Cancer Flashcards

1
Q

What are the types of lung cancer?

A

NSCLC- COMMON: SCC, Adenocarcinoma, Large cell carcinoma, Other (Carcinoid, mesothelioma)
SCLC

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2
Q

What sort of hormones can SCLC’s secrete?

A

ADH = SIADH
ACTH = ↑Cortisol = Cushing’s syndrome
PTH = ↑Ca2 = Polyuria/polydipsia, N&V, Abdo pain
GFa

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3
Q

What are the risk factors for lung cancer?

A

> 40yo
Smoking
Occupation (Asbestos exposture, uranium mining, ship building, petrol refining)
EFGR activation- Adenocarcinoma

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4
Q

What are the initial signs of lung Ca?

A

Cough +/- haemoptysis
Dyspnoea
Chest pain
Recurrent chest infections

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5
Q

What syndromal symptoms can be seen in lung Ca?

A

APICAL TUMOURS:
Horner’s syndrome = Miosis + Anhidrosis + Ptosis
Pacoast’s syndrome = pain in nerve root distribution

MEDIASTINAL TUMOURS:
SVCO
Recurrent laryngeal nerve palsy: Hoarse voice = urgent referral to ENT

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6
Q

What indicates a 2w urgent CXR?

A

> 40yo + Smoker + 1 unexplained Sx
40yo + 2 unexplained Sx

Cough, SOB, Chest pain, Fatigue, Anorexia, ↓weight

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7
Q

How is Lung Ca managed?

A

SCLC: Chemo +/- adjuvant RT
NSCLC: Surgical resection

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8
Q

How is lung Ca investigated?

A

1) CXR: Where +/- lobar collapse
2) CT chest w/contrast = DIAGNOSTIC
3) Sputum cytology
4) Bronchoscopy: Biopsy & bronchial washings for histological diagnosis
5) PET scan: Operable disease to look for distal mets

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9
Q

What are the criteria for an urgent appointment in lung clinic?

A

CXR suggestive of lung Ca

>40yo w/haemoptysis

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10
Q

What is mesothelioma?

A

Aggressive, malignant Ca of mesothelium (lining of thoracic & abdominal cavity)

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11
Q

What are the causes of a mesothelioma?

A

Asbestos

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12
Q

How can asbestos lead to a mesothelioma?

A

Inhaled into interstitial space of lungs
Epithelial cells of visceral/parietal pleura = inflammed
Epithelial cells divide rapidly = mesothelial plaques of lungs
(produce calretinin – regulates Ca2+)
End line = Mesothelioma

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13
Q

Where are mesotheliomas most commonly found?

A

Lungs
Liver
Spleen
Bowels

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14
Q

What are the signs of a mesothelioma?

A
Chest pain + dyspnoea + ↓weight
Haemoptysis
U/L exudative pleural effusion
Pneumothorax
LATE: Palpable chest wall mass
Ascites (peritoneal mesothelioma)
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15
Q

What are the signs of asbestosis?

A

Progressive dyspnoea
↓Exercise tolerance
Clubbing
Fine end-inspiratory crackles

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16
Q

Where does asbestosis commonly affect?

A

Lower lobe = fibrosis

17
Q

How is a mesothelioma/asbestosis investigated?

A

1) CXR- suspicious → CT

2) Thoracoscopy biopsy = DIAGNOSIS from histology

18
Q

What is seen on a CXR of mesothelioma/asbestosis?

A

Pleural plaques
Mediastinal shift to I/L side
Pleural thickening
Pleural effusion- Bloody pleural fluid

19
Q

What is pneumoconiosis?

A

Inhalation of coal dust
Ingested by macrophages which then die
Release enzymes
Leads to pulmonary fibrosis

20
Q

What are the Sx of pneumoconiosis?

A

Dyspnoea on exertion
Cough +/- BLACK sputum
Resp failure

21
Q

How is pneumoconiosis investigated?

A

CXR: UPPER lobe fibrosis, Round, irregular nodules

Spirometry

22
Q

How is pneumoconiosis managed?

A

INCURABLE- manage Sx
Lifestyle: Chest physio
Prevention: Facemasks at work

23
Q

What is a complication of pneumoconiosis?

A

Caplan’s Syndrome: Pneumoconiosis with RA

24
Q

How does a lung abscess form?

A

Severe suppurative & localised infection

Leads to necrotic cavity

25
What are the causes of a lung abscess?
Staph Aureus Klebsiella (OH- & DM) TB Fungal: Aspergillosis, Cryptococcus
26
How are lung abscesses categorised?
``` Primary = Normal lung Secondary = Diseased lung ```
27
What are the risk factors for a lung abscess?
``` Inhaled foreign body Penetrating trauma Untreated bacterial pneumonia Aspiration Bronchial obstruction Septic emboli ```
28
How does a lung abscess present?
``` SWINGING FEVER Productive cough Halitosis Dyspnoea Pleuritic chest pain Empyema ```
29
How is a lung abscess investigated?
1) CXR: Walled cavity w/air/ fluid level 2) Bloods: FBC, CRP, Cultures 3) CT
30
How is a lung abscess treated?
1) Abx: Cephalosporin + Clindamycin 4-6w | 2) Postural drainage/aspiration
31
What is bronchiectasis?
Permanent dilatation of airways following chronic infection or CF
32
What are the causes of bronchiectasis?
INFECTION: Hib, Pseudomonas, Strep Pneumonia, Measles, TB, Pertussis CONGENITAL: CF, Kartagener's Malignancy
33
What are the Sx of bronchiectasis?
``` Persistent productive cough w/purulent sputum Haemoptysis Recurrent chest infection Cor-Pulmonale Clubbing C/L Coarse inspiratory crackles Wheeze ```
34
How is bronchiectasis investigated?
2) HRCT Chest= GOLD STANDARD shows tramline + signet ring sign, bronchial wall dilatation 1) CXR: Cystic shadows, thick bronchial walls, tramline + ring shadows 3) Sputum culture: Determine cause 4) Spirometry: Obstructive 5) Other: Sweat test- CF
35
How is bronchiectasis managed?
1) Inspiratory muscle training 1) Postural drainage 2) Bronchodilators 3) Abx: Based on sputum culture 4) Steroids: IF co-existing asthma