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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
Local complications of lung cancer
``` Recurrent laryngeal palsy Phrenic nerve palsy Horner's syndrome Pancoast's syndrome CVS(SVCO, pericarditis, AF) Rib erosion ```
26
Metastatic complications of lung cancer
Brain - confusion, focal neurological deficits Bone - Bone pain, hypercalcaemia Liver - hepatomegaly Adrenal - addison's disease
27
Endocrine complications of lung cancer
Inappropriate antidiuretic hormone secretion Non-metastatic hypercalcaemia Cushing's syndrome Gynaecomastia Hypoglycaemia Hyperthyroidism
28
Skeletal complications of lung cancer
Hypertrophic pulmonary osteoarthropathy | sometimes with gynaecomastia
29
Renal complications of lung cancer
Glomerulonephritis | Nephrotic syndrome
30
Vascular complications of lung cancer
Vasculitis SLE Endocarditis
31
Haematological complications of lung cancer
Anaemia Thrombocytosis Thrombocytopenic purpura DIC
32
Which types of lung cancer are most associated with smoking
Squamous cell carcinoma | Small cell lung cancer
33
Location of most lung adenocarcinomas
Peripheral
34
Features of lung adenocarcinomas
Females > Males Slow growth, early metastasis KRAS(oncogene) Grows on old scars(TB)
35
Features of lung squamous cell carcinomas
Males > females Cavitation and local extension leading to atelectasis and pneumonitis Late metastasis Failure of P53 tumour suppressor gene
36
Which lung cancers are associated with hypercalcaemia and why
Squamous cell carcinoma | Secrete PTHrP --> high serum Ca2+ --> low PTH (neg feedback)
37
Symptoms of hypercalcaemia
``` Groans - constipation Thrones - Polyuria Stones - Kidney stones Overtones - Psychiatric issues Phones(999) - Acute pancreatitis emergency ```
38
Conditions associated with small cell lung cancers
Secrete ACTH (Cushing) and/or ADH(SIADH) Associated with LEMS
39
What type of lung cancer most commonly results in pancoast tumours
Squamous cell carcinoma
40
Why can pancoast tumours cause horner syndrome
Impingement of the superior cervical ganglion (sympathetic)
41
Symptoms of horner syndrome
Ispilateral ptosis, myosis and anhydrosis
42
Why can pancoast tumours cause upper limb weakness and shoulder pain
Impingement on brachial plexus
43
Malignant causes of superior vena cava obstruction(SVCO)
Primary lung cancer Lymphoma Secondary lung cancer
44
Non-malignant causes of superior vena cava obstruction(SVCO)
Goitre Aortic aneurysm Benign tumours
45
Pathophysiology of SVCO
Small or squamous cell tumour compresses SVC --> reduced blood drainage from the upper body --> congestion of veins in the upper body
46
Symptoms and signs of SVCO
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
Management of SVCO
Mild cases - head elevation and diuretics Endovenous stents Severe cases due to cancer - palliative treatment
48
What is a mesothelioma
Mesothelioma is a cancer of the mesothelial layer of the pleural cavity that is strongly associated with asbestos exposure
49
Features of mesothelioma
``` 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
IX for mesothelioma
1st - CXR (pleural effusion or thickening) 2nd - Pleural CT Local anaesthetic thoracoscopy Image-guided pleural biopsy
51
Management of mesothelioma
Symptomatic Industrial compensation Chemotherapy, Surgery if operable Prognosis poor, median survival 12 months
52
What are pleural plaques
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
How does phrenic nerve palsy present
Phrenic nerve palsy due to nerve compression causes diaphragm weakness and presents as shortness of breath.
54
How does SVCO present
It presents with facial swelling, difficulty breathing and distended veins in the neck and upper chest
55
What is pemberton's sign
Pemberton’s sign” is where raising the hands over the head causes facial congestion and cyanosis. This is a medical emergency. --> SVCO
56
What causes horner's syndrome in lung cancer
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
What causes hypercalcaemia in lung cancer
Hypercalcaemia caused by ectopic parathyroid hormone from a squamous cell carcinoma.
58
What is limbic encephalitis
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
Antibodies associated with limbic encephalitis
Anti-Hu antibodies
60
What is carcinoid syndrome
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
Features of carcinoid tumours
``` flushing (often earliest symptom) diarrhoea bronchospasm hypotension right heart valvular stenosis ```
62
Which molecules may be released by carcinoid tumours
ACHT | GHRH
63
IX for carcinoid tumours
urinary 5-HIAA | plasma chromogranin A y
64
Mx of carcinoid tumours
somatostatin analogues e.g. octreotide | diarrhoea: cyproheptadine may help

General med - Resp (11 decks)

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