Cancer Flashcards
What are the types of lung cancer?
NSCLC- COMMON: SCC, Adenocarcinoma, Large cell carcinoma, Other (Carcinoid, mesothelioma)
SCLC
What sort of hormones can SCLC’s secrete?
ADH = SIADH
ACTH = ↑Cortisol = Cushing’s syndrome
PTH = ↑Ca2 = Polyuria/polydipsia, N&V, Abdo pain
GFa
What are the risk factors for lung cancer?
> 40yo
Smoking
Occupation (Asbestos exposture, uranium mining, ship building, petrol refining)
EFGR activation- Adenocarcinoma
What are the initial signs of lung Ca?
Cough +/- haemoptysis
Dyspnoea
Chest pain
Recurrent chest infections
What syndromal symptoms can be seen in lung Ca?
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
What indicates a 2w urgent CXR?
> 40yo + Smoker + 1 unexplained Sx
40yo + 2 unexplained Sx
Cough, SOB, Chest pain, Fatigue, Anorexia, ↓weight
How is Lung Ca managed?
SCLC: Chemo +/- adjuvant RT
NSCLC: Surgical resection
How is lung Ca investigated?
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
What are the criteria for an urgent appointment in lung clinic?
CXR suggestive of lung Ca
>40yo w/haemoptysis
What is mesothelioma?
Aggressive, malignant Ca of mesothelium (lining of thoracic & abdominal cavity)
What are the causes of a mesothelioma?
Asbestos
How can asbestos lead to a mesothelioma?
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
Where are mesotheliomas most commonly found?
Lungs
Liver
Spleen
Bowels
What are the signs of a mesothelioma?
Chest pain + dyspnoea + ↓weight Haemoptysis U/L exudative pleural effusion Pneumothorax LATE: Palpable chest wall mass Ascites (peritoneal mesothelioma)
What are the signs of asbestosis?
Progressive dyspnoea
↓Exercise tolerance
Clubbing
Fine end-inspiratory crackles
Where does asbestosis commonly affect?
Lower lobe = fibrosis
How is a mesothelioma/asbestosis investigated?
1) CXR- suspicious → CT
2) Thoracoscopy biopsy = DIAGNOSIS from histology
What is seen on a CXR of mesothelioma/asbestosis?
Pleural plaques
Mediastinal shift to I/L side
Pleural thickening
Pleural effusion- Bloody pleural fluid
What is pneumoconiosis?
Inhalation of coal dust
Ingested by macrophages which then die
Release enzymes
Leads to pulmonary fibrosis
What are the Sx of pneumoconiosis?
Dyspnoea on exertion
Cough +/- BLACK sputum
Resp failure
How is pneumoconiosis investigated?
CXR: UPPER lobe fibrosis, Round, irregular nodules
Spirometry
How is pneumoconiosis managed?
INCURABLE- manage Sx
Lifestyle: Chest physio
Prevention: Facemasks at work
What is a complication of pneumoconiosis?
Caplan’s Syndrome: Pneumoconiosis with RA
How does a lung abscess form?
Severe suppurative & localised infection
Leads to necrotic cavity
What are the causes of a lung abscess?
Staph Aureus
Klebsiella (OH- & DM)
TB
Fungal: Aspergillosis, Cryptococcus
How are lung abscesses categorised?
Primary = Normal lung Secondary = Diseased lung
What are the risk factors for a lung abscess?
Inhaled foreign body Penetrating trauma Untreated bacterial pneumonia Aspiration Bronchial obstruction Septic emboli
How does a lung abscess present?
SWINGING FEVER Productive cough Halitosis Dyspnoea Pleuritic chest pain Empyema
How is a lung abscess investigated?
1) CXR: Walled cavity w/air/ fluid level
2) Bloods: FBC, CRP, Cultures
3) CT
How is a lung abscess treated?
1) Abx: Cephalosporin + Clindamycin 4-6w
2) Postural drainage/aspiration
What is bronchiectasis?
Permanent dilatation of airways following chronic infection or CF
What are the causes of bronchiectasis?
INFECTION: Hib, Pseudomonas, Strep Pneumonia, Measles, TB, Pertussis
CONGENITAL: CF, Kartagener’s
Malignancy
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
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
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
