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Week 8 - Respiratory > Lung cancer > Flashcards

Lung cancer Flashcards

1
Q

Which lung cancers have the strongest association with smoking?

A

Squamous and small cell

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2
Q

What are the risk factors of lung cancer?

A
  • Environmental tobacco smoke
  • Ionising radiation
  • Air pollution
  • Asbestos
  • Other e.g. fibrosis of the lung, HPV, hereditary (polymorphisms in cytochrome P450)
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3
Q

What are the symptoms of lung cancer?

A
  • Cough
  • Haemoptysis
  • Shortness of breath
  • Chest pain
  • Weight loss/ anorexia
  • General malaise
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4
Q

What are the symptoms of central lung cancer and what causes these symptoms?

A
  • Ulceration of the bronchus: cough and haemoptysis

* Bronchial obstruction: retention pneumonia, lung abscess, bronchiectasis, wheeze, SOB

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5
Q

What are the symptoms of peripheral lung cancer and what causes these symptoms?

A
  • Pleural involvement: pain, effusion
  • Pericardial involvement: pericarditis and effusion
  • May have few symptoms
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6
Q

Where are the most common metastases of lung cancer?

A
  • Lymph nodes
  • Brain
  • Bone
  • Liver
  • Adrenals
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7
Q

Which areas are affected by local spread of lung cancer?

A
  • Pleura
  • Hilar lymph nodes
  • Adjacent lung tissue
  • Pericardium
  • Mediastinum
  • Pancoast tumour
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8
Q

What is the effect of local spread to the pleura?

A

Haemorrhagic effusion

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9
Q

What is the effect of local spread to the mediastinum?

A
  • Superior vena caval obstruction
  • Recurrent laryngeal nerve
  • Phrenic nerve
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10
Q

What are the symptoms of a pancoast tumour?

A
  • Involvement of the brachial plexus gives sensory and motor symptoms
  • Horner’s syndrome/oculosympathetic palsy due to damage of the cervical sympathetic chain
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11
Q

What are the effects of a superior vena cava obstruction?

A
  • Distension of the jugular, axillary and subclavian veins

* Oedema of the face, neck and upper chest

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12
Q

What is the sign of a phrenic nerve palsy on a chest X ray?

A

Raised semi diaphragm

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13
Q

What is a sign of a left phrenic nerve palsy?

A

Hoarseness

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14
Q

How does haematogenous spread occur from lung cancer?

A

Invasion of the pulmonary veins

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15
Q

What are the non metastatic endocrine effects of lung cancer?

A
  • ACTH secretion,Adrenal hyperplasia, Raised blood cortisol: Cushing’s syndrome
  • ADH secretion, retention of water, dilution hyponataemia (SIADH)
  • Parathyroid hormone related peptide (PTHrP) secretion, osteoclastic activity, hypercalcaemia
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16
Q

Which lung cancer is most associated with Cushing’s syndrome?

A

Small cell carcinoma

17
Q

What are the symptoms of Cushing’s syndrome?

A
  • moon face
  • Buffalo hump
  • Obesity
  • Thin, wrinkled skin
  • Abdominal striae
  • Amenorrhoea
  • Muscle weakness
  • Osteoporosis
  • Purpura
  • Skin ulcers
18
Q

Describe prognosis of small cell cancer

A
  • Usually advanced at diagnosis

* Repsonds to chemotherapy

19
Q

Describe the prognosis of non-small cell cancer

A

May be localised at diagnosis and can be treated by surgery or radiotherapy

20
Q

What type of tumours do central tumours tend to be?

A

Squamous or small cell carcinoma

21
Q

What type of tumours do peripheral tumours tend to be?

A

Predominantly adenocarcinoma

22
Q

Where do squamous cell carcinomas tend to arise from?

A

Centrally from the major bronchi

23
Q

Describe the formation and growth of squamous cell carcinomas in the lung

A
  • Often arise within dysplastic epithelium following squamous metaplasia
  • Slow growing and metastasise late
  • May undergo cavitation
  • May block the bronchi leading to retention pneumonia or collapse
24
Q

Describe the appearance of squamous cell carcinoma in the lung

A
  • Malignant epithelial tumour showing keratinisation and/or intracellular bridges
  • In situ squamous cell carcinoma may be seen in the adjacent airway in mucosa
25
Q

Where do adenocarcinomas tend to arise

A

In the periphery, sometimes in relation to scarring

26
Q

What is the appearance of adenocarcinoma?

A
  • Glandular
  • Solid
  • Papillary or lepidic
  • Mucin production
27
Q

What is the appearance of small cell carcinoma?

A
  • Oval to spindle shaped cells
  • inconspicuous nucleoli
  • Scant cytoplasm
  • nuclear moulding
28
Q

Where do large cell carcinomas tend to arise?

A

Usually centrally

29
Q

What is large cell carcinoma

A

Undifferentiated malignant epithelial tumour that lacks the cytological features of SCLC and glandular o squamous differentiation

30
Q

What is a carcinoid tumour?

A

Tumour of neuroendocrine cells

31
Q

Describe the pathogenesis of lung cancer

A
  • Chronic irritation/stimulation of cells by carcinogens
  • Increased cell turnover
  • Progressive accumulation of genetic abnormalities in molecules involved in cell cycle, signalling and angiogenesis pathways
32
Q

What are the targeted therapies in lung cancer?

A
  • EGFR receptor: tyrosine kinase inhibitors
  • NSCLC, EML4-ALK gene fusions may respond to ALK inhibitors
  • ROS-1 oncogenic fusion may respond to targeted therapies
  • PD-l1 is overly expressed is some patients with NSCLC and may respond to PD-l1 inhibitors
33
Q

What is the most common lung cancer

A

Secondary spread to the lungs i.e. metastatic

34
Q

Which cancers most commonly spread to the lungs?

A
  • Breast
  • Colon
  • Head and neck
  • Kidney
  • Testicular carcinoma
  • Sarcoma
35
Q

What are the symptoms of metastatic spread to the lungs?

A
  • Cough
  • Haemoptysis
  • Shortness of breath
  • Pleural effusion
36
Q

Which stain is used to help with the diagnosis of tuberculosis?

A

Ziehl-Neelsen stian

37
Q

What is mesothelioma?

A
  • Primary pleural tumour
  • Almost always due to asbestos exposure
  • Tumour had either an epithelial or sarcomatous appearance or a mixture of both (biphasic)
38
Q

where does mesothelioma tend to be

A

Lining the chest wall

Week 8 - Respiratory (12 decks)

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