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General med - Resp > Lung cancer > Flashcards

Lung cancer Flashcards

1
Q

What do SCLCs arise from

A

Kulchitsky cells, which are part of the amine precursor uptake and decarboxylation(APUD) endocrine system

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2
Q

Prognosis of SCLCs

A

Grow rapidly and are highly malignant, they spread early and are almost always inoperable at presentation

Respond to chemotherapy but prognosis is poor

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3
Q

Types of NSCLCs(starting with most common)

A 
Squamous(42%)
Adenocarcinoma 
Large-cell 
Carcinoid 
Bronchoalveolar cell
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4
Q

Risk factors for lung cancer

A 
Active or passive smoking 
Increased age 
COPD 
Previous history of cancer 
Industrial dust diseases
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5
Q

Initial symptoms and signs of lung cancer

A 
Cough 
Dyspnoea 
Weight loss 
Chest pain 
Haemoptysis 
Bone pain 
Finger clubbing
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6
Q

Symptoms and signs of metastatic disease in lung cancer

A 
Bone tenderness 
Hepatomegaly 
Confusion 
Fits 
Focal neurological deficit 
Cerebellar syndrome 
Proximal myopathy
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7
Q

When should patients be referred within 2 week pathway

A

CXR findings suggestive of lung cancer

Patients aged over 40 years and have unexplained haemoptysis

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8
Q

Use of contrast-enhanced chest CT scan in lung cancer diagnosis

A

To stage the tumour
Scan should include liver and adrenal glands
Should be performed before any other biopsy procedure

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9
Q

Purpose of bronchoscopy in lung cancer

A

To establish a histological diagnosis and assess operability

Should be performed on patients with central lesions where nodal staging does not influence treatment

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10
Q

Use of sputum cytology in lung cancer

A

Rarely indicated and should be reserved for the investigation of patients who have centrally placed nodules or masses and are unable to tolerate, or unwilling to undergo other invasive tests

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11
Q

What should all patients with NSCLC undergo before radical treatment

A

Staging PET-CT to detect occult distant metastases

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12
Q

Staging system used for lung cancer

A

TNM7(tumour, node, metastasis)

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13
Q

Which global risk assessment tool should be used to calculate the risk of death in lung cancer surgery

A

Thoracoscore

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14
Q

Treatment of choice for patients with stage 1 or 2 lung cancer

A

Lobar resection
Patients who would not tolerate lobectomy because of comorbid disease or pulmonary compromise, should be considered for limited section or radical radiotherapy

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15
Q

What should all patients undergoing surgical resection for lung cancer undergo during the procedure

A

Hilar and mediastinal lymph node sampling to provide accurate pathological staging

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16
Q

Which assessments should lung cancer patients undergo prior to treatment

A

Lung function tests

Cardiovascular risk assessment

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17
Q

When is radical radiotherapy indicated for patients with lung cancer

A

Stage I, II or III NSCLC who have good performance status and whose disease can be encompassed in a radiotherapy treatment

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18
Q

When is chemotherapy indicated for patients with lung cancer

A

Patients with stage III or IV NSCLC and good performance status, to improve survival, disease control and quality of life

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19
Q

Normal chemotherapy regimen for advanced NSCLC

A

Combination of a single third generation agent(docetaxel) plus a platinum drug

Either carboplatin or cisplatin may be administered

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20
Q

Use of erlotinib in NSCLC

A

Possible treatment with locally advanced or metastatic NSCLC that has already been treated with non-targeted chemotherapy

If cancer tests positive for the EGFR-TK mutation

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21
Q

Staging investigations for small-cell lung cancer

A

Serum lactate dehydrogenase
LFTs
Serum sodium

Contrast-enhanced CT scan of chest, liver and adrenal glands

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22
Q

Management of SCLC

A

Multidrug regimens (cisplatin-based chemotherapy)

Radiotherapy following chemotherapy

Surgery may be an option in patients presenting at an early stage

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23
Q

Management of breathlessness in palliative care

A

Strong opiate - eg morphine or diamorphine

Non-drug interventions based on psychosocial support, breathing control and coping strategies should be considered

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24
Q

Management of bronchial obstruction in palliative care

A

External beam radiotherapy

Debulking bronchoscopic procedures(for large airway obstruction)

Patients with extrinsic compression may be considered for treatment with stents

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25
Q

Local complications of lung cancer

A 
Recurrent laryngeal palsy 
Phrenic nerve palsy 
Horner's syndrome 
Pancoast's syndrome 
CVS(SVCO, pericarditis, AF) 
Rib erosion
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26
Q

Metastatic complications of lung cancer

A

Brain - confusion, focal neurological deficits
Bone - Bone pain, hypercalcaemia
Liver - hepatomegaly
Adrenal - addison’s disease

27
Q

Endocrine complications of lung cancer

A

Inappropriate antidiuretic hormone secretion

Non-metastatic hypercalcaemia

Cushing’s syndrome

Gynaecomastia

Hypoglycaemia

Hyperthyroidism

28
Q

Skeletal complications of lung cancer

A

Hypertrophic pulmonary osteoarthropathy

sometimes with gynaecomastia

29
Q

Renal complications of lung cancer

A

Glomerulonephritis

Nephrotic syndrome

30
Q

Vascular complications of lung cancer

A

Vasculitis
SLE
Endocarditis

31
Q

Haematological complications of lung cancer

A

Anaemia
Thrombocytosis
Thrombocytopenic purpura
DIC

32
Q

Which types of lung cancer are most associated with smoking

A

Squamous cell carcinoma

Small cell lung cancer

33
Q

Location of most lung adenocarcinomas

A

Peripheral

34
Q

Features of lung adenocarcinomas

A

Females > Males
Slow growth, early metastasis
KRAS(oncogene)
Grows on old scars(TB)

35
Q

Features of lung squamous cell carcinomas

A

Males > females
Cavitation and local extension leading to atelectasis and pneumonitis
Late metastasis
Failure of P53 tumour suppressor gene

36
Q

Which lung cancers are associated with hypercalcaemia and why

A

Squamous cell carcinoma

Secrete PTHrP –> high serum Ca2+ –> low PTH (neg feedback)

37
Q

Symptoms of hypercalcaemia

A 
Groans - constipation 
Thrones - Polyuria 
Stones - Kidney stones 
Overtones - Psychiatric issues 
Phones(999) - Acute pancreatitis emergency
38
Q

Conditions associated with small cell lung cancers

A

Secrete ACTH (Cushing)
and/or ADH(SIADH)
Associated with LEMS

39
Q

What type of lung cancer most commonly results in pancoast tumours

A

Squamous cell carcinoma

40
Q

Why can pancoast tumours cause horner syndrome

A

Impingement of the superior cervical ganglion (sympathetic)

41
Q

Symptoms of horner syndrome

A

Ispilateral ptosis, myosis and anhydrosis

42
Q

Why can pancoast tumours cause upper limb weakness and shoulder pain

A

Impingement on brachial plexus

43
Q

Malignant causes of superior vena cava obstruction(SVCO)

A

Primary lung cancer
Lymphoma
Secondary lung cancer

44
Q

Non-malignant causes of superior vena cava obstruction(SVCO)

A

Goitre
Aortic aneurysm
Benign tumours

45
Q

Pathophysiology of SVCO

A

Small or squamous cell tumour compresses SVC –> reduced blood drainage from the upper body –> congestion of veins in the upper body

46
Q

Symptoms and signs of SVCO

A

Swelling of face and neck
Opening of venous anastomoses(collaterals) –> visible, distended veins on the anterior chest wall
Blood will ooze into capillaries and leak to surrounding walls –> cough, dyspnoea
Less blood returning to right atrium –> hypotension

47
Q

Management of SVCO

A

Mild cases - head elevation and diuretics
Endovenous stents
Severe cases due to cancer - palliative treatment

48
Q

What is a mesothelioma

A

Mesothelioma is a cancer of the mesothelial layer of the pleural cavity that is strongly associated with asbestos exposure

49
Q

Features of mesothelioma

A 
Dyspnoea, weight loss, chest wall pain
Clubbing
30% present as painless pleural effusion
Only 20% have pre-existing asbestosis
History of asbestos exposure in 85-90%
50
Q

IX for mesothelioma

A

1st - CXR (pleural effusion or thickening)

2nd - Pleural CT

Local anaesthetic thoracoscopy

Image-guided pleural biopsy

51
Q

Management of mesothelioma

A

Symptomatic
Industrial compensation
Chemotherapy, Surgery if operable
Prognosis poor, median survival 12 months

52
Q

What are pleural plaques

A

Pleural plaques are benign and do not undergo malignant change. They, therefore don’t require any follow-up.

They are the most common form of asbestos-related lung disease and generally occur after a latent period of 20-40 years.

53
Q

How does phrenic nerve palsy present

A

Phrenic nerve palsy due to nerve compression causes diaphragm weakness and presents as shortness of breath.

54
Q

How does SVCO present

A

It presents with facial swelling, difficulty breathing and distended veins in the neck and upper chest

55
Q

What is pemberton’s sign

A

Pemberton’s sign” is where raising the hands over the head causes facial congestion and cyanosis. This is a medical emergency.
–> SVCO

56
Q

What causes horner’s syndrome in lung cancer

A

Horner’s syndrome is a triad of partial ptosis, anhidrosis and miosis.

It is caused by a Pancoast’s tumour (tumour in the pulmonary apex) pressing on the sympathetic ganglion.

57
Q

What causes hypercalcaemia in lung cancer

A

Hypercalcaemia caused by ectopic parathyroid hormone from a squamous cell carcinoma.

58
Q

What is limbic encephalitis

A

A paraneoplastic syndrome where SCLC causes the immune system to make antibodies to tissues in the brain, specifically the limbic system, causing inflammation in these areas.

This causes symptoms such as short term memory impairment, hallucinations, confusion and seizures.

59
Q

Antibodies associated with limbic encephalitis

A

Anti-Hu antibodies

60
Q

What is carcinoid syndrome

A

occurs when metastases are present in the liver and release serotonin into the systemic circulation

may also occur with lung carcinoid as mediators are not ‘cleared’ by the liver

61
Q

Features of carcinoid tumours

A 
flushing (often earliest symptom)
diarrhoea
bronchospasm
hypotension
right heart valvular stenosis
62
Q

Which molecules may be released by carcinoid tumours

A

ACHT

GHRH

63
Q

IX for carcinoid tumours

A

urinary 5-HIAA

plasma chromogranin A y

64
Q

Mx of carcinoid tumours

A

somatostatin analogues e.g. octreotide

diarrhoea: cyproheptadine may help

General med - Resp (11 decks)

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