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Cancer Flashcards

1
Q

What are paraneoplastic factors?

A

Systemic effects from biologically active molecules released from the tumour cells which mimic the effect of naturally released hormones

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2
Q

What can lung cancer present as?

A

Primary tumour, local invasion, metastases, paraneoplastic factors

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3
Q

What are symptoms of lung cancer?

A

Cough for > 3 weeks, breathlessness for no reason, hoarseness, weight loss, haemoptysis, not clearing/recurrent chest infections, chest/shoulder pain, tiredness

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4
Q

What is bronchial mucosa lined with?

A

Ciliated epithelium

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5
Q

What does lung cancer cause in terms of histology?

A

Reddened mucosa

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6
Q

What often happens to a lung as the cancer progresses?

A

It will shrink- when looking at a CXR, the smaller lung is usually the affected one

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7
Q

What is stridor?

A

Difficulty breathing in and an inspiratory wheeze

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8
Q

What are examples of other structures the tumour could reach to cause symptoms?

A

Recurrent laryngeal nerve, pericardium, oesophagus, branchial plexus, pleura, SVC

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9
Q

What does invasion in the pericardium cause?

A

Breathlessness, AF, pericardial effusion

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10
Q

What does invasion in the oesophagus cause?

A

Dysphagia

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11
Q

What is a Pancoast tumour?

A

A tumour at the apex of the lungs

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12
Q

What is a common site of invasion in a Pancoast tumour?

A

Brachial plexus

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13
Q

What does invasion of the brachial plexus present as?

A

Weakness in the hand due to T1 root infiltration

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14
Q

When does a pleural effusion occur in lung cancer and what is the symptom of this?

A

When the tumour invades the pleural space- presents with breathlessness

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15
Q

What does an extended jugular vein and puffy eyelids/headache suggest?

A

Invasion of the SVC abstructing drainage from head/arms

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16
Q

What does bone erosion present as?

A

Pain which is worse at night

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17
Q

What can a tumour invading into the pulmonary artery and main bronchus result in?

A

Sudden death with massive haemoptysis

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18
Q

What are common sites for metastases for lung cancer?

A

Bone, skin, liver, adrenal glands, other sites of lung, brain

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19
Q

What are signs of cerebral metastases?

A

Gradual onset weakness, visual disturbance, headaches which are worse in the morning and fits

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20
Q

What is a short term therapy for the symptoms of cerebral metastases?

A

High dose corticosteroids

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21
Q

What can liver metastases present as?

A

Pain, and sometimes jaundice

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22
Q

What will bone metastases show on a CXR?

A

Lytic lesion on x-ray (section out of bone)

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23
Q

What will bone metastases present as?

A

Localised pain worse at night, pathological fracture

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24
Q

What must happen if new finger clubbing is found?

A

CXR

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25
What are paraneoplastic factors of lung cancer?
Finger clubbing, hypertrophic pulmonary osteoarthropathy, weight loss, thrombophlebitis, hypercalcaemia, hyponatraemia, weakness
26
What do paraneoplastic factors result fro?
Effects of biochemically active products from the primary tumour- not indicative of metastatic disease
27
What is the cause of hypercalcaemia?
Tumour producing a substance which mimics the parathyroid hormone
28
What are symptoms of a tumour mimicking parathyroid hormone?
Headaches, thirst, confusion, constipation
29
What does hyponatraemia result from and what is the main symptom of this?
Substance mimics ADH- main symptom is confusion
30
What are symptoms of HPO?
Pain/tenderness in long bones near joints
31
What does thrombophlebitis present as?
Painful cord like structure
32
What is coughing up clear sputum every day generally caused by?
Chronic bronchitis
33
What will a cough caused by lung cancer often feel like?
Like they need to cough something up but it never comes
34
What are causes of breathlessness in terms of lung cancer?
Pleural effusion, PE, pericardial invasion
35
What does localised chest wall pain usually suggest?
Tumour invading the chest wall
36
What investigations do you do for lung cancer?
FBC, coagulation screen, spirometry, Us and Es, CXR. CT of thorax, PET scan bronchoscopy, endobronchial US
37
What test do you not do in suspected lung cancer?
Sputum cytology
38
What are differentials of lung cancer?
Lung cancer, TB, vasculitis, PE, secondary cancer, lymphoma, bronchiectasis
39
What are ways to make a diagnosis from tissue?
Bronchoscopy, CT guided biopsy, lymph node aspirate, aspiration of pleural fluid, endobronchial ultrasound, thoracoscopy
40
What are risk factors for lung cancer?
Smoking, asbestos, nickel, chromate, atmospheric pollution, genetics, radiation
41
What are the local effects of lung cancer and what do these cause?
Airway obstruction (pneumonia), invasion of the chest wall (pain) and ulceration (haemoptysis)
42
What are systemic effects of lung cancer?
Weight loss and 'ectopic' hormone production
43
What hormone do squamous carcinomas release?
Parathyroid hormone
44
What hormone does small cell cancer release?
Adrenocorticotropic hormone (stimulates cortisol release from adrenal glands)
45
What are the 4 smoking types of lung cancer from most to lease common?
Adenocarcinoma, squamous cell carcinoma, small cell carcinoma, non-small cell carcinoma
46
What are non-smoking associated tumours?
Neuroendocrine tumours or bronchial gland tumours
47
If the tumour is seen and accessible, how is it diagnosed?
Bronchoscopy and biopsy
48
If the tumour cannot be accessed, how is it diagnosed?
Needle aspiration or biopsy of metastases
49
What is the prognosis of lung cancers (worst to best)?
Small cell carcinoma, non-small cell carcinoma, squamous/adenocarcinoma
50
How is small cell cancer treated?
It responds well to chemotherapy but grows back very quickly so it is ineffective. Treatment is mainly palliative
51
What is the primary treatment for all other lung cancers apart from small cell?
Surgery if there has been no metastases
52
What type of lung cancer expresses thyroid transcription factor 1?
Adenocarcinoma
53
What type of lung cancer expresses nuclear antigen p63 and high molecular weight cytokeratins?
Small cell carcinomas
54
What type of cancer are mutations almost exclusively seen in?
Adenocarcinomas
55
What do adenocarcinomas involving mutations respond to?
Tyrosine kinase inhibitors
56
What are the different types of primary bronchial epithelium?
Mucous, ciliated, neuroendocrine, reserve
57
What are the different type of primary bronchiolar/alveolar epithelium?
Clara cells (exocrine), alveolar type 1 and 2 cells
58
What is the pathological transformation of bronchial tumours?
Squamous metaplasia, dysplasia, carcinoma in situ, invasive malignancy
59
What is the pathological transformation of peripheral adenocarcinomas?
Atypical adenomatous hyperplasia, spread of neoplastic cells along the alveolar walls (bronchioalveolar carcinoma), invasive adenocarcinoma
60
What are carcinoid lung neoplasms?
Neuroendocrine neoplasms of low grade malignancies
61
What are bronchial gland neoplasms?
Adenoid cystic carcinomas, mucoepidermoid carcinomas
62
What is the only type of primary tumour of the pleura?
Mesothelioma
63
After telling a patient a lung cancer diagnosis, what should you do?
Make sure they have understood, discuss a treatment plan and inform their GP
64
What often goes along with chemotherapy for SCC?
Radiation
65
What are treatment options for NSCC?
Surgery or radical radiotherapy
66
What are the factors to consider when thinking about surgery for lung cancer?
Can it be cut out? Is it localised? Will the patient tolerate surgery? What will residual lung function be?
67
What is a big risk of surgery for lung cancer?
The cancer may return later in life
68
When will a tumour be impossible to remove?
Within 2cm of the carina
69
What are surgery options for lung cancer?
Pneumonectomy or lobectomy via thoracotomy or keyhole surgery
70
What is the disadvantage of a thoracotomy?
Long recovery time
71
Why is performance status measured before chemotherapy?
A patient has to be fairly fir to undergo it
72
What is the purpose of chemotherapy in lung cancer?
Rarely curative but gives longer survival
73
What do side effects of chemotherapy include?
Nausea and vomiting, tiredness, bone marrow suppression, hair loss, pulmonary fibrosis
74
Where does radiation often cause collateral damage to?
Spinal cord, oesophagus, surrounding lung tissue
75
What does visceral pleura cover and form?
Covers the lungs and forms the inter-lobular fissures
76
Where are the inferior borders of the pleura compared to the lungs?
Lower
77
Where is there no pleura?
At the hilum
78
What cancers metastasise to the pleura?
Virtually all
79
What type of pleural effusions should always raise alarms?
Large unilateral ones
80
What tests do you do to diagnose a pleural malignancy?
CXR, pleural aspirate, biochemistry, cytology, culture
81
What will a CXR show if there is fluid in the pleura?
Trachea will be deviated- to make sure you can make the patient lie on their side to see if the fluid will move
82
What can small bilateral pleural effusions be due to?
Heart failure or PE
83
What does a straw coloured effusion suggest?
Cardiac failure
84
What does a bloody pleural effusion suggest?
Trauma, malignancy, infection, infarction
85
What does a milky/foul smelling effusion suggest?
Infection
86
What do food particles in an effusion suggest?
Ruptured oesophagus
87
What does a bilateral effusion suggest?
LVF, PE, drugs
88
What is a transudate effusion?
Not much protein, due to osmotic pressure, does not always have a benign aetiology
89
What is a exudate effusion?
High protein, always look for serous pathology
90
What is mesothelioma?
Uncommon malignant tumour of the lining of the lungs or occasionally the abdominal cavity
91
How long does it take for mesothelioma to develop?
Often 30-40 years
92
How do you treat mesothelioma?
Pleurodese effusions, radiotherapy, chemotherapy, palliative care, report death
93
What type of lung cancer can cause compression of nerves and blood vessels?
Adenocarcinoma
94
What is the result when adenocarcinoma suppresses the recurrent laryngeal nerve?
Hoarseness
95
What is the result when adenocarcinoma suppresses the sympathetic chain?
Horner's syndrome (drooping of eyelids, constricted pupils and flushing of one side of face)
96
What type of tumours is Horner's syndrome most common in and what is this caused by?
Pancoast tumours causing sympathetic chain disruption
97
What is a Pancoast tumour?
A tumour at the apex of the lungs
98
As well as adrenocorticotropic hormone, what other hormone can small cell lung cancers produce?
ADH
99
What is caused by high parathyroid hormone production in squamous cell carcinomas?
Hypercalcaemia, osteoporosis
100
What is caused by increased ADH production in small cell cancer?
Increased water reabsorption so increased serum osmolarity and decreased urine osmolarity
101
What will adenocarcinomas cause in non-smokers?
Mucous secretion
102
Which investigation would you do to look for bone metastases?
PET scan
103
What test do you use to stage cancer?
CT scan
104
What scan is used to detect osteoporosis?
DEXA bone scan

Respiratory (16 decks)

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