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Respiratory system > lung cancer > Flashcards

lung cancer Flashcards

1
Q

what is the aetiology of lung cancer?

A 
tobacco
asbestos 
air pollution
radiation
diseases such as pulmonary fibrosis
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2
Q

what are the 2 main pathways of lung cancer?

A

lung periphery- bronchioalveolar epithelial stem cells transform to create an adenocarcinoma
central lung airways- bronchial epithelial stem cells transform to create squamous cell carcinoma

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3
Q

what are the main 4 carcinomas of the lung?

A

squamous cell
adenocarcinoma
small cell carcinoma
large cell carcinoma

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4
Q

what are the three tumours of the bronchial gland?

A

adenoid cystic carcinoma
mycoepidermal carcinoma
benign adenoma

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5
Q

what are the local effects of bronchial obstruction on the lungs?

A

collapse
pneumonia
infection/absess
brochiestasis

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6
Q

whats the indirect effect of cancer on the pleura?

A

inflammation

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7
Q

whats the direct effect of lung cancer on the pleura ?

A

malignant invasion

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8
Q

what are the non metastatic side effects of lung cancer?

A

finger clubbing
hypertrophic pulmonary osteoarthropathy
endocrine ACTH in small cell carcinoma
endocrine PTH in squamous cell

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9
Q

whats the life expectancy after being diagnosed with small cell carcinoma?

A

9 months

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10
Q

what are biomarkers used for?

A

selecting patients for therapy

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11
Q

what biomarkers are used in adenocarcinomas?

A 
EGFR
KRAS
HER2
BRAF mutation
ALK & ROS1 translocator
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12
Q

what are the main symptoms of lung cancer?

A 
chronic cough
coughing up blood
wheeze
chest and bone pain
recurrent chest infections
hoarseness and dyspnea
unexplained weight loss
nail clubbing
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13
Q

what metastatic effect can lung cancer have?

A

bone pain
spinal cord compression
cerebral metastases
thrombosis

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14
Q

what non-metastatic (paraneoplastic) effect can lung cancer have?

A 
hyponatraemia (low sodium)
anaemia
hypercalcaemia (high calcium)
dermatomycosis (fungal infection of skin)
sensomotor neuropathy
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15
Q

what are some clinical signs that someone may be suffering from lung cancer?

A

lymphadenopathy (abnormal lymph nodes)
horners syndrome (decreased pupil size and droopy eyelid)
superior vena cava obstruction
skin nodules

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16
Q

what investigations must be carried out in order to diagnose someone with lung cancer?

A 
chest xray
ct
full blood count
renal and liver function test
calcium levels
spirometry
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17
Q

what are the two aims of treatment

A

radical- cure the disease

palliative- control the disease

18
Q

what are the review areas on a chest X-ray?

A 
hila
apices
behind the heart and diaphragm
between ribs
compare lobes
ensure trachea is central
19
Q

what should you do after discovering an abnormality on a chest X-ray?

A

compare with previous imaging, confirm it is in the lung and get a CT

20
Q

whats the difference between a pulmonary mass and pulmonary nodule?

A

mass- opacity in lung over 3CM

nodule- 3CM or less

21
Q

explain TNM staging

A

T- size and position of Tumour
N- has it spread to lymph Nodes?
M- has is Metastasised

22
Q

what kind of tumour invades the mediastinum ?

A

T4

23
Q

whats the purpose of a PET/CT scan?

A

whole body scanning, discloses metastases and other pathologies which are not detected by other means

24
Q

in surgical management of cancer what techniques are used to determine the staging?

A

TNM
CXR
blood tests
CT

25
Q

in the surgical management of cancer what do you look for in X-rays in order to determine the staging off the cancer?

A

pleural effusion
chest wall invasion
phrenic nerve palsy
collapsed lobe or lung

26
Q

in the surgical management of cancer what do you look for in blood tests in order to determine staging?

A

anaemia
abnormal LFT’s
abnormal bone profile

27
Q

in the surgical management of cancer what do you look for in CT’s to determine staging?

A

is the diaphragm involved?
pleural/pericardial effusion which would make it inoperable
size of tumour
mediastinal nodes
metastatic disease
proximity to important structures that cannot be resected eg. brachial plexus

28
Q

what test will determine fitness for surgery but also the presence or absence of significant pericardial effusion?

A

ECHO

29
Q

what scan do you use to check for chest wall invasion or bony metastasis?

A

bone scan

30
Q

what test is used for determining the degree of vascular or neurological involvement of a tumour ?

A

MRI

31
Q

what procedure is used to ensure the tumour is not invading the carina?

A

bronchoscopy

32
Q

in the surgical management of cancer whats included in respiratory function testing?

A

spirometry
diffusion studies
ABG on air
VIQ scan

33
Q

what are the main reasons for peri-operative death?

A 
ARDS(acute respiratory distress syndrome)
bronchopneumonia
myocardial infarction
PTE
intrathoracic bleeding
pneumothorax
34
Q

how are non-small cell lung cancer treated non-surgically?

A

adjuvant immunotherapy
very high dose SABR
chemo radiotherapy

35
Q

in regards to non-surgical management of cancer what is meant by adjuvant?

A

after definitive treatment

36
Q

what are some forms of palliative treatment?

A

chemo immunotherapy
TKI
palliative radiotherapy

37
Q

whats the aim of palliative care?

A

improve quality of life
management of bone metastasis
prevent cord compression and haemoptysis

38
Q

whats the doubling time for non-small and small cell lung cancer ?

A

non-small cell lung cancer- 129 days

small cell lung cancer- 29 days

39
Q

what are some side effects of chemotherapy ?

A

sepsis
nausea/vomitting/fatique
renal impairment
weight loss

40
Q

what are some side effects of radiotherapy?

A

lethargy
pneumonitis
fibrosis
2nd malignancies

Respiratory system (20 decks)

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