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B13 - CardioResp > Intrathoracic Malignancy > Flashcards

Intrathoracic Malignancy Flashcards

1
Q

What cell type is a carcinoma a malignancy of?

A

Epithelial cells

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2
Q

what cell type is involved in a sarcoma?

A

Soft tissue or mesenchyme

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3
Q

What percentage of primary lung malignancies do carcinomas make up?

A

> 90%

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4
Q

What percentage of lung carcinomas are caused by smoking?

A

90%

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5
Q

What occupations put some people at a higher risk of radon exposure?

A

occupations like air crew, nuclear fuel plant and power station workers

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6
Q

What is the name given to mutations that are essential for tumour cell survival

A

Driver mutations

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7
Q

In an adenocarcinoma of the lung which mutations are common in non-smokers?

A

EGFR
ALK
RET
ROS1

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8
Q

In an adenocarcinoma of the lung, whcih mutations are common in smokers

A

KRAS

BRAF

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9
Q

List some cellular/molecular processes seen in squamous cell carcinoma.

A

loss of heterozygosity (LOH) of 3p and 9p.
Oncogene SOX2 amplification in 3q.
TP53 inactivation
LOH of 8p and 5q

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10
Q

What mutations would you see occurring in a small cell carcinoma

A

inactivation of TP53 and RB1 in all tumours.
RB1 mutation is a hallmark of small cell carcinoma
PTEN mutations
FGFR1 amplifications and SOX2 amplifications.
mutations in SLIT and EPHA7.

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11
Q

What mutation is a hallmark of small cell carcinoma?

A

RB1 mutation

(RB1 gene normally makes a protein called pRB which acts as a tumour suppressor.

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12
Q

List some common symptoms of lung cancer

A 
progressive shortness of breath
cough
weight loss
chest pain
hoarseness
increased sputum production
haemoptysis
paraneoplastic manifestation
symptoms referable to metastases
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13
Q

If a tumour obstructs the airway what clinical features may occur?

A

Pneumonia, abscess, lobar collapse

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14
Q

If a tumour spreads to the pleura what clinical features may occur?

A

pleural effusion

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15
Q

if a lung tumour invades the recurrent laryngeal nerve what clinical feature may be seen?

A

Hoarseness

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16
Q

oesophageal invasion of a lung tumour may cause what?

A

dysphagia

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17
Q

phrenic nerve invasion may cause what?

A

diaphragm paralysis

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18
Q

chest wall invasion of a lung carcinoma may cause what?

A

Rib destruction

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19
Q

SVC compression by tumour may cause what?

A

SVC syndrome - swelling of face and upper limbs, SOB, coughing etc.

20
Q

Horner syndrome may be seen when a tumour invades what? What tumours most commonly do this?

A

Sympathetic ganglia invasion.

Tends to be by apical (Pancoast) tumours

21
Q

If a lung carcinoma affects the heart what clinical features might you see?

A

Pericarditis

tamponade (fluid in the pericardium builds up, resulting in compression of the heart).

22
Q

Where do carcinomas of the lung tend to metastasise to?

A

lymph nodes, bone, brain, liver, skin, adrenal glands

23
Q

What is meant by a paraneoplastic syndrome?

A

symptoms that occur at sites distant from a tumour or its metastasis

24
Q

In what ways can cancers spread/metastasise?

A
  1. direct route
  2. lymphatic route
  3. haematogenous routes
25
Q

Lung cancer cells can produce hormones ectopically - true or false?

A

True

26
Q

ADH can be produced by lung cancer cells (syndrome of inappropriate ADH secretion) - what would it cause?

A

hyponatraemia - clinical manifestations are primarily neurologic due to an osmotic shift of water into brain cells causing oedema.

27
Q

If you see a patient with Cushing-syndrome what may be causing it in terms of malignancy?

A

lung cancer cells producing ACTH

28
Q

Humoral hypercalcaemia of malignancy is caused by a tumour producing what hormone ectopically?

A

Parathyroid hormone (PTH)

29
Q

Humoral hypocalcaemia of malignancy is caused by a tumour producing what hormone ectopically?

A

calcitonin

30
Q

What paraneoplastic disorder can small cell carcinomas of the lung cause which may present as weakness in the limbs?

A

Lambert-Eaton myasthenic syndrome

31
Q

What is Trousseau syndrome?

A

a thromboembolic disorder associated with malignancy. Makes thromboembolisms more likely as it is a hypercoagulability syndrome.

32
Q

What percentage of lung carcinomas are small cell and what are non-small cell?

A

small cell carcinomas = 13%

non-small cell carcinomas = 87%

33
Q

What is an adenocarcinoma?

A

A malignant tumour formed from glandular structures in epithelial tissue

34
Q

What is the first line therapy for non-small cell carcinomas?

A

surgery

35
Q

What is first line therapy for small cell carcinomas?

A

Chemotherapy

36
Q

What is the second line therapy for non-small cell lung cancers?

A

radiotherapy

37
Q

what is the 5 year survival rate for non-small cell lung cancers TNM stages I-II

A

23-60%

38
Q

what is the 5 year survival rate for patients with advanced lung carcinoma TNM stages III-IV?

A

<1%

39
Q

what is the median survival time of patients diagnosed with limited small cell carcinoma?

A

18 months

40
Q

What class of drugs may be used if a EGFR mutation is present?

A

tyrosine kinase inhibitors

e.g. erlotinib, gefitinib, osimertinib

41
Q

What carcinogen are 90% of malignant mesotheliomas associated with exposure to?

A

asbestos

42
Q

What cellular processes might carcinogenic substances cause?

A

chronic inflammation and fibrosis

43
Q

what type of lung cancer might you see pleurisy and plural effusion in?

A

malignant mesothelioma

44
Q

When taking a history of a patient with suspected malignant mesothelioma, what is a good question to ask?

A

Occupational history and whether they’ve had any exposure to asbestos

45
Q

What is pleurodesis?

A

a treatment for a pleural effusion caused by a malignant mesothelioma where a sclerosing agent, e.g. sterile talc, is instilled into the plural cavity which irritates the pleura and causes fibrosis to occur so the pleura sticks together and fluid can no longer accumulate in the cavity.

46
Q

What is meant by secondary lung cancer?

A

Where cancer cells have spread to the lungs from a cancer that started somewhere else in the body.

B13 - CardioResp (1 decks)

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