Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y2 - BRS - CVR > Cancers of the Lung, Heart and Vasculature > Flashcards

Cancers of the Lung, Heart and Vasculature Flashcards

1
Q

What is cardiovascular cancer?

How common are cardiovascular cancers?

A

Primary cancer of blood vessels and heart

Very rare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is angiosarcoma?

A

Malignancy of vascular endothelial cells
Of skin, heart, liver, etc
UK annual incidence 1.5 cases per million

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are primary cardiac tumours?

A

Most common = myxoma = tumour of connective tissue in the heart
Annual incidence <1 case per million

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Why are cardiac cancers so rare?

A

Low exposure of cells to carcinogens (e.g. compared to lungs)

Turnover rate: cardiac myocytes divide very rarely

Strong selective advantage against anything, e.g. shape of cell which is highly specialised for CV function, as it could compromise function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Why might other organs be exposed more too carcinogens?

A

Lung- inhaled particles, smoking etc.

Kidney/Liver - exposed to toxins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How big of an issue is lung cancer?

A

3rd most common cancer in UK

~48,000 diagnoses/ year

~35,000 deaths/ year

Leading cause of cancer death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

From when has lung cancer become more common?

Who linked smoking habits with lung cancer?

A

After the 1930s
Smoking was only really popular after WW1

Doll and Hill - in the 1950s, classic prospective case-control study >40,000 British doctors’ smoking habits and development of lung cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are risk factors for lung cancer?

What is most relevant in smoking history?

A 
Age, peak 75-90
Sex, M>F
Lower socioeconomic status
Smoking history - duration, intensity
and if / when stopped
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are other causes of lung cancer other than smoking?

A

Passive smoking

Asbestos – exposure (plumbers, ship-builders, carriage workers, carpenters, etc) – risk up to x2

Radon – e.g. silver miners in Germany late 19th century; 1950s uranium mining in Colorado

Indoor cooking fumes – wood smoke, frying fats

Chronic lung diseases (COPD, fibrosis)

Immunodeficiency - HIV

Familial/ genetic – several loci identified

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the different types of lung cancer?

A

Non-small cell lung cancer (NSCLC):

Squamous cell carcinoma
Adenocarcinoma
Large cell lung cancer

Small cell lung cancer (SCLC):

Small cell lung cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the features of the 4 different types of lung cancer?

Squamous cell carcinoma
Adenocarcinoma
Large cell lung cancer
Small cell lung cancer

A

Non-small cell lung cancer (NSCLC):

Squamous cell carcinoma - originating from bronchial epithelium; centrally located, 30% of cases

Adenocarcinoma - originating from mucus-producing glandular tissue; more peripherally-located, 40% of cases

Large cell lung cancer - heterogenous group, undifferentiated, 15% of cases

Small cell lung cancer (SCLS):

Small cell lung cancer - originate from pulmonary neuroendocrine cells, highly malignant, very aggressive, frequently presents at a later stage, 15% of cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe the model of lung cancer development?

A 
Normal Epithelium
Hyperplasia
Squamous metaplasia
Dysplasia
Carcinoma in situ
Invasive carcinoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is meant by the terms metaplasia and dysplasia?

A

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

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are some important oncogenes and why are they relevant clinically?

A

Mutations in the genes below are important for directed treatment

Epidermal growth factor receptor (EGFR) tyrosine kinase - adenocarcinoma

Anaplastic lymphoma kinase (ALK) tyrosine kinase - NSCLC, young, non-smokers

c-ROS oncogene 1 (ROS1) receptor tyrosine kinase - NSCLC, young, non-smokers

BRAF (downstream cell-cycle signalling mediator) - NSCLC, smokers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What do genetic kinase defects cause?

A

Lung cancer most common in those who have never smoked

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the key symptoms of lung cancer?

A 
Cough
Weight loss
Breathlessness
Fatigue
Chest pain
Haemoptysis - coughing up blood
Or frequently asymptomatic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Why is lung cancer often diagnosed late?

A

Nature of lung
Lots of space in the thoracic cavity
Does not impede on other structures quickly
Non-specific symptoms = esp. in smokers, they experience coughs and breathlessness due to other co-morbidities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are features of advanced/metastatic disease?

A

Neurological features:
e.g. focal weakness, seizures, spinal cord compression

Bone pain

Paraneoplastic syndromes:
e.g. clubbing, hypercalaemia, hyponatraemia, Cushing’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is finger clubbing?

What is cachexia?

A

Characteristic change in shape of the distal digits

Muscle wasting and weight loss = reduced nutritional intake due to loss of appetite / increased metabolism due to tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is Pemberton’s sign?

What is Pemberton’s sign indicative of?

A 
Characterised by:
Engorgement of the face due to decreased blood flow
Redness
Facial swelling
Distention of veins of neck and chest
More evidence on elevation of the arms

Superior Vena Cava obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is Horner’s syndrome?

What is Horner’s syndrome caused by?

A

Characterised by decreased pupil size (pupillary reconstruction), a drooping eyelid (ptosis) and decreased sweating on the affected side of your face

Apical lung tumour

22
Q

What is the diagnostic strategy for lung cancer?

A

Establish most likely diagnosis

Establish fitness for investigation and treatment

Confirm diagnosis - specific type of cancer if considering systemic treatment

Confirm staging

23
Q

What imaging can be used to diagnose lung cancer?

What may be seen on this imaging?

A

Chest X-ray:
Tumours appear white
Might show unilateral pleural effusion

Staging ST (chest and abdomen)

PET

24
Q

What is unilateral pleural effusion often indicative of?

A

Malignancy

Likely metastasised from lung to pleura

25
Q

In what order are the imaging and other tests conducted and why?

A

First, chest x-ray, to see if anything is wrong - i.e. tumour, pleural effusion

Next, staging CT of chest and abdomen to confirm the findings seen on the chest x-ray and to look for spread of tumour i.e. into the mediastinum or abdomen

Then, PET scan as it is most useful to exclude occult metastases

Lastly, biopsy to confirm the diagnosis of lung cancer and to work out the histological subtype

26
Q

How does a PET scan work?

A

Ingestion of radioactively labelled glucose
Taken up by all parts of the body metabolising
Tumours metabolise at a greater rate = radioactive glucose shows up brighter on the scan

27
Q

What are the different types of biopsies and their methods?

How is a biopsy method chosen?

A

Bronchoscopy - fibro-optic tube passed down the bronchi, suitable for tumours in the central airway and where tissue staging is not important

Endobronchial ultrasound and trans bronchial needle - aspiration of mediastinal lumph nodes (ABUS [TBNA]), used to stage mediastinum and achive tissue diagnosis

CT guided lung biopsy - to access peripheral lung tumours

Choose method based on accessibility, availability, and impact on staging

28
Q

How do you stage lung cancer?

A

The TNM system:

T1-4: tumour size and location

N0-3: lymph node involvement – mediastinum + beyond

M0-1c: metastases + number

TNM can be simplified to stages 1 to 4

29
Q

What are the treatment options?

What determines treatment selection?

A

Surgical
Radiological
Pharmacological
Supportive

Patient fitness
Cancer histology
Cancer stage
Patient preference
Health service factors
30
Q

For patient fitness, what are WHO’s 6 performance statuses?

A

0 = Asymptomatic (Fully active, able to carry on all predisease activities without restriction)

1 = Symptomatic but completely ambulatory (Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature. For example, light housework, office work)

2 = Symptomatic, <50% in bed during the day (Ambulatory and capable of all self care but unable to carry out any work activities. Up and about more than 50% of waking hours)

3 = Symptomatic, >50% in bed, but not bedbound (Capable of only limited self-care, confined to bed or chair 50% or more of waking hours)

4 = Bedbound (Completely disabled. Cannot carry on any self-care. Totally confined to bed or chair)

5 = Death

31
Q

At what WHO performance stages for patient fitness is radical treatment considered?

What other factors are considered for radical treatment?

A

0-2

Other co-morbidities and lung function

32
Q

How is surgery used to treat lung cancer?

A

Surgical resection is standard of care for early stage disease

Wedge resection - tumour and small area of surrounding healthy tissue removed

Sublobar resection if stage 1 (≤3 𝑐𝑚) - larger portion of the lobe is removed containing the tumour

Lobectomy + lymphadenectomy usual approach - entire lobe containing the tumour and lymph nodes affected are removed

Pneumonectomy - entire lung removed

33
Q

How is surgery conducted?

A

Open thoracotomy - cranking open the ribs at the side of the chest to remove part of the lung

Video-assisted thoracoscopic surgery (VATS) - more commonly used nowadays, keyhole surgery

34
Q

Why is VATS preferred over open thoracotomy?

A

Less post-op pain
Lower risk of post-op infections
Fewer days spent post-op in hospital
Resection is still just as good performed via VATS vs open thoracotomy

35
Q

How and when is radical radiotherapy used to treat lung cancer?

A

Alternative to surgery for early stage disease - used if not fit enough for surgery (particularly comorbidity) or refuse surgery

Stereotactic ablative body radiotherapy (SABR):

  • Involves a lot of 3D planning due to high precision of target
  • Technique of choice
  • High-precision targeting, multiple convergent beams
36
Q

When are oncogene-directed systemic pharmacological treatments used?

What are some NICE approved drugs for these treatments?

A

First line for metastatic NSCLC with specific mutation - the drugs are usually protein kinase inhibitors

EGFR: erlotinib, gefitinib, afatinib, dacomitinib, and osimertinib

ALK: crizotinib, ceritinib, alectinib, brigatinib, lorlatinib

ROS-1: crizotinib, entrectinib

37
Q

What is the efficacy of drug treatments?

A

Drugs are better than standard chemo therapy in terms of progression free survival and side effects (but not necessarily overall survival)

These are palliative treatments - to help control the disease and improve symptoms rather than cure the disease

e.g. erlotinib PFS 13 vs 5 months, OS 23 vs 27 months compared to chemo (OPTIMAL trial)

PFS = progression free survival, OS = overall survival

38
Q

What are the side effects of the drug treatments?

A

Generally well-tolerated (tablets)

Rash, diarrhoea, and (uncommonly) pneumonitis

39
Q

What is immunotherapy?

A

New, progressive field, radical approach

Harnesses own immune system to attack cancer cells

40
Q

When are immunotherapy systemic pharmacological treatments used?

What are some examples of NICE approved drugs for these treatments?

A

First line for metastatic NSCLC with no mutation (and PDL1 >50%)

Pembrolizumab, atezolizumab, nivolumab

41
Q

What is the efficacy of immunotherapy?

What are side effects of immunotherapy?

A

Improvements in progression-free survival and overall survival vs standard chemotherapy:
e.g. pembrolizumab PFS 10 vs 6 months, OS 30 vs 14 months (KEYNOTE-024 trial)

Generally well-tolerated
Immune-related side-effects in 10-15% (thyroid, skin, bowel, lung, liver)

42
Q

When are cytotoxic chemotherapy systemic treatment used?

What are the features of chemo?

A

First line for metastatic NSCLC with no mutation and PDL1 ≤50% (in combination with immunotherapy)

Target any rapidly dividing cells
Platiunum-based regimens, e.g. carboplatin, cisplatin, paclitaxel, pemetrexed

43
Q

What is the efficacy of chemo?

A

Modest improvements in overall survival vs best supportive care:
e.g. 29% vs 20% one year survival in clinical trials

44
Q

What are the side effects of chemo?

A

Frequent: fatigue, nausea, bone marrow suppression, nephrotoxicity

Quality of life poorly evaluated in trials; no evidence for improvement

45
Q

What is the fourth dimension in cancer care?

A

Palliative care

Supportive care

46
Q

What are the features of palliative care?

What members of the MDT are key in delivering palliative care?

A

Should be offered as standard to all patients with advanced stage disease

Offers symptom control, psychological support, education, practical and financial support, planning for end of life

Lung cancer specialist nurse, other nurses

47
Q

Why is palliative care important and what does it result in?

A

Improve QoL
Lower depression scores
Mean survival can increase

48
Q

What treatment is used for early stage disease?

A

Surgery or radiotherapy with curative intent

49
Q

What treatment is used for locally advances disease? (involving thoracic lymph nodes)

A

Surgery + adjuvant chemotherapy

Radiotherapy + chemotherapy +/- immunotherapy

50
Q

What is the treatment for metastatic lung cancer?

A

With targetable mutation (e.g. EFGR, ALK, ROS-1): tyrosine kinase inhibitor

No mutation, PDL-1 positive: immunotherapy

No mutation, PDL-1 negative: ‘standard’ chemotherapy

Palliative care, alone or with the above

Y2 - BRS - CVR (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions