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1B Cardiorespiratory > cancers of lung, heart and vasculature > Flashcards

cancers of lung, heart and vasculature Flashcards

1
Q

how prevalent is primary cancer of blood vessels and heart?

A

very rare

  • Low exposure of cells to carcinogens
  • Turnover rate: cardiac myocytes divide very rarely
    • Growth via increasing size of individual cardiac myocytes rather than dividing
  • Strongly selective advantage against anything which could compromise function
    • Preventing any damage to cells
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2
Q

what are the types of primary cancer of blood vessels and heart?

A
  1. angiosarcoma
    1. malignancy of vascular endothelial cells
    2. of skin, heart, liver etc
  2. cardiac tumors
    1. E.g Myxoma, tumour of connective tissue
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3
Q

how common is lung cancer in UK?

A

3rd most common

leading cause cancer mortality in men and women

prior to smoking popularity lung cancer rare

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4
Q

what are the lung cancer prevalence trends?

A
  • Age peak 75-90
  • Mex: M>F
  • Low socioeconomic status
  • Smoking history
    • Duration, intensity, when stopped
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5
Q

what are causes of lung cancer?

A
  • smoking
    • (10-15% patients have never smoked)
  • passive smoking
  • Asbestos- exposure (plumber)
  • Radon gas (uranium mines)
  • Indoor cooking fumes- wood smoke, frying fats
  • Chronic lung diseases (COPD, fibrosis)
  • Immunodeficiency (HIV)
  • Familial/genetic
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6
Q

what are the different types of cancer cells?

A

squamous cell carcinoma

adenocarcinoma

large cell carcinoma

small cell carcinoma

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7
Q

what is squamous cell carcinoma?

A

2nd most common

originating from bronchial epithelium

centrally located

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8
Q

what is adenocarcinoma?

A

40% lung cancer

most common from 1980’s onwards- low tar cigarettes, retained longer

originating from mucus-producing glandular tissue more peripherally located

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9
Q

what is large lung cell cancer?

A
  1. Heterogenous group, undifferentiated
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10
Q

what are the features of small cell lung cancer?

A
  1. Originate from pulmonary neuroendocrine cells
  2. Highly malignant and very aggressive, presenting at late stage
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11
Q

what is metaplasia?

A

reversible change in which one adult cell type replaced by another cell type; adaptive

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12
Q

what is dysplasia?

A

abnormal pattern of growth in which some of the cellular and architectural feature of malignancy are present; pre invasive stage with intact basement membrane

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13
Q

what are the stages of lung cancer development?

A
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14
Q

what are the key features of cancer cells?

A
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15
Q

what are DNA adducts?

A
  • DNA adducts= segment of DNA bound to a cancer causing chemical
  • Normally corrected by anti-tumour genes such as p53 or Rb
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16
Q

what are the important oncogenes in lung cancer treatments?

A
  1. EGFR tyrosine kinase
  2. anaplastic lymphoma kinase (ALK) tyrosine kinase
  3. c-ROS oncogene 1 (ROS1) receptor tyrosine kinase
  4. BRAF
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17
Q

in what ethnicity is EGFR tyrosine kinase mutation prevalent?

A

high in women, Asian ethnicities, never-smoked

15-30% adenocarcinomas

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18
Q

in what population is ALK mutation more likely?

A

2-7% non-small cell lung cancer

especially in younger patients and never smokers

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19
Q

in what population is ROS1 oncogene more likely?

A

1-2% non-small cell lung cancer

especially in younger people and never smoked

20
Q

in what population is BRAF oncogene more likely?

A

1-3% non-small cell lung cancers

especially in smokers

21
Q

what are the key symptoms of lung cancer?

A
  • cough
  • weight loss (cachexia)
  • breathlessness
  • fatigue
  • chest pain
  • haemoptysis

frequently asymptomatic

22
Q

what are the features of advanced lung cancer/metastatic disease?

A
  • neurological features
    • focal weakness, seizures, spinal cord compression, horner’s syndrome
  • bone pain
  • paraneoplastic syndromes
    • clubbing, hypercalcaemia, hyponatraemia, Cushing’s
  • superior vena cava obstruction (Pemberton’s sign)
23
Q

what is horner’s syndrome?

A

ptosis (drooping eyelid)

miosis (constriction pupil)

anhydrosis (absence sweating face)

24
Q

what is pemberton’s sign?

A

positive sign= bilateral arm elevation causes facial plethora

25
Q

what are the common sites of lung cancer metastases?

A

liver

brain

bones

lymph nodes

adrenal glands

26
Q

what is a pet scan most useful for?

A

most useful to exclude occult metastases

ingestion of radioactively labeled glucose (taken up by all parts metastasising)

27
Q

what are the different methods used to biopsy lung tumour?

what are each method used for?

A
  • Choosing method based on accessibility, availability and impact on staging
  • Bronchoscopy
    • For tumours of central airway
    • Where tissue staging not important
  • Endobronchial ultrasound and transbronchial- needle aspiration of mediastinal lymph nodes (EBUS)
    • To stage mediastinum +/- achieve tissue diagnosis
  • CT-guided lung biopsy
    • Access peripheral lung tumours
28
Q

how is cancer staged?

A

stages 0-4

  • Stage 1= early single nodule with no evidence of spread
  • Stage 4= metastatic disease in multiple sites
29
Q

What are the staging of TNM system?

A
  • T1-4: tumour size and location
  • N0-3: lymph node involvement- mediastinum + beyond
  • M0-1c: metastases + number
30
Q

what are the treatment options for lung cancer?

A

surgical

radiological

pharmacological

supportive

31
Q

when is surgical treatment used?

A
  • Surgical resection is standard of care for early stage disease
  • Lobectomy + lymphadenectomy usual approach
  • Sublobar resection if stage 1 (<3cm)

Done via open thoracotomy or video-assisted thoracoscopic surgery (VATS)

32
Q

what are the types of surgical treatment?

A

wedge resection

  • removes small section of lung that contains tumour along with a margin of healthy tissue

Segmental resection

  • removes a larger portion of lung, but not entire lobe

lobectomy

  • removes entire lobe of one lung

pneunonectomy

  • removes an entire lung
33
Q

when is radiological treatment done for lung cancer?

A
  • Alternative to surgery for early stage disease
  • Particularly if comorbidity
  • Stereotactic ablative body radiotherapy (SABR)
    • Technique of choice
    • High precision targeting, multiple convergent beams
34
Q

what are the types of systemic treatments?

A
  1. oncogene directs
  2. immunotherapy
  3. cytotoxic chemotherapy
35
Q

when is oncogene-directed treatment used?

A

first line for metastatic NSCLC with mutation

36
Q

how does oncogene-directed treatment work?

A
  1. Tyrosine kinase inhibitors
    1. ETFR, ALK, ROS-1 inhibitors
  2. Efficacy- improvements in progression free-survival, but not necessarily overall survival vs standard chemotherapy
  3. Still palliative therapy
  4. Side effects
    1. Generally well tolerated (tablets)
    2. Rash, diarrhoea and pneumonitis
37
Q

how does immunotherapy work?

A

use body’s own immune system to attack cancer cells

e.g block PDL-1 or PD-1 allows T cell killing of tumour cell

  • First line for metastating non-small cell lung cancer with no mutation (PDL1>50%)
  • Effecacy
    1. Imporvements in progression- free survival and overall survival vs standard chemotherapy
  • Side effects
    1. Generally well tolerated
    2. Immune related side effects in 10-15% (thyroid, skin, bowel, lung, liver)
38
Q

when is cytotoxic chemotherapy used?

A
  1. First line for metastotic non-small cell lung cancer with no mutation and PDL1 <50% (in combination with immunotherapy)
  2. Long established
    1. Target any rapidly dividing cells
    2. Platinum-based regimens
39
Q

what is an example of cytotoxic chemotherapy?

A

Carboplatin, cisplatin

  1. Efficacy- modest improvements in overall survival vs best supportive care
  2. Side effects
    1. Frequent: fatigue, nausea, bone marrow suppression, nephrotoxicity
    2. Quality of life poorly evaluated in trials; no evidence for improvement QOL
40
Q

when should palliative and supportive care be offered?

A
  • Should be offered as standard to all patients with advanced stage disease
41
Q

what are the benefits of palliative and supportive care?

A
  • Symptom control, psychological support, education, practical and financial support, planning for end of life
  • Evidence for survival as well as symptomatic benefit
    • Improved QOL, lower depression scores
42
Q

what is lung cancer treatment determined by?

A

patient fitness ( ECOG/WHO)

cancer histology

cancer stage

patient preference

health service factors

43
Q

what is the classification of patient fitness?

A
  • Radical treatment restricted to <50% in bed during day or better (0-2)
  • 0- asymptomatic
  • 1- symptomatic but completely ambulatory
  • 2- symptomatic, <50% in bed during day
  • 3- symptomatic >50% in bed, but not bedbound
  • 4-bedbound
  • 5-death
  • Comorbidity + lung function also very important
44
Q

what is the prognosis for lung cancer?

A
  • Only 10% live >10yrs
  • Depends performance status and stage at diagnosis
45
Q

what is the simplified treatment for different stages of lung cancer?

A

1B Cardiorespiratory (15 decks)

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