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Respiratory and Cardio > Intrathoracic malignancy > Flashcards

Intrathoracic malignancy Flashcards

1
Q

Primary intrathoracic malignancies can be in the:

A

Lungs

Pleura

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2
Q

leading cause of cancer mortality in men and women =

A

Carcinoma of the lung

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3
Q

90% of carcinoma of the lung cases are caused by:

A

Smoking

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4
Q

Smoking risk increases with

A

Duration

Number per day

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5
Q

Risk with smoking declines following

A

Cessation

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6
Q

Carcinogenic substances can act:

A

Directly

Indirectly

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7
Q

Indirect effects of carcinogens =

A

Chronic inflammation
Hyperplasia
Metaplasia

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8
Q

Lung specific and most potent carcinogens in cigarettes:

A

Tobacco specific nitrosamides
Polycyclic aromatic hydrocarbons
Polonium 210

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9
Q

Carcinogenic metal =

A

Arsenic
Nickel
Cadmium
Chromium

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10
Q

Irritants can cause cancer by

A

Increasing cell turn over, cell more susceptible to mutation

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11
Q

Ex of irritant

A

Formaldehyde

Nitrogen dioxide

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12
Q

Causes of lung cancer:

A 
Smoking
Occupational exposure
Enviornmental radon
Air pollution
Chronic lung disease
FHx
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13
Q

Radon =

A

Radioactive gas found in soil and rocks

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14
Q

Chronic lung diseases which are a RF for lung cancer:

A

Pulmonary fibrosis
COPD
Tuberculosis

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15
Q

Smoking can interact with other RFs in what manners?

A

Additive

Synergistic

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16
Q

Driver mutations =

A

Mutations essential for tumour cell survival

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17
Q

Common driver mutations for adenocarcinoma:

A

Non-smokers: EGFR, ALK, RET, ROS1

Smokers = KRAS, BRAD

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18
Q

Drug for EGFR mutations

A

Tyrosine kinase inhibitors

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19
Q

Suffix of tyrosine kinase inhibitors =

A

-inib

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20
Q

Drug for ALK mutations

A

ALK inhibitors

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21
Q

Driver mutations of squamous cell carcinoma =

A

LOH
SOX2 amplification
TP53 inactivation
LOH

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22
Q

LOH =

A

Loss of heteogenicity

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23
Q

SOX2 =

A

Oncogene

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24
Q

Driver mutations of small cell carcinoma =

A

Inactivation of p53 and RB1

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25
Q

Rb1 sequesters

A

EF2

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26
Q

What is a hallmark of small-cell lung cancers?

A

Rb1 mutation

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27
Q

Symptoms of lung cancer:

A 
SOB
Cough
Weight loss
Pain
Hoarseness
Increased sputum
Haemoptysis
Paraneoplastic
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28
Q

Locally, a lung cancer can effect what structures?

A 
Airway
Oesophagus
Pleura
Nerves: phrenic, recurrent laryngeal
Chest wall 
SVC
Sympathetic ganglia
Heart
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29
Q

Effects of airway obstruction =

A

Pneumonia
Lobar collapse
Abscess

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30
Q

Effects of tumour spread to pleura =

A

Pleural effusion

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31
Q

Effects of invasion of recurrent laryngeal nerve =

A

Hoarseness

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32
Q

Effects of oesophageal invasion

A

Dysphagia

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33
Q

Effects of phrenic nerve invasion

A

Diaphragm paralysis

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34
Q

Effects of chest wall invasion

A

Rib destruction

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35
Q

SVC syndrome causes =

A

Facial oedema, arm oedema, flushed face

36
Q

Evasion of synpathetic ganglia can cause =

A

Horner syndrome

37
Q

What kind of tumor causes horner syndrome?

A

Pancoast tumor

38
Q

Symptoms of horner syndrome =

A

Ptosis
Miosis
Anhydrosis

39
Q

Effects of pericardial involvement:

A

Pericarditis

Tamponade

40
Q

Pancoast tumors start at the

A

hilum

41
Q

What can a pancoast tumor invade?

A 
Top ribs
Brachicephalic vein
Subclavian artery
Phrenic nerve
Recurrent laryngeal nerve 
Vagus nerve 
Sympathetic ganglion
42
Q

Metastatic spread can be via:

A

Direct
Lymphatic
Haemotagenous

43
Q

What can a tumour cause (hint = hormones)

A

Paraneoplastic syndromes

44
Q

Examples of paraneoplastic syndromes:

A 
ADH = hyponatraemia
ACTH = cushings
PTH = hypercalcemia 
Calcitonin = hypocalcaemia 
Gonadotropins = gynaecomastia
45
Q

Lambert-eaton myasethenic syndrome =

A

Auto-antibodies against neuronal calcium channels. Similar symptoms to myasthenia gravis

46
Q

Systemic effects of lung carcinoma =

A 
Metastatic spead
Paraneoplastic syndromes
Lamber-easton
Peripheral sensory neuropathy 
Derm
47
Q

Hypertrophic pulmonary osteoarthropathy =

A

Finger clubbing

48
Q

Diagnosis of lung cancer is done via:

A

Imaging techniques = CXR, CT, MRI
Bronchoscopy
Sputum, bronchal brushing
Biopsy

49
Q

Main histological types of epithelial tumours =

A

Non-small cell

Small call

50
Q

Most common type of lung cancer

A

Non-small cell/adenocarcinoma

51
Q

Types of non-small cell carcinoma =

A

Adenocarcinoma
Squamous cell carcinoma
Large cell carcinoma

52
Q

Adenocarcinomas are from

A

Glandular structures

Generate mucins

53
Q

Squamous cell carcinomas are from

A

Square-shaped cells

Produce keratin

54
Q

Large cell carcinomas lack

A

Glandular or squamous differentiation

55
Q

Small cell carcinomas are from

A

Small, immature neuroendocrine cells

56
Q

Which type grows and metastasises quickest?

A

Small cell carcinomas

57
Q

Normal respiratory tract-type epithelium

A

Pseudostratified
Columnar
Ciliated

58
Q

Pre-invasive lesion of adenocarcinoma =

A

Atypical adenomatous hyperplasia

59
Q

What will be seen on staining of adenocarcinoma?

A

Abnormal acinar, glandular or papillary structures

Mucin production

60
Q

What may be seen on cytology of squamous cell carcinoma

A

Exfoliated cells in sputum, broncial washing and brushing

61
Q

What will be seen on staining of squamous cell carcinoma?

A

Excessive growth of abnormal squamous cells

Intercellular bridges and keratinisation

62
Q

What will be seen on staining of small cell lung cancer?

A 
Small
Round
Blue 
Hyperchromic nuclei, scanty cytoplasm
High mitotic count
Neuroendocrine differentiation = ribbons, rosettes, pseudorosettes
63
Q

Types of treatments for lung cancer:

A 
Surgery - lobectomy, pneumectomy
Chemo
Radio
Targeted 
Immuno
64
Q

Staging lung cancer is done via what scale?

A

TNM

65
Q

If a cancer has metastasised, what stage is it automatically?

A

IV

66
Q

Treatment of adeno/squamous in early TNM stages

A

Surgery

Radical radio

67
Q

Treatment of adeno/squamous in late TNM

A

Palliative chemo and radio

68
Q

KRAS mutation is found in what kind of cancers

A

Colorectal
Pancreatice
Adenocarcinoma

69
Q

Treatment of limited SCC

A

Radical chemo and radio

70
Q

Treatment of extensive SCC

A

Palliative chemo and radio

71
Q

2 types of ‘new’ therapies =

A

Targeted

Immunotherapy

72
Q

Targeted drugs are for which mutations in which kind of cancer?

A

Adenocarcinoma/non-small cell

  • EGFR
  • ALK
  • ROS1
73
Q

Immunotherpay is used for which kind of cancer?

A

Non small cell

74
Q

Immunotherapy =

A

PD-1 and PDL-1 inhibitors - stop tumor killing T cells

75
Q

PD-1 is found on

A

Activated T cells

76
Q

PD-L1 is found on

A

Tumor cells

77
Q

Suffix of immunotherpay

A

-umab

78
Q

Crizotinib =

A

Inhibits ALK

79
Q

Erlotinib =

A

Tyrosine kinase inhibitors

80
Q

Prembrolizumab =

A

PD-1, PDL-1 inhibitor

81
Q

Cancer of pleura =

A

Malignant mesothelioma

82
Q

> 90% of cases of malignant mesothelioma is due to:

A

Asbestos exposure

83
Q

Asbestos exposure can be:

A

Direct
Indirect
Neighbourhood
Ambient

84
Q

Most potent type of asbestos =

A

Blue/crocidolite

85
Q

Asbestosis is

A

Diffuse interstitial fibrosis

86
Q

Pleurodesis =

A

Sclerosis agent into cavity, adheres lung to chest wall - prevents pneumothoarx or pleural effusion

Respiratory and Cardio (14 decks)

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