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Respiratory > cancer > Flashcards

cancer Flashcards

1
Q

risk factors

A 
smoking 
asbestos 
nickel
chromates
radiation 
atmospheric pollution 
genetics
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2
Q

clinical presentation local effects

A

obstruction of airways - pneumonia
invasion of chest wall - pain
ulceration - haemoptysis

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3
Q

clinical presentation metastases

A

nodes
bones
liver
brain

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4
Q

clinical presentation systemic effects

A

weight loss
ectopic hormone production
PTH - squamous cancer
ACTH - small cell cancer

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5
Q

respiratory acinus

A

functional unit of the lung

extends through respiratory bronchiole, alveolar ducts and alveoli

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6
Q

classification

A 
adenocarcinoma - 35%
squamous carcinoma - 30%
small cell carcinoma - 25%
large cell carcinoma - 10%
neuroendocrine 
bronchal gland
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7
Q

why classify

A

prognosis
treatment
pathogenesis/biopsy
epidemiology

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8
Q

survival time

A

small cell worst

large cell worse than squamous or adenocarcinoma

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9
Q

immunohistochemistry adenocarcinoma

A

expresses TTF - thyroid transcription factor

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10
Q

immunohistochemistry squamous carcinoma

A

expresses nuclear antigen p63 and high molecular weight cytokeratins

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11
Q

EFGR

A

oncogene

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12
Q

erlotinib

A

tyrosine kinase inhibitors

EGFR tumours respond

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13
Q

crizotinib

A

EML4-ALK fusion oncogene also identifies a target for specific drug treatment

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14
Q

pathogenesis

A

pulmonary epithelium
bronchial - ciliated, mucous, neuroendocrine, reserve
bronchioles/alveoli - club cells, types 1 and 2 alveolar cells

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15
Q

bronchial large airway tumours

A

squamous metaplasia
dysplasia
carcinoma in situ
invasive malignancy

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16
Q

peripheral adenocarcinomas

A

atypical adenomatous hyperplasia
spread of neoplastic cells along alveolar walls
true invasive adenocarcinoma

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17
Q

carcinoid

A

neuroendocrine neoplasms of low grade malignancy

18
Q

bronchial gland neoplasms

A

often seen in salivary glands
adenoid cystic carcinoma
mucoepidermoid carcinoma

19
Q

treatment options

A 
giving the diagnosis
surgery
radiotherapy
chemotherapy
supportive care
20
Q

small cell

A

rapidly progressive disease
early metastases
rarely suitable for surgery
good initial response to chemotherapy

21
Q

non small cell

A

includes squamous and adeno carcinoma
curative options are surgery or radical radiotherapy
palliative chemotherapy and new targeted treatment
majority of lung cancers

22
Q

surgery for lung cancer

A

pneumonectomy or lobectomy
curative objective
peri-operative mortality
post-operative morbidity

23
Q

cytotoxic chemotherapy

A 
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
24
Q

chemotherapy side effects

A 
nausea and vomiting 
tiredness
bone marrow suppression 
hair loss
pulmonary fibrosis
25
Q

radiotherapy

A

ionising radiation
radical - curative intent
palliative
well tolerated

26
Q

radiotherapy negatives

A

maximum cumulative dose
collateral damage
only goes where you point the beam

27
Q

SABR

A 
sterotactic ablative radiotherapy 
many more beams 
less collateral damage 
total dose to tumour is higher and so more effective 
4D scanning required
28
Q

endobronchial therapy

A

stent insertion for stridor
photodynamic therapy
other laser therapy

29
Q

palliative care

A 
pain 
breathless
cough
anxiety
poor mobility
30
Q

mesothelioma

A

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

31
Q

mesothelioma symptoms

A 
SOB
chest pain
weight loss
fever
sweating
cough
32
Q

chrysotile

A

white asbestos

most common

33
Q

amosite

A

brown asbestos

34
Q

crocidolite

A

most dangerous

35
Q

mesothelima investigations

A

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

36
Q

mesothelioma treatment

A 
pleurodese effusions
radiotherapy
surgery
chemotherapy
palliative care
report deaths to fiscal
37
Q

malignant pleural effusion treatment

A 
palliate 
repeated pleural taps 
drain and/or pleurodesis
long term pleural catheters
surgical options - abrasion, pleurectomy
38
Q

TALC

A 
slurry
in suspension
poudrage
insufflated 
involves a hospital stay
39
Q

Talc complications

A 
minor pleuritic pain and fever
pneumonia
resp failure
talc pneumonitis/ARDS
secondary empyema
local tumour implantation at port site in mesothelioma
40
Q

predicting survival in malignant pleural effusion

A 
LENT score
LDH
ECOG PS
neutrophil to lymphocyte ratio
tumour type
41
Q

malignant pleural effusion treatment

A

depends on cause
LVF - diuretics
Infection - drain, antibiotics, surgery
malignancy - drain, pleurodesis, pleural catheter

Respiratory (19 decks)

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