Cancers of the lung, heart and vasculature Flashcards
What is a myxoma?
- primary cardiac tumour
- tumour of connective tissue
Why are cardiac cancers so rare?
- low exposure of cells to carcinogens
- low turnover rate (cardiac myocytes divide v rarely)
- strong selective advantage against anything that could compromise function
What are the risk factors for lung cancer?
- age (peak 75-90)
- sex M>F
- smoking history (duration, intensity, when stopped)
- lower socioeconomic status
- passive smoking
- asbestos exposure (plumbers, ship-builders, carpenters…)
- radon
- indoor cooking fumes
- chronic lung diseases e.g. COPD, fibrosis
- immunodeficiency e.g. HIV
- familial/genetic- several loci identified
What are the different types of lung cancer?
- squamous cell carcinoma: from bronchial epithelium, central
- adenocarcinoma (most common): from mucus-producing glandular tissue, peripheral
- large cell lung cancer: mixed bag, undifferentiated
- small cell lung cancer: from pulmonary neuroendocrine cells, highly malignant!
What are the important oncogenes involved in lung cancer?
- EGFR tyrosine kinase–> never smokers, female, 15-30% of adenocarcinoma
- ALK tyrosine kinase–> young, never smokers
- ROS1 tyrosine kinase–> young, never smokers
- BRAF–> in smokers
What are the key symptoms of lung cancer?
- cough
- weight loss
- breathlessness
- fatigue
- chest pain
- haemoptysis
- frequently detected when asymptomatic
What are features of advanced/metastatic lung cancer?
- neurological features: focal weakness, seizures, spinal cord compression
- bone pain
- paraneoplastic syndromes: clubbing, hypercalcaemia, hyponatraemia, Cushing’s
What are some signs associated with lung cancer?
- clubbing
- cachexia
- Horner’s syndrome (ptosis, mitosis, anhidrosis)
- Pemberton’s sign (superior vena cava obstruction)
What is the first investigation for someone with suspected lung cancer?
chest x-ray
N.B. unilateral pleural effusion suspicious for malignancy (metastases) esp if no features of infection
What scan would you do to stage a lung cancer?
CT chest+abdomen
What scan is best to exclude occult metastases?
PET scan
When would you use bronchoscopy to take a biopsy?
- for tumours of central airway
- where tissue staging not important
When would you use EBUS (endobronchial ultrasound and transbronchial needle aspiration of mediastinal lymph nodes)?
to stage mediastinum and achieve tissue diagnosis
How would you take a biopsy of a peripheral lung tumour?
CT-guided lung biopsy
small risk of pneumothorax
How do you stage lung cancer?
- TNM
- T1-4 size and location
- N 0-3 lymph node involvement
- M 0-1c metastases + number
late stage at diagnosis is common :(
