clinical lung cancer Flashcards

1
Q

risk factors for squamous cell carcinoma?

A

Smoking
Age > 40
Environmental
– Radon Gas
– Urban Living
Occupational
– Asbestos
– Uranium Mining
– Tin Mining
Pulmonary Scarring
– Cryptogenic Fibrosing Alveolitis
– Sarcoidosis

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2
Q

when to refer?

A

Persistent haemoptysis in smokers of ex
smokers over 40 years of age
Signs of superior vena caval obstruction
(swelling of face/neck with fixed elevation
of JVP
Stridor

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3
Q

examinations?

A

Hands - Clubbing, muscle wasting
Face - Eyes, mucous membranes
Neck - Lymph nodes, trachea
Breasts - Axillae
Chest signs - collapse, consolidation,
stridor, wheeze
Abdo - hepatomegaly

Neurological assessment -
mental status, muscle wasting, pain,
paraneoplastic manifestations
Skin lesions – primary, secondary
Musculoskeletal- bony tenderness,
mobility

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4
Q

spirometry?

A
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5
Q

lung performance score?

A
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6
Q

lung cancer investigations?

A

Blood Tests
FBC, Coag, UEC, LFT, Bone profile
CXR
CT
– Chest
– Abdomen
– Brain
PET Scan
Ultrasound Scan

CXR
Staging CT scan
PET scan (staging)
Bone scan
U/Sound

invasive

Percutaneous needle biopsy
Bronchoscopy
EBUS
Mediastinoscopy

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7
Q
A
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8
Q

purpose of bronchoscopy?

A

Diagnostic
– Endobronchial Biopsy
– Extraluminal Biopsy - TBNA
– Transbronchial Biopsy
– Bronchoalveolar Lavage
Therapeutic
– Foreign Body
– Removal of Tumour
– Stent Insertion

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9
Q

CP-EBUS?

A

convex probe endobronchial ultrasound

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10
Q

other biopsy

A

Pleural Aspiration/Biopsy
Lymph Node Aspiration/Biopsy
Skin Metastasis Aspiration/Biopsy
Surgical Biopsy
– VATS
– Medistinoscopy

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11
Q

squamous cell cancer

A

Arises in metaplastic squamous epithelium
25 - 35% of all Ca lung
Male preponderance
Cigarette smoking
Bulky mass, central or peripheral,
cavitation and necrosis common

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12
Q

all plasias

A

Anaplasia – dedifferentiation
Aplasia – when an entire organ or a part of an organ is missing
Hypoplasia – inadequate or below-normal number of cells
Hyperplasia – physiological proliferative increase in number of cells
Neoplasia – abnormal proliferation
Dysplasia – change of phenotype (size,shape and organization of tissue)
Metaplasia – cell type conversion
Prosoplasia – cell type develops new function
Desmoplasia – connective tissue growth

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13
Q

adenocarcinoma

A

Usually in periphery
Commonest form of primary lung cancer
Female preponderance
Several morphological subtypes
Cuboid to columnar cells, often mucin
secreting forming acinar and papillary
structures

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14
Q

small cell carcinoma

A

Small cells, scant cytoplasm
Clinically often centrally located
Neuroendocrine cell origin
Chemosensitive
Aggressive course

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15
Q

tnm stage?

A

Tumour
– X,1,2,3,4
– Size of Tumour
– Where it Invades
Node
– 0,1,2,3
– Extent of Nodal Spread
Metastasis
– 0,1a, 1b
– Are there any?

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16
Q

staging

A
17
Q

treatment

A

Surgical resection – stages 1 & 2
Mediastinoscopy – frozen section
wedge resection
lobectomy
pneumonectomy
Approx 8% patients are suitable

18
Q

radiothrerapy?

A

Radical radiotherapy – stage 1 & 2 not suitable
for surgery
Palliative radiotherapy – pain, SVCO,
hypercalcaemia
Radiosurgery – cyberknife, gammaknife

19
Q

radiosurgery

A

Radiotherapy for patients “medically
inoperable”
Precise, image guided high dose radiation
Fiducial markers (gold seeds)

20
Q

stage 3 an 4

A

Can extend life by 2 – 3 months
Platinum based doublet therapy
Side effects vs quality of life
Palliation of symptoms

21
Q
A