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Respiratory > Carcinoma of the Bronchus > Flashcards

Carcinoma of the Bronchus Flashcards

1
Q

What is a carcinoma of the bronchus?

A
  • Uncontrolled cell division of the cells in the bronchus

- Second most common type of cancer in the UK

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2
Q

What are the risk factors of Bronchial Carcinoma?

A
  • Cigarette and Passive Smoking
  • Asbestos
  • Chromium
  • Arsenic
  • Iron oxides
  • Radiation
  • Genetics
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3
Q

How can the clinical features of lung cancer be categorised?

A
  • Local signs and symptoms
  • SVC obstruction
  • Pancoast’s tumour
  • Horner’s syndrome
  • Paraneoplastic Syndrome
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4
Q

What are the local signs and symptoms of lung cancer?

A
  • Weight loss
  • Hoarse voice
  • Cough
  • Haemoptysis
  • Dyspnoea
  • Stridor
  • Chest pain
  • Pneumonia
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5
Q

What are the signs and symptoms of SVC obstruction?

A
  • Head fullness
  • Facial swelling
  • Cough
  • Dysphagia
  • Chest pain
  • Hoarseness
  • Stridor

SVC obstruction only occurs when the cancer is on the right hand side

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6
Q

What are the signs and symptoms of Pancoast tumour?

A
  • Shoulder pain radiating down the arm in ulnar distribution
  • Hoarseness of voice due to compression of recurrent laryngeal nerve

Diagnosed through CT chest

It is caused by the cancer at the apex of the lung affecting C8 and thoracic nerve

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7
Q

What are the signs in Horners Syndrome?

A
  • Endophthalmos (eye ball depression)
  • Ptosis (droop)
  • Miosis (pupil constriction)
  • Anhidrosis (absence of sweating)
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8
Q

What are the signs and symptoms in Paraneoplastic syndrome?

A
  • Hypercalcemia (squamous cell carcinoma)
  • SIADH (small cell carcinoma)
  • Ectopic ACTH secretion by tumour (small cell carcinoma)
  • Lambert Eaton Myasthemic Syndrome (small cell carcinoma)
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9
Q

What are the 4 different types of lung cancers?

A

=> Small cell lung carcinoma

=> Non-small cell lung carcinoma:

  • Squamous cell carcinoma
  • Adenocarcinoma
  • Large cell carcinoma
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10
Q

What is squamous cell carcinoma?

A
  • Usually starts central bronchus
  • Strong association with smoking
  • Metaplasia => Dysplasia => Carcinoma
  • Obstructive lesions that can lead to infection
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11
Q

What is adenocarcinoma?

A
  • Most common type of lung cancer in non-smokers
  • Seen in peripheral small airways
  • Precursor lesion = atypical adenomatous hyperplasia
  • Associated with gynaecosmatia
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12
Q

What is large cell carcinoma?

A

Undifferentiated carcinomas that cannot be categorised microscopically

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13
Q

What is small cell carcinoma?

A
  • Strongest association with smoking
  • Highly aggressive
  • No precursor lesion
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14
Q

What are the investigations in suspected lung cancers?

A

=> Bronchoscopy
Good for central lesions

=> CT guided smalping
Good for peripheral lesions - also used for staging

=> CXR - typically first line

=> Sputum cytology

=> CT Head

=> Bloods

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15
Q

What is the management of lung cancer?

A

Tyrosine Kinase Inhibitors:

  • Gefitinib
  • Erlotinib

Immunotherapy:

  • Cancer cells express PDL-1 which inhibits T cells by binding to PD1
  • Responsive to Pembrolizumab

Management of Small cell lung cancer:
- Chemotherapy

Management of Non-Small Lung Carcinoma:

  • Surgery
  • Radiotherapy
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16
Q

What is Mesothelioma?

A
  • Malignant tumour due to asbestos exposure

- Long latency period

17
Q

In what group of people does Mesothelioma occur in?

A
  • Men

- Aged 60+

18
Q

What is the clinical presentation of Mesothelioma and investigation?

A
  • Dyspnoea
  • Chest pain
  • Pleural effusion

=> Investigations:

  • Gold standard is ultrasound guided thoracosopy
  • CXR may show pleural effusions
19
Q

What is Asbestosis?

A
  • Diffuse parrenchymal lung disease
  • Gradually worsening breathlessness which ends in chronic respiratory failure

=> Asbestos exposure can also cause:

  • Mesothelioma
  • Asbestosis
  • Lung cancer
  • Pleural thickening
  • Pleural plaques
20
Q

What is the criteria for Cancer referral and what is the criteria for Urgent CXR within 2 weeks? (Note they are different)

A

=> Cancer Referral:

  • CXR finding suggestive of lung cancer
  • > 40 and unexplained haemoptysis

=> Urgent CXR within 2 weeks if ≥ 2 of following:

  • Fatigue
  • Cough
  • SOB
  • Chest pain
  • Weight loss

=> Note, for urgent CXR, only one of the criteria is needed if the patient smokes or has a PMH of smoking

Respiratory (10 decks)

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