Cancer Flashcards
What are paraneoplastic factors?
Systemic effects from biologically active molecules released from the tumour cells which mimic the effect of naturally released hormones
What can lung cancer present as?
Primary tumour, local invasion, metastases, paraneoplastic factors
What are symptoms of lung cancer?
Cough for > 3 weeks, breathlessness for no reason, hoarseness, weight loss, haemoptysis, not clearing/recurrent chest infections, chest/shoulder pain, tiredness
What is bronchial mucosa lined with?
Ciliated epithelium
What does lung cancer cause in terms of histology?
Reddened mucosa
What often happens to a lung as the cancer progresses?
It will shrink- when looking at a CXR, the smaller lung is usually the affected one
What is stridor?
Difficulty breathing in and an inspiratory wheeze
What are examples of other structures the tumour could reach to cause symptoms?
Recurrent laryngeal nerve, pericardium, oesophagus, branchial plexus, pleura, SVC
What does invasion in the pericardium cause?
Breathlessness, AF, pericardial effusion
What does invasion in the oesophagus cause?
Dysphagia
What is a Pancoast tumour?
A tumour at the apex of the lungs
What is a common site of invasion in a Pancoast tumour?
Brachial plexus
What does invasion of the brachial plexus present as?
Weakness in the hand due to T1 root infiltration
When does a pleural effusion occur in lung cancer and what is the symptom of this?
When the tumour invades the pleural space- presents with breathlessness
What does an extended jugular vein and puffy eyelids/headache suggest?
Invasion of the SVC abstructing drainage from head/arms
What does bone erosion present as?
Pain which is worse at night
What can a tumour invading into the pulmonary artery and main bronchus result in?
Sudden death with massive haemoptysis
What are common sites for metastases for lung cancer?
Bone, skin, liver, adrenal glands, other sites of lung, brain
What are signs of cerebral metastases?
Gradual onset weakness, visual disturbance, headaches which are worse in the morning and fits
What is a short term therapy for the symptoms of cerebral metastases?
High dose corticosteroids
What can liver metastases present as?
Pain, and sometimes jaundice
What will bone metastases show on a CXR?
Lytic lesion on x-ray (section out of bone)
What will bone metastases present as?
Localised pain worse at night, pathological fracture
What must happen if new finger clubbing is found?
CXR
What are paraneoplastic factors of lung cancer?
Finger clubbing, hypertrophic pulmonary osteoarthropathy, weight loss, thrombophlebitis, hypercalcaemia, hyponatraemia, weakness
What do paraneoplastic factors result fro?
Effects of biochemically active products from the primary tumour- not indicative of metastatic disease
What is the cause of hypercalcaemia?
Tumour producing a substance which mimics the parathyroid hormone
What are symptoms of a tumour mimicking parathyroid hormone?
Headaches, thirst, confusion, constipation
What does hyponatraemia result from and what is the main symptom of this?
Substance mimics ADH- main symptom is confusion
What are symptoms of HPO?
Pain/tenderness in long bones near joints
What does thrombophlebitis present as?
Painful cord like structure
What is coughing up clear sputum every day generally caused by?
Chronic bronchitis
What will a cough caused by lung cancer often feel like?
Like they need to cough something up but it never comes
What are causes of breathlessness in terms of lung cancer?
Pleural effusion, PE, pericardial invasion
What does localised chest wall pain usually suggest?
Tumour invading the chest wall
What investigations do you do for lung cancer?
FBC, coagulation screen, spirometry, Us and Es, CXR. CT of thorax, PET scan bronchoscopy, endobronchial US
What test do you not do in suspected lung cancer?
Sputum cytology
What are differentials of lung cancer?
Lung cancer, TB, vasculitis, PE, secondary cancer, lymphoma, bronchiectasis
What are ways to make a diagnosis from tissue?
Bronchoscopy, CT guided biopsy, lymph node aspirate, aspiration of pleural fluid, endobronchial ultrasound, thoracoscopy
What are risk factors for lung cancer?
Smoking, asbestos, nickel, chromate, atmospheric pollution, genetics, radiation
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)
What are systemic effects of lung cancer?
Weight loss and ‘ectopic’ hormone production
What hormone do squamous carcinomas release?
Parathyroid hormone
What hormone does small cell cancer release?
Adrenocorticotropic hormone (stimulates cortisol release from adrenal glands)
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
What are non-smoking associated tumours?
Neuroendocrine tumours or bronchial gland tumours
If the tumour is seen and accessible, how is it diagnosed?
Bronchoscopy and biopsy
If the tumour cannot be accessed, how is it diagnosed?
Needle aspiration or biopsy of metastases
What is the prognosis of lung cancers (worst to best)?
Small cell carcinoma, non-small cell carcinoma, squamous/adenocarcinoma
How is small cell cancer treated?
It responds well to chemotherapy but grows back very quickly so it is ineffective. Treatment is mainly palliative
What is the primary treatment for all other lung cancers apart from small cell?
Surgery if there has been no metastases
What type of lung cancer expresses thyroid transcription factor 1?
Adenocarcinoma
What type of lung cancer expresses nuclear antigen p63 and high molecular weight cytokeratins?
Small cell carcinomas
What type of cancer are mutations almost exclusively seen in?
Adenocarcinomas
What do adenocarcinomas involving mutations respond to?
Tyrosine kinase inhibitors
What are the different types of primary bronchial epithelium?
Mucous, ciliated, neuroendocrine, reserve
What are the different type of primary bronchiolar/alveolar epithelium?
Clara cells (exocrine), alveolar type 1 and 2 cells
What is the pathological transformation of bronchial tumours?
Squamous metaplasia, dysplasia, carcinoma in situ, invasive malignancy
What is the pathological transformation of peripheral adenocarcinomas?
Atypical adenomatous hyperplasia, spread of neoplastic cells along the alveolar walls (bronchioalveolar carcinoma), invasive adenocarcinoma
What are carcinoid lung neoplasms?
Neuroendocrine neoplasms of low grade malignancies
What are bronchial gland neoplasms?
Adenoid cystic carcinomas, mucoepidermoid carcinomas
What is the only type of primary tumour of the pleura?
Mesothelioma
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
What often goes along with chemotherapy for SCC?
Radiation
What are treatment options for NSCC?
Surgery or radical radiotherapy
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?
What is a big risk of surgery for lung cancer?
The cancer may return later in life
When will a tumour be impossible to remove?
Within 2cm of the carina
What are surgery options for lung cancer?
Pneumonectomy or lobectomy via thoracotomy or keyhole surgery
What is the disadvantage of a thoracotomy?
Long recovery time
Why is performance status measured before chemotherapy?
A patient has to be fairly fir to undergo it
What is the purpose of chemotherapy in lung cancer?
Rarely curative but gives longer survival
What do side effects of chemotherapy include?
Nausea and vomiting, tiredness, bone marrow suppression, hair loss, pulmonary fibrosis
Where does radiation often cause collateral damage to?
Spinal cord, oesophagus, surrounding lung tissue
What does visceral pleura cover and form?
Covers the lungs and forms the inter-lobular fissures
Where are the inferior borders of the pleura compared to the lungs?
Lower
Where is there no pleura?
At the hilum
What cancers metastasise to the pleura?
Virtually all
What type of pleural effusions should always raise alarms?
Large unilateral ones
What tests do you do to diagnose a pleural malignancy?
CXR, pleural aspirate, biochemistry, cytology, culture
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
What can small bilateral pleural effusions be due to?
Heart failure or PE
What does a straw coloured effusion suggest?
Cardiac failure
What does a bloody pleural effusion suggest?
Trauma, malignancy, infection, infarction
What does a milky/foul smelling effusion suggest?
Infection
What do food particles in an effusion suggest?
Ruptured oesophagus
What does a bilateral effusion suggest?
LVF, PE, drugs
What is a transudate effusion?
Not much protein, due to osmotic pressure, does not always have a benign aetiology
What is a exudate effusion?
High protein, always look for serous pathology
What is mesothelioma?
Uncommon malignant tumour of the lining of the lungs or occasionally the abdominal cavity
How long does it take for mesothelioma to develop?
Often 30-40 years
How do you treat mesothelioma?
Pleurodese effusions, radiotherapy, chemotherapy, palliative care, report death
What type of lung cancer can cause compression of nerves and blood vessels?
Adenocarcinoma
What is the result when adenocarcinoma suppresses the recurrent laryngeal nerve?
Hoarseness
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)
What type of tumours is Horner’s syndrome most common in and what is this caused by?
Pancoast tumours causing sympathetic chain disruption
What is a Pancoast tumour?
A tumour at the apex of the lungs
As well as adrenocorticotropic hormone, what other hormone can small cell lung cancers produce?
ADH
What is caused by high parathyroid hormone production in squamous cell carcinomas?
Hypercalcaemia, osteoporosis
What is caused by increased ADH production in small cell cancer?
Increased water reabsorption so increased serum osmolarity and decreased urine osmolarity
What will adenocarcinomas cause in non-smokers?
Mucous secretion
Which investigation would you do to look for bone metastases?
PET scan
What test do you use to stage cancer?
CT scan
What scan is used to detect osteoporosis?
DEXA bone scan
