cancer Flashcards
risk factors
smoking asbestos nickel chromates radiation atmospheric pollution genetics
clinical presentation local effects
obstruction of airways - pneumonia
invasion of chest wall - pain
ulceration - haemoptysis
clinical presentation metastases
nodes
bones
liver
brain
clinical presentation systemic effects
weight loss
ectopic hormone production
PTH - squamous cancer
ACTH - small cell cancer
respiratory acinus
functional unit of the lung
extends through respiratory bronchiole, alveolar ducts and alveoli
classification
adenocarcinoma - 35% squamous carcinoma - 30% small cell carcinoma - 25% large cell carcinoma - 10% neuroendocrine bronchal gland
why classify
prognosis
treatment
pathogenesis/biopsy
epidemiology
survival time
small cell worst
large cell worse than squamous or adenocarcinoma
immunohistochemistry adenocarcinoma
expresses TTF - thyroid transcription factor
immunohistochemistry squamous carcinoma
expresses nuclear antigen p63 and high molecular weight cytokeratins
EFGR
oncogene
erlotinib
tyrosine kinase inhibitors
EGFR tumours respond
crizotinib
EML4-ALK fusion oncogene also identifies a target for specific drug treatment
pathogenesis
pulmonary epithelium
bronchial - ciliated, mucous, neuroendocrine, reserve
bronchioles/alveoli - club cells, types 1 and 2 alveolar cells
bronchial large airway tumours
squamous metaplasia
dysplasia
carcinoma in situ
invasive malignancy
peripheral adenocarcinomas
atypical adenomatous hyperplasia
spread of neoplastic cells along alveolar walls
true invasive adenocarcinoma
carcinoid
neuroendocrine neoplasms of low grade malignancy
bronchial gland neoplasms
often seen in salivary glands
adenoid cystic carcinoma
mucoepidermoid carcinoma
treatment options
giving the diagnosis surgery radiotherapy chemotherapy supportive care
small cell
rapidly progressive disease
early metastases
rarely suitable for surgery
good initial response to chemotherapy
non small cell
includes squamous and adeno carcinoma
curative options are surgery or radical radiotherapy
palliative chemotherapy and new targeted treatment
majority of lung cancers
surgery for lung cancer
pneumonectomy or lobectomy
curative objective
peri-operative mortality
post-operative morbidity
cytotoxic chemotherapy
rarely curative but longer survival better response in small cell cancer major side effects IV every 3-4 weeks outpatient visits targets rapidly dividing cells
chemotherapy side effects
nausea and vomiting tiredness bone marrow suppression hair loss pulmonary fibrosis
radiotherapy
ionising radiation
radical - curative intent
palliative
well tolerated
radiotherapy negatives
maximum cumulative dose
collateral damage
only goes where you point the beam
SABR
sterotactic ablative radiotherapy many more beams less collateral damage total dose to tumour is higher and so more effective 4D scanning required
endobronchial therapy
stent insertion for stridor
photodynamic therapy
other laser therapy
palliative care
pain breathless cough anxiety poor mobility
mesothelioma
uncommon malignant tumour of the lining of the lung or very occasionally of the lining of the abdominal cavity
30-40 years to develop
asbestos
mesothelioma symptoms
SOB chest pain weight loss fever sweating cough
chrysotile
white asbestos
most common
amosite
brown asbestos
crocidolite
most dangerous
mesothelima investigations
imaging - pleural nodularity, circumferential pleural thickening, local invasion, lung entrapment
pleural fluid aspiration - low cytological yield, avoid repeated aspiration
biopsy - thorascopy or CT/US guided
mesothelioma treatment
pleurodese effusions radiotherapy surgery chemotherapy palliative care report deaths to fiscal
malignant pleural effusion treatment
palliate repeated pleural taps drain and/or pleurodesis long term pleural catheters surgical options - abrasion, pleurectomy
TALC
slurry in suspension poudrage insufflated involves a hospital stay
Talc complications
minor pleuritic pain and fever pneumonia resp failure talc pneumonitis/ARDS secondary empyema local tumour implantation at port site in mesothelioma
predicting survival in malignant pleural effusion
LENT score LDH ECOG PS neutrophil to lymphocyte ratio tumour type
malignant pleural effusion treatment
depends on cause
LVF - diuretics
Infection - drain, antibiotics, surgery
malignancy - drain, pleurodesis, pleural catheter
