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BRS 1b > Lung cancer > Flashcards

Lung cancer Flashcards

1
Q

What is an angiosarcoma?

A

A primary cancer forming within the blood and lymph vessels, manifesting as a malignancy of vascular endothelial cells.

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2
Q

What is a myxoma?

A

A tumour of connective tissue can grow within the cardiac chambers leading to occlusion of blood flow

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3
Q

Why are cardiac cancers rare?

A

Relatively low cellular exposure to carcinogens compared to that with the lungs

Low turnover rate –> Cardiac myocytes divide very rarely (Growth is due to hyperplastic mechanisms, whereby the individual cell grows).

There is a strong selective advantage

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4
Q

What impact does a strong selective advantage in the heart have in terms of cancers?

A

Abnormal cells with incorrect architecture are selected against to minimise the risk of compromising cardiac function

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5
Q

What are the common causes of lung cancer?

A 
Passive smoking
Asbestos exposure
Radon
Indoor cooking fumes --> wood, smoke, frying fats
Chronic lung diseases (COPD, fibrosis)
Immunodeficiency (HIV)
Familial/genetic
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6
Q

Which cancer is centrally located, originating in the bronchial epithelium?

A

Squamous cell carcinoma

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7
Q

Which cells are implicated in an adenocarcinoma?

A

Adenocarcinoma originate from the mucous-producing glandular tissue, located more peripherally in the lung.

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8
Q

Which type of cancer is typically associated with a large cell lung cancer?

A

Undifferentiated heterogenous cancers

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9
Q

Which cells are involved in a small cell lung cancer?

A

Originate from pulmonary neuroendocrine cells that are highly malignant

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10
Q

Which lung cancers are classified as non-small cell lung cancers?

A

Squamous cell carcinoma
Adenoma carcinoma
Large cell lung cancer

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11
Q

What is metaplasia?

A

Refers to the reversible change in which one adult cell is replaced by another adult cell type: adaptive in response to physiological changes

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12
Q

What is dysplasia?

A

Dysplasia refers to an abnormal pattern of growth in which aspects of cellular and architectural features of malignancy are present, this is considered to be the pre-invasive stage with an intact basement membrane (no invasion).
• Dysplasia is not reversible.

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13
Q

What is an invasive carcinoma?

A

An invasive carcinoma is concerned with an abnormal uncontrolled growth of cancerous cell, with invasion of neighbouring tissues and the ability to metastasise (Secondary growth formation).

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14
Q

Which type of intracellular enzyme is involved with lung cancer?

A

Tyrosine kinases

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15
Q

What function is performed by tyrosine kinases?

A

Tyrosine kinases are mediators of signal transduction during the cell cycle controlling cell proliferation, differentiation, and apoptosis.

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16
Q

Which oncogene mutation is involved with adenocarcinoma? (15-30% of the time).

A

epidermal growth factor receptor (EGFR) tyrosine kinase

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17
Q

What is the epidemiology of the EGFR tyrosine kinase mutation?

A

Mutation in 15-30% of adenocarcinoma

More so in women, Asian ethnicity, never smokers

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18
Q

Which lung cancer oncogene mutation is concerned with smoking?

A

BRAF (downstream cell-cycle signalling mediator).

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19
Q

What are the four main oncogenes concerned with lung cancer?

A

Epidermal growth factors receptor (EGFR) tyrosine kinases

Anaplastic lymphoma kinase (ALK) tyrosine kinase

C-ROS oncogene 1 (ROS1) receptor tyrosine kinases

BRAF (downstream cell-cycle signalling mediator)

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20
Q

What are the symptoms with lung cancer?

A 
Cough
Dyspnoea
Haemoptysis 
Chest/shoulder pain 
Weight loss
fatigue

Symptoms are non-specific

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21
Q

What are the neurological features of metastatic disease?

A

Neurological features : focal weakness, seizures (brain metastases), spinal cord decompression

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22
Q

What are the paraneoplastic features of metastatic disease?

A

Paraneoplastic syndromes:

• Clubbing, hypercalcaemia of malignancy, hyponatremia, Cushing’s (Ectopic release of ACTH).

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23
Q

What are the three main features of metastatic disease?

A

Neurological features

Bone pain (PTH related peptides, ectopic release from lung cancer)

Paraneoplatic syndrome

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24
Q

What are the four main signs of metastatic lung cancer?

A

Finger clubbing

Cachexia

Horner’s syndrome

Pemberton’s sign

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25
Q

Why does finger clubbing occur in metastatic disease?

A

Clubbing of the distal digits and nails due to low oxygen saturation inducing vasodilation

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26
Q

What is cachexia in metastatic disease?

A

Muscle atrophy of weight loss due to reduced nutritional intake and catabolism from tumour

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27
Q

What is Horner’s syndrome?

A

Triad of ptosis, miosis, and ipsilateral anhidrosis (loss of sweating) occurs more frequently in patients with superior sulcus tumour –> Invades sympathetic plexus.

28
Q

What is Pemberton’s sign?

A

• Superior vena cava obstruction (Pemberton’s sign): Engorgement of the face due to reduced blood flow to the right atrium  Redness of face and swelling (Evident upon the elevation of the arms).

29
Q

What is the diagnostic strategy for lung cancer?

A

Establish most likely diagnosis
Establish fitness for investigation and treatment
Confirm diagnosis
Specific type of cancer if considering systemic treatment
Confirm staging

30
Q

What type of imaging is conducted for patients with diagnosed lung cancer?

A

A standard posteroanterior chest X-ray

Chest x-rays can be used to track pleural effusions and growth of mass.

31
Q

What are chest X-rays used for in terms of patients with lung cancer?

A

In patients with diagnosed lung cancer: Chest x-rays can be used to track pleural effusions and growth of mass.
• Detection of single or multiple pulmonary nodules
• Mass
• Lung collapse
• Mediastinal or hilar fullness.

32
Q

Which type of imaging can be used to monitor the size, location and extent of primary tumour?

A

Staging CT (chest and abdomen)

33
Q

What is the purpose performed by a staging CT in an individual with lung cancer?

A

Staging CT (Chest and abdomen)
• Size, location and extent of primary tumour
• Evaluates for hilar and/or mediastinal lymphadenopathy and distant metastases.

34
Q

Which imaging can be conducted to exclude occult metastases (cannot find location primary tumour)?

A

PET-Scan

35
Q

What function is performed by a PET scan in a patient with lung cancer?

A

Most useful to exclude occult metastases (cannot find location of primary tumour).

Activity within the mediastinum strongly leads to metastases.

36
Q

What is the ultimate investigation to confirm the diagnosis fo lung cancer?

A

Biopsy

37
Q

Which type of biopsy is conducted for peripheral lesions that are not accessible with bronchoscopy?

A

A CT-guided trans-thoracic needle aspiration

38
Q

Which type of biopsy is conducted for central airway tumours?

A

Tumours of central airways (would identify endobronchial lesions).

39
Q

How is lung cancer diagnosed from a biopsy sample?

A

Typing, subtyping and mutation testing.

40
Q

What are the three staging features of cancer?

A

T1-4: Tumour size and location
N0-3: Lymph node involvement
M0-1c: Metastases + number

41
Q

What fitness score is associated with radical treatment for lung cancer?

A

PS 0-2

42
Q

What is PS0 in terms of patient fitness?

A

Asymptomatic (Fully active, able to conduct activities of daily living and that of pre-disease without restriction.

43
Q

What PS score is given for a patient that is Symptomatic but completely ambulatory (restricted in physically strenuous activity but ambulatory, and able to carry out work of a light or sedentary nature)?

A

PS1

44
Q

What is PS2 in terms of patient fitness?

A

Symptomatic, <50% in bed during the day (ambulatory and capable of all self-care but unable to carry out any work activities, up for more than 50% of waking hours).

45
Q

What is PS3 in terms of patient fitness?

A

Symptomatic, >50% in bed, but not bedbound (capable of only limited self-care, confined to the bed for more than 50% of waking hours).

46
Q

What is PS4 in terms of patient fitness?

A

Bedbound (completely disabled, cannot conduct any self-care, totally confined to bed).

47
Q

Which patient fitness category is equal to death?

A

PS5

48
Q

Which type of surgical intervention is available for early stage disease of lung cancer?

A

Surgical resection

49
Q

What is lobectomy?

A

The removal of an entire lung lobe

50
Q

When is sublobar resection conducted in an individual with lung cancer?

A

If stage 1 (<3cm).

51
Q

What is the alternative to surgical intervention in an individual with lung cancer?

A

Radical radiotherapy

Stereotactic ablative body radiotherapy (SABR)

52
Q

What treatments are available for metastatic disease of lung cancer?

A

Immunotherapy
Chemotherapy
Tyrosine kinase inhibitor

53
Q

Which drugs are available for oncogene-directed therapy for EGFR?

A

• EGFR - Erlotinib, gefitinib, afatinib, dacomitinib, and osimertinib

54
Q

What drug is used for oncogene-directed therapy for both ALK and ROS-1 mutations?

A

Crizotinib

55
Q

What are the common side effects for systematic oncogene-directed treatments?

A

Rash
Diarrhoea
Pneumonitis

56
Q

Which receptor is exhibited by tumour cells?

A

PDL-1 receptor

57
Q

How do tumour cells evade the immune system?

A

• Tumour cells exhibit the PDL-1 receptor with the capacity to bind onto PD-1 ligands on T-cells, through this binding action, it enables to tumour cell to evade T-cell cytotoxic responses.

58
Q

How is immunotherapy used to target tumour cells?

A

In immunotherapy, the PDL-1 receptor is blocked by anti-PDL-1, this therefore enables T-cell recognition of the tumour cells –> Inducing an cytotoxic response

59
Q

What is the first line of treatment for metastatic NSCLC with no mutation (and PDL-1 >50%)?

A

Immunotherapy

Drug: Pembrolizumab, atezolizumab, nivolumab

60
Q

What are the side effects associated with immunotherapy of NSCLC?

A

Side effects:
• Generally well-tolerated
• Immune-related side effects in 10-15% (thyroid, skin, bowel, lung, liver).

61
Q

When is cytotoxic chemotherapy used?

A

First line for metastatic NSCLC with no mutation and PDL-1 <50% (in combination with immunotherapy).

62
Q

What drugs are typically used for cytotoxic chemotherapy?

A

Platinum based regimes (carboplatin, cisplatin)

63
Q

What are the side effects associated with cytotoxic chemotherapy?

A

Side effects
• Frequent: Fatigue, nausea, bone marrow suppression, nephrotoxicity.
• Quality of life poorly evaluated in trials, no evidence for improvement.

64
Q

What type of treatment should be offered as a standard to all patients with advanced stage disease?

A
  • Symptom control
  • Psychological support
  • Education
  • Practical
  • Financial support
  • Planning for end of life.
65
Q

What is the treatment outcome for early-staged disease?

A

Surgery or radiotherapy with curative intent

66
Q

What is the treatment outcome for locally advanced disease (involving thoracic lymph nodes)?

A

Surgery + adjuvant chemotherapy

BRS 1b (62 decks)

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