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Respiratory Anatomy & Disease Mechanisms > Clinical Aspects of Bronchial Carcinoma (DISEASE MECHANISMS) > Flashcards

Clinical Aspects of Bronchial Carcinoma (DISEASE MECHANISMS) Flashcards

1
Q

What are the general features of cancer? (5)

A 
Uncontrolled replication
Malignant growth
Local invasion
Metastasis
Non-metastatic systemic effects?
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2
Q

What aspect of cancer causes non-metastatic systemic effects?

A

Biologically active cells released from tumour cells

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3
Q

What are para-neoplastic symptoms?

A

Symptoms that come up because of chemicals or hormones that the malignant tissue produce

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4
Q

What are the early symptoms of lung cancer? (8)

A 
Cough for > 3 weeks 
Breathlessness without reason
Persistent chest infection
Haemoptosis 
Unexplained weight loss
Chest/Shoulder pains
Unexplained fatigue/lethargy
Hoarse voice
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5
Q

What lines the bronchial mucosa?

A

Ciliated epithelium

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6
Q

What tool is used to take a sample during bronchoscopy?

A

Cytology Brush

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7
Q

What can be the underlying cause of recurrent pneumonia?

A

Underlying primary tumour

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8
Q

What is stridor?

A

Distressing symptom of difficulty breathing in

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9
Q

What sound is stridor typically associated with?

A

Coarse audible wheeze dring inspiration

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10
Q

What are the 6 common sites of local invasion of lung tumours?

A 
Recurrent laryngeal nerve
Pericardium
Oesophagus
Brachial plexus
Pleural cavity
Superior vena cava
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11
Q

How would a local invasion of the recurrent laryngeal nerve present?

A

Hoarse voice / Inability to speak

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12
Q

How would a local invasion of the pericardium present?

A

Breathless
Atrial fibrillation
Pericardial effusion

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13
Q

How would a local invasion of the oesophagus present

A

Dysphagia

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14
Q

What is dysphagia?

A

Difficulty/Inability swallowing

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15
Q

What is pericardial effusion?

A

Fluid build-up in the pericardium

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16
Q

What can pericardial effusion lead to?

A

Tamponade
Tachycardia
Fibrillations

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17
Q

What is a pan coast tumour?

A

Tumour in the apex of the lung

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18
Q

What can brachial plexus invasion of a tumour cause?

A

Wasting of muscles in the upper limb/pectoral girdle?

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19
Q

What does the brachial plexus supply?

A

Upper limbs and pectoral girdle

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20
Q

What can a tumour invading the pleural cavity cause?

A

Pleural effusion

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21
Q

What does local invasion of the SVC cause?

A

Obstruction of blood drainage from the arms and head

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22
Q

How do patients with a SVC obstruction present?

A

Puffy eyelids
Headache
Distension of superficial veins

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23
Q

Blood bypasses obstructed SVC by opening _______ with __ tributaries

A

Anastomoses

IVC

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24
Q

How does a patient with chest wall invasion by lung cancer present?

A

Localised chest wall pain - worse with movement

If there is bone erosion, often worse pain at night

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25
Q

How do patients with a pulmonary artery obstruction present?

A

Breathless

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26
Q

What is the danger of a tumour eroding the pulmonary artery and major bronchus?

A

Sudden death due to massive haemoptysis

27
Q

What are the common sites for metastases of primary lung cancer? (6)

A 
Liver
Brain
Bone
Adrenal
Skin
Lung
28
Q

How would a patient with cerebral metastases present?

A 
Insidious onset of: 
Weakness
Visual disturbance
Headaches
Fits/Seizures
29
Q

What distinguishes headaches caused by cerebral metastases?

A

Worse in the morning
Not photophobic
Worse when leaning forward

30
Q

Why do cerebral metastases cause headaches?

A

Raised intracranial pressure

31
Q

If cerebral metastases involve the cortex, the patient may present with ______

A

Epileptic fits

32
Q

Cerebral metastases can displace vessels in the brain causing ______

A

Oedema

33
Q

Oedematous brain can be treated with _____

A

Corticosteroid therapy

34
Q

Which corticosteroid could be used to treat oedematous brain?

A

Dexamethasone

35
Q

How would a patient with liver metastases adjacent to the liver capsule present?

A

Abdominal pain

36
Q

How would a patient with liver metastases obstructing the biliary drainage present?

A

Obstructive jaundice

37
Q

How can liver metastases often be identified?

A

Felt upon palpation - liver can become enormous

38
Q

How do patients with bone metastases commonly present?

A

Localised pain, usually mid-shaft that is worse at night

39
Q

What is the issue with adrenal metastases?

A

Often don’t show many symptoms

40
Q

What are the most common neoplasms in the adrenal?

A

Adenomas

41
Q

What are the common paraneoplastic symptoms of lung cancer?

A 
Finger clubbing
Hypertrophic pulmonary osteoarthropathy (HPOA)
Weight loss
Thrombophlebitis
Hypercalcaemia
Hyponatraemia (SIADH)
Weakness - Eaton Lambert syndrome
42
Q

How can tumours cause hypercalcaemia?

A

By producing a substance that mimics th effects of the parathyroid hormone

43
Q

What are common features of hypercalcaemia?

A

Headaches, confusion, thirst and constipation

44
Q

How can tumours cause hyponatraemia?

A

Production of a substance which mimics anti-diuretic hormone

45
Q

What is the main symptom of hyponatraemia?

A

Confusion

46
Q

What characterises Eaton-Lamber syndrome

A

Muscle weakness of the limbs

47
Q

How would you identify hypertrophic pulmonary osteoarthropathy on an X-ray?

A

Fuzzy appearance around the outer layer of the bone

48
Q

Where are common sites for hypertrophic pulmonary osteoarthropathy?

A

Hands, legs, and lower legs

49
Q

What is Thrombophlebitis?

A

Inflammation of the wall of a vein associated with thrombosis

50
Q

How do patients with thrombophelibits present?

A

Painful red tracking up the veins that doesn’t settle down very easily

51
Q

What important things should you ask for in a history in regards to lung cancer?

A 
Cough
Haemoptysis 
Cigarette smoker
Breathless
Weight loss
Chest Wall pain
Tiredness
Recurrent infection
Other smoking-related disease
52
Q

Why do lung cancer patients present with a cough?

A

Distortion of normal bronchial mucosa stimulates signal to cough

53
Q

How can tumours cause haemoptysis?

A

Ulcerate through mucosa - prone to bleeding

54
Q

Almost all smokers cough up ___ sputum in the morning

A

clear

55
Q

Why do patients with lung cancer often get recurrent lung infections?

A

Due to partial obstruction of a bronchial division by a tumour

56
Q

Why do many lung cancer patients present breathless?

A

Obstruction of airways

57
Q

What things should be watched out for in terms of signs of lung cancer during examination?

A 
Finger clubbing
Breathless
Cough
Weight loss
Bloated face
Hoarse voice
Lymphadenopathy
Tracheal deviation
Dull percussion
Stridor
Enlarged liver
58
Q

What are the possible investigation at clinic?

A 
Full blood count
Coagulation screen
Na, K, Ca, Alk Phos
Spirometry, FEV1
Chest X-ray
CT scan of thorax
PET scan
Bronchoscopy
Endobronchial Ultrasound (EBUS)
59
Q

How does a PET scan work?

A

Analysis of tissue uptake of radio labelled glucose - tissues with high metabolic activity “light up”

60
Q

Why does the bladder always light up during a PET scan?

A

Because the bladder is where contrast is excreted

61
Q

Why does the brain always light up during a PET scan?

A

Because it is highly metabolically active

62
Q

How can a tissue diagnosis of lung cancer be made?

A 
Bronchoscopy
CT guided biopsy
Lymph node aspirate
Aspiration of pleural fluid
Endobronchial ultrasound
Throacoscopy
63
Q

Why is video-bronchoscopy more suitable for central disease?

A

Can’t reach too far

Respiratory Anatomy & Disease Mechanisms (13 decks)

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