Cancer of the Lungs, Heart and Blood Vessels Flashcards
What is an angiosarcoma?
malignancy of vascular endothelial cells
What is a myoxma?
benign tumour of connective tissue containing mucus or gelatinous material
Why are cardiac cancers so rare?
low exposure to carcinogens
low turnover rate
strong selective advantage against things that compromise function
In what age group is lung cancer most prevalent?
75-90
In what sex is lung cancer most prevalent?
male
Are populations of lower or higher socioeconomic status more likely to develop lung cancer?
lower socioeconomic status
What is a huge factor (apart from sex age and socioeconomic status) that can increase risk of lung cancer?
smoking
duration, intensity, stopped/continued
What factors other than smoking can cause lung cancer?
passive smoking asbestos exposure radon exposure indoor cooking fumes chronic lung diseases immunodeficiency family history/genetic
List the pathophysiologies of lung cancer.
squamous cell carcinoma
adenocarcinoma
large cell lung cancer
small cell lung cancer
Most common lung cancer is?
adenocarcinoma
Small cell lung cancer originates from what cells?
pulmonary neuroendocrine cells
Squamous cell carcinoma originates from what cells?
bronchial epithelium, centrally located
Adenocarcinoma originates from what cells?
mucus-producing glandular tissue, more peripherally located
What is metaplasia?
reversible change in which one adult cell type replaced by another adult cell type; adaptive
What is dysplasia?
abnormal pattern of growth in which some of the cellular and architectural features of malignancy are present; pre-invasive stage with intact basement membrane
Describe a model of lung cancer development.
normal epithelium > hyperplasia > squamous metaplasia > dysplasia > carcinoma in situ > invasive carcinoma
What is important oncogene in adenocarcinoma?
EGFR epidermal growth factor receptor tyrosine kinase
EGFR important in what population?
women
Asian ethnicity
never smokers
What is important oncogenes in non-small cell lung cancer?
anaplastic lymphoma kinase (ALK) tyrosine kinase
c-ROS oncogene 1 (ROS1) receptor tyrosine kinase
BRAF (downstream cell-cycle signalling mediator)
ALK/ROS1 is important in what population?
younger patients
never smokers
BRAF is important in what population?
smokers
What are common symptoms of lung cancer?
cough weight loss breathlessness fatigue chest pain haemoptysis
What are features of advanced/metastatic disease?
neuro (focal weakness, seizures, spinal cord compression), bone pain, paraneoplastic syndromes (clubbing, hypercalcaemia, hyponatraemia, Cushing;s)
What is cachexia?
weakness and wasting of the body due to severe chronic illness
What is Pemberton’s sign?
used to evaluate venous obstruction in patients with goiters
+ve when bilateral arm elevation causes facial plethora
PET scanning is most useful for?
excluding occult metastases
How to choose biopsy method?
based on accessibility, availability and impact on staging
List types of biopsy?
bronchoscopy
endobronchial ultrasound + transbronchial needle aspiration of mediastinal lymph nodes
CT guided lung biopsy
When is bronchoscopy used?
for tumours of central airway
where tissue staging not important
When is EBUS (TBNA) used?
To stage mediastinum +/- achieve tissue diagnosis
When is CT guided lung biopsy used?
access peripheral lung tumours
How is cancer staged?
T1-4 tumour size/location
N0-3 lymph node involvement
M0-1c metastases and number
What are determinants of treatment?
Patient fitness Cancer histology Cancer stage Patient preference Health service factors
How is patient fitness assessed?
WHO performance status
comorbidities
lung function
What treatment options are there for cancer?
surgical
radiological
pharmacological
supportive
When is surgical resection the standard of care? Usual approach?
early stage disease
lobectomy + lymphadenectomy
At what stage is sublobar resection appropriate?
stage 1
What is an alternative to surgery in early stage disease?
radical radiotherapy
When is radical radiotherapy appropriate?
if there is comorbidity
What is the technique of choice for radical radiotherapy?
Stereotactic ablative body radiotherapy (SABR)
When the disease is locally advanced, what is the treatment?
surgery + adjuvant chemo
radio + chemo +/- immunotherapy
How is metastatic disease with a targetable mutation (e.g. EFGR, ALK, ROS1) treated?
tyrosine kinase inhibitor
also palliative care
How is metastatic disease with no mutation, PDL-1 +ve treated?
immunotherapy
also palliative care
How is metastatic disease with no mutation, PDL-1 -ve treated?
‘standard’ chemotherapy
also palliative care
Overall prognosis of lung cancer, what % of lung cancer patients live >10 years?
only 10%
