lung tissue
  3. Only goes where you put the beam
86
Q

Name 4 endobronchial palliative therapies?

A
  1. Stend insertion for stridor
  2. Photodynamic therapy
  3. Other laser therapy
  4. Radioactive pellets

Resp JL (27 decks)

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