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Respiratory medicine > L13 - Lung Cancer > Flashcards

L13 - Lung Cancer Flashcards

1
Q

Lung cancer may arise from…

A
  • Bronchial epithelium

- mucous glands.

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2
Q

Common cell types causing lung cancer…

A

Adenocarcinoma
Squamous
Small-cell
Large-cell

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3
Q

Clinical features of lung cancer

A
  1. Cough, often dry, purulent sputum?
  2. Haemoptysis
  3. Breathlessness
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4
Q

Haemoptysis

A

Coughing of blood from resp tract below level of larynx

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5
Q

Haematemesis

A

Vomiting of blood from the GI tract

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6
Q

Psuedohaemoptysis

A

Cough reflex is stimulated by blood not derived from the lungs or bronchial tubes.

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7
Q

Possible causes of bronchial obstruction

A
  • Lung cancer, adenoma
  • Enlarged tracheobronchial lymph nodes
  • Inhaled foreign bodies esp. Right lung
  • Bronchial plug of inspissated mucus or blood clots
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8
Q

Pleural pain may indicate

A

Malignant pleural invasion

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9
Q

Intercostal nerve involvement causes pain…

A

Pain in distribution of thoracic dermatome.

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10
Q

Cancer in lung apex may cause…

A

Horner’s syndorme

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11
Q

What characterises Horner’s syndrome?

A
  • Ipsilateral partial ptosis
  • Enophthalmos: posterior displacement of eyeball in orbit due to changes in volume.
  • Miosis: excessive constriction of pupil of the eye
  • Hypohidrosis: person exhibits diminished sweating
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12
Q

Describe what may happen in the mediastinal spread of lung cancer? (3)

A
  1. Involvement of oesophagus - dysphagia
  2. If pericardium invaded - arrhythmia or pericardial effusion
  3. If superior vena cava obstructed
    - suffusion (swelling neck and face)
    - conjucntival oedema
    - headache
    - dilated veins on chest wall
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13
Q

Obstruction of SVC may lead to

A
  1. Suffusion
    - swelling of neck and face
  2. Conjunctival oedema
    - due to oozing of exudate from abnormally permeable
    capillaries
  3. Headache
  4. Dilated veins on chest wall
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14
Q

Tumours at left hilum of lung may affect which nerve

A
  1. Left recurrent laryngeal nerve

2. Leading to left vocal cord paralysis, voice alterations

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15
Q

What is finger clubbing?

A
  • Overgrowth of soft tissue of the terminal phalanx.
  • Leads to increased nail curvature.
  • Nail bed fluctuation.
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16
Q

HPOA - Hypertrophic pulmonary osteoarthropathy

A

Painful periostitis of :

  • distal tibia
  • fibula
  • radius
  • ulna
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17
Q

Summarise some endocrine manifestations of lung cancer

A
  1. Inappropriate ADH secretions - hyponatraemia
  2. Ectopic ACTH secretions
  3. Secretion PTH related peptide - hyperkalemia
  4. Gynaecomastia
  5. Carcinoid syndrome
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18
Q

Carcinoid syndrome

A

Caused by endogenous secretions of serotonin & kallikrein, paraneoplastic syndrome

Symptoms that occur secondary to carcinoid tumours - flushing, diarrhea, heart failure.

19
Q

Invasion of the phrenic nerve may lead to…

A

Diaphragmatic paralysis

20
Q

What may be seen / heard on examination of a patient to aid in the diagnosis of parenchymal lung disease…

A
  1. Crackles: typically bilateral and basal
  2. Clubbing: common in idiopathic pulmonary fibrosis and abestosis
  3. Central cyanosis
  4. Signs of right heart failure
21
Q

How may radiology be used to diagnose parenchymal lung disease?

A

X-Ray may show :

  • smaller lung volume
  • reticulonodular shadowing
22
Q

Which view is preffered when taking X-ray of lungs

A

Posterior-Anterior

- to get a good view of lung fields, heart and mediastinum

23
Q

How might you interpret a chest X-ray?

A
  1. Look at Lung fields –> transluency, masses, consolidation, cavitation
  2. Check behind lung apices
  3. Trachea
  4. Heart
  5. Hila –> L should be higher than R
  6. Diaphragm –> R should be higher than L
  7. Costophrenic angle –>acute, well defined
24
Q

What may pulmonary and pleural shadowing indicate?

A
  1. Consolidation
  2. Lobar collapse
    - mucus plugging, tumour, compression by lymph nodes
  3. Pleural abnormalities
25
Q

Increased transluency on X-ray

A

Due to:
- Bullae (fluid filled sac)

  • Pneumothorax
  • Oligoaemia
26
Q

Pneumothorax

A

Collapsed lung

27
Q

Oligoaemia

A

AKA hypvolaemia

- decreased volume of circulating blood in body

28
Q

Increased shadowing on X-ray may indicate

A
  • Accumulation of fluid
  • lobar collapse
  • consolidation
29
Q

Advantages of using CT

A
  • Displays range of densities.
  • Can be adjusted to highlight different structures.
  • Can identify extent and appearance of pleural thickenings
30
Q

Describe PET scan

A

Uses Radiotracer FDG

Quantifies rate of glucose metabolism

31
Q

Describe MRI in lung disease

A

Role in differentiation of benign from malignant in pleural disease

32
Q

Why is USS useful?

A

Can distinguish between pleural fluid from pleural thickening.

33
Q

Why might laryngoscopy be important?

A
  • Important as left hand side tumour may affect Left recurrent laryngeal nerve.
  • Hence paralysing left vocal cord.
  • Leading to hoarse voice
34
Q

What occurs during bronchoscopy

A

Abnormal tissue can be biopsied.

35
Q

Describe endobronchial USS

A
  • Direct needle aspiration from peribronchial node

- used to increasingly stage lung cancer.

36
Q

Thoracoscopy

A
  • Insertion of endoscopy through chest wall.
  • Minimally invasive.
  • Facilitates biopsy under direct vision.
  • Gold standard for evaluation of pleural interface.
37
Q

Describe the TNM tumour metastasis staging system

A

T - Size of primary tumor
N - Spread of cancer to regional lymph nodes
M -Indicate whether cancer has metastasized

38
Q

Lobectomy

A

Removing section of lung

39
Q

Pneumonectomy

A

Removing entire lung

40
Q

Wedge resection

A

Removing part of lobe

41
Q

Is lung cancer inherited?

A

Majority of cases: genetic changes acquired during persons lifetime and only present in certain cells of lung. Somatic mutations are not inherited!

42
Q

Describe lung cancer susceptibility genes

A

Chromosome 6

There is a gene which may given a genetic predisposition to nicotine addiction.

43
Q

Tumour at apex of lung could affect what plexus…

A

Sympathetic plexus.

44
Q

Examples of places of extrathoracic metastatic manifestations

A

Brain
Liver
Bone
Adrenals

Respiratory medicine (16 decks)

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