L4- respiratory malignancies

Question 1

What are the clinical features of lung cancer

Answer 1

• Smoker
• Haemoptypsis
• Weight loss
• Dyspnoea
• Cough
• Chest pain
• Hoarse voice

Question 2

What is the aetiology behind lung cancer

Answer 2

• Smoking
• Asbestos
• Radiation
• Genetic prediposition

Question 3

How do you diagnose lung cancer?

Answer 3

Question 4

What are the types of lung cancer

Answer 4

• Non Small Cell Lung Cancer NSCLC
  
  • Squamous
  • Adenocarcinoma
  • undifferentiated/mixed
• Small cell
• Carcinoid
• Others

Question 5

Give two examples of specific tumour markers.

Answer 5

• EGFR receptor- antagonists e.g. gefitinib
• ALK receptor- inhibitors e.g. crizotinib
• Tumours may have mutations in their DNA which dictate response to treatment HOT

Question 6

What are the ways of staging lung cancer?

Answer 6

• CT guided biopsy
• bronchoscopy
  
  • brushing
  • washing
  • biopsy
• Endobronchial ultrasound bronchoscopy- EBUS
  
  • needle aspiration on lymph nodes during bronchoscopy
• Mediastinoscopy
  
  • small incision in the neck above the brestbone, mediastonoscope inserted to access lymph glands
• PETCT thorax
  
  • show metabolically active hot spots- tumours
• Lymph nodes are important in staging

Question 7

What are the staging of lung cancer and how does it affect managment?

Answer 7

• NSCLC
  
  • TNM classification
    
    • Tumour size T1-T4
    • Nodes N0-N3
    • Metastases
  • Treatment
    
    • Surgery- low TNM, confined to 1 lobe and lymph glands associated that that lobe- cure
    • Radiotherapy- not fit for surgery
    • Chemotherapy- spread, beyond one lobe
• Small Cell
  
  • Limited or extensive staging
  • Treatment
    
    • Chemotherapy- as small cell carcinomas spread rapidly through the systemic system and lymph and to other areas of the body
    • Cranial radiotherapy

Question 8

How do lung cancer spread

Answer 8

• Via lymphatics or blood
• Commonly pleura, brain and bone
• Radiotherapy- brain/bone

Question 9

What are the complications of lung cancer

Answer 9

• SVC obstruction
  
  • Fixed raised JVP (jugular vein pressure)
  • Lips cyanosed due to reduced venous returns
  • Collaterals- blue veins coming up to the surface of skin
• Horners syndrome- interupted sympathetic chain
• Recurrent laryngeal nerve palsy - causes hoarse noice
• Pleural effusion

Question 10

What are the clinical features of pleural effusion?

Answer 10

• Dyspnoea
• Pain
• Of underlying cause
• Reduced expansion
• Dull percussion note
• Reduced vocal resonance

Question 11

Where does the fluid in the pleural effusion come from?

What are the other causes of pleural effusion

Answer 11

• ↑Leakage into the pleural space
• Produced by pathology in the pleural space
• ↓removal from pleural space
• accumulation faster than removal
• Cause an be determined by the amount of protein in the fluid

Question 12

How do we investigate and manage effusions?

Answer 12

• Tap fluid- protein, glucose, cells, culture Think about causes to choose other tests
• Aspirate
• Drain

Question 13

What is Mesothelioma?

Answer 13

• Cancer of pleura related to asbestos exposure
• Think about risk professions plumbing, building, insulation
• Peak in UK will be year 2020 (2700-3000 deaths pa)
• Common presentations
  
  • Pain
  • Pleural effusion
  • Diagnostic path similar to lung cancer

Question 14

What is the treatment for Mesothelioma

Answer 14

• Poor prognosis, extremely difficult to treat
• Chemotherapy
• Radiotherapy
• Surgery
  
  • Pleurodesis
  • Pleurectomy
  • Extra-pleural pneumonectomy
• Immunotherapy
• Gene therapy