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Year 3 Respiratory Core Conditions > Bronchial Carcinoma > Flashcards

Bronchial Carcinoma Flashcards

1
Q

What is % of all cancers is bronchial carcinoma?

A

Bronchial carcinoma accounts for 19% of all cancer and 27% of cancer deaths.

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2
Q

What are the risk factors of bronchial carcinoma?

A
  • smoking
  • asbestos
  • chromium
  • arsenic
  • iron oxides
  • radon gas (radiation)
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3
Q

What percentage of bronchial carcinomas are squamous cell?

A

35% of bronchial carcinomas are Squamous cell

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4
Q

What % of bronchial carcinomas are adenocarcinomas?

A

27% of bronchial ca are adenorcarcinoma

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5
Q

small oat cell ca makes up what % of bronchial carcinomas?

A

20%

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6
Q

Who does bronchial ca affect?

A

3X more men than women.

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7
Q

What are the symptoms of bronchial carcinoma/

A
  • Cough
  • haemoptysis
  • SOB
  • chest pain
  • slow resolving pneumonia
  • lethargy
  • weight loss
  • loss of appetite
  • hoarse voice
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8
Q

What are the signs of bronchial carcinoma?

A
  • Cachexia
  • anaemia
  • clubbing
  • supraclavicular / axillary nodes

chest signs:

  • can be none OR
  • consolidation
  • pleural effusion
  • collapse

Signs of metastases:

  • bone tenderness
  • hepatomegaly
  • confusion
  • peripheral neuropathy
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9
Q

What are the chest signs of bronchial carcinoma?

A

There can be no chest signs OR
collpase,
Pleural effusion
consolidation

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10
Q

What are the signs of metastases?

A 
bone pain
hepatomegaly
confusion
peripheral neuropathy
proximal myopathy
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11
Q

What are the LOCAL complications of bronchial carcinoma?

A

Local:

  • recurrent laryngeal nerve palsy (hoarse voice)
  • Horner’s syndrome (pancoast tumour —> involvement of sympathetic ganglion)
  • Pancoast tumour —> brachial plexus —> pain in shoulder and inner surface of arm.
  • phrenic nerve palsy (paralysis of diaphragm)
  • SVC obstruction (SOB, chest pain, oedema)
  • rib erosion
  • pericarditis
  • atrial fibrillation
  • dysphagia
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12
Q

What is horner’s syndrome?

A

Horner’s syndrome involves 3 symptoms:

1) Ptosis (eyelid drooping)
2) Miosis (pupillary constriction)
3) hemifacial anhidrosis (absence of sweating on one side of face)

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13
Q

what is a pancoast tumour?

A

Tumour in apex of lung.

If it invloves the sympathetic ganglion can lead to horner’s syndrome.

If involved the brachial plexus can cause shoulder pain and pain in inner arm.

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14
Q

What are the metastatic complications of bronchial carcinoma?

A

BONE : bone pain, anaemia, hyperCa2+
Adrenals : Addisons
Endocrine: ectopic hormone secretion e.g. ACTH in cushing’s
Brain: confusion, fits, proximal myopathy

Other: clubbing, dermomyositis (rash and muscle weakness), ancanthosis nigricans

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15
Q

What are the investigations done for bronchial carcinoma?

A

Bloods:
FBC (anaemia)
LFT (liver mets?)
U&E ( hyperCa2+ , hypoNa)

Cytology:

  • sputum
  • pleural fluid

CXR shows:

  • peripheral nodule
  • hilar enlargement
  • consolidation
  • lung collapse

Fine needle aspiration/ biopsy

CT / PET CT (to stage tumour)

Bronchoscopy

Lung function test (to assess suitability for lobectomy)

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16
Q

What is the treatment of Non small cell bronchial tumours?

A

1) Surgical Excision (for peripheral tumour with no mets)
2) Curative Radiotherapy (if resp reserve poor)
3) Chemo + Radiotherapy for more advanced disease

17
Q

How are non small cell bronchial carcinomas staged?

A

TNM staging.
T = primary tumour, N = regional nodes, M=mets
T0) (no primary carcinoma evident)
T1) <3cm in lobar or more distal airway
T2) more than 3cm tumour distal to carina / pleural involvement
T3) involved chest wall, diaphragm, pleura, pericardium and nodules in same lobe.
T4) involved heart, trachea, oesoph, vertebral body, nodules in another lobe.

N0 (no nodes involved) —-> N3 nodes in hilum, supraclavicular involved.

M0 (no mets), M1 (mets present)

18
Q

What is the treatment of small cell tumours?

A

Small cell tumours are nearly always disseminated at presentation so chemotherapy +/- radiotherapy is best.

19
Q

What symptoms may radiotherapy be used to treat in a palliative patient with bronchial carcinoma/

A
  • bone pain
  • haemoptysis
  • SVC obstruction
20
Q

What is involved in palliative care of bronchial tumours?

A

palliative care:

  • radiotherapy for symptoms of bone pain, haemoptysis, svc obstruction.
  • SVC stent
  • endobronchial therapy ( tracheal stent, laser)
  • pleural drainage

Medications:

  • steroids to improve appetite
  • morphine (pain) + antiemetic
  • codeine (cough suppressant)
  • laxitives
  • bronchodilator
21
Q

What are the differentials for bronchial carcinoma?

A

Pneumonia

TB

22
Q

What is the prognosis of non small cell bronchial carcinoma?

A

50% two year survival without spread, 10% with spread.

23
Q

What is the prognosis of small cell bronchial carcinoma?

A

3 months if untreated.

1- 1.5 years if treated

24
Q

What are the differentials for a nodule on a CXR?

A
  • malignancy
  • carcinoid tumour
  • skin tumour
  • pulmonary harmatoma (area of fibrosis)

Infective:

  • abscess
  • granuloma
  • cyst
  • encysted effusion
  • arterio venous malformation
  • foreign body

Year 3 Respiratory Core Conditions (9 decks)

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