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finals: medicine > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

What is the most important aetiological factor in lung cancer

A

Smoking

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2
Q

There are different types of primary lung cancer and they are divided into 2 main groups.

Name these two main groups

A

small cell lung cancer (SCLC)

non small cell lung cancer (NSCLC)

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3
Q

There are different types of primary lung cancer and they are divided into 2 main groups: non-small cell lung cancer and small cell lung cancer.

Which is most common?

A

Non small cell lung cancer

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4
Q

Small cell lung cancer (SCLC) are most commonly caused by?

A

Smoking

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5
Q

Small Cell Lung Cancer – less common but worse prognosis. Why is this?

A

Tend to spread quite early on.

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6
Q

Small cell lung cancers are also classed as neuroendocrine tumours.

What are Neuroendocrine tumours

A

Rare tumours that develop in cells of the neuroendocrine system.

In small cell lung cancer, the tumour starts in the neuroendocrine cells of the lung.

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7
Q

Non small cell lung cancer account for 80% of lung cancer cases.

What are the three main types?

A

Adenocarcinoma

Squamous cell carcinoma

Large cell carcinoma

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8
Q

There are three main types of non small cell lung cancer: adenocarcinoma, squamous cell carcinoma and large cell carcinoma.

Which is the most common type of non small cell lung cancer?

A

adenocarcinoma

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9
Q

Adenocarcinoma is a type of non small cell lung cancer (NSCLC).

It tends to be located where in the lungs?

A

Tend to occur in lung peripheries

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10
Q

Adenocarcinoma is a type of non small cell lung cancer (NSCLC).

What cells are affected?

A

Starts in the mucus-secreting gland cells that line the airways

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11
Q

Squamous cell lung cancer is a type of ___

a) small cell lung cancer
b) non-small cell lung cancer

A

b) non-small cell lung cancer

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12
Q

Adenocarcinoma lung cancer is a type of ___

a) small cell lung cancer
b) non-small cell lung cancer

A

b) non-small cell lung cancer

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13
Q

Large cell lung cancer is a type of ___

a) small cell lung cancer
b) non-small cell lung cancer

A

b) non-small cell lung cancer

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14
Q

Adenocarcinoma is the most common histological type of lung cancer.

What is the second?

A

Squamous cell lung cancer

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15
Q

Large cell lung cancer tend to metastasis ____

a) early
b) late

A

a) early

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16
Q

Small cell lung cancer has a ____ prognosis

a) good
b) poor

A

b) poor

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17
Q

What is the most common type of lung cancer in non-smoker

A

Adenocarcinoma

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18
Q

Mesothelioma is a lung malignancy affecting the mesothelial cells of the pleura.

What is it strongly linked to

A

Asbestos inhalation

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19
Q

Small cell lung cancer occurs almost exclusively in which patient group

A

In smokers

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20
Q

Name some of the risk factors for lung cancer

A

Smoking

Other environmental agents e.g. asbestos, silica, welding fumes, coal

HIV

Organ transplantation

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21
Q

In the majority of lung cancer cases patients are asymptomatic.

If there are symptoms, what are the classic symptoms?

A

Chronic cough

Malaise

Haemoptysis

Cancer symptoms e.g. Weight loss, night sweats, fevers, recurrent infections

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22
Q

Hoarseness is a potential symptom of lung cancer.

How does this occur?

A

Occurs in Pancoast tumours which pressing on the recurrent laryngeal nerve

23
Q

What are the two key examination findings of lung cancer that automatically indicate an urgent referral

A

Finger clubbing

Lymphadenopathy – often supraclavicular nodes

24
Q

Squamous cell NSCLC typically occurring in the ____ parts of the lungs

a) Central
b) Peripheral

A

a) Central

25
Q

What are the 3 signs of pleural effusion on respiratory examination

A

Dull (‘stony dull’) percussion

Reduced vocal fremitus

Reduced breath sounds

26
Q

What is the cancer that is associated with Horners syndrome

A

Pancoast tumour

27
Q

Horner’s syndrome is a triad of symptoms.

Name the symptoms

A

Partial ptosis

Anhidrosis

Miosis

28
Q

Define Paraneoplastic syndromes

A

Refer to remote effects of tumours - usually due to hormones produced by the tumor or antibodies produced by the immune system.

They can affect the function of other bodily tissues and organs and cause symptoms at sites distant from the tumor

29
Q

Name some of the paraneoplastic syndrome signs that can be caused by small cell lung cancer

A

Cushing’s syndrome

Lambert-Eaton syndrome

30
Q

Name some of the paraneoplastic syndrome signs that can be caused by squamous cell lung cancer

A

Hyperparathyroidism

Hyperthyroidism due to ectopic TSH

31
Q

Name some of the paraneoplastic syndrome signs that can be caused by Adenocarcinoma lung cancer

A

Gynaecomastia

32
Q

Name some of the Extrapulmonary manifestations of lung cancer

A

Recurrent laryngeal nerve palsy

Phrenic nerve palsy

Superior vena cava obstruction

Horner’s syndrome

Syndrome of inappropriate ADH (SIADH)

Cushing’s syndrome

Hypercalcaemia

33
Q

Recurrent laryngeal nerve palsy is a potential extrapulmonary manifestation of lung cancer.

Describe how lung cancer causes this?

A

The cancer pressing on or affecting the recurrent laryngeal nerve as it passes through the mediastinum.

Presents with a hoarse voice

34
Q

Phrenic nerve palsy is a potential extrapulmonary manifestation of lung cancer.

Describe how lung cancer causes this?

A

Caused by nerve compression causes diaphragm weakness

Presents as shortness of breath

35
Q

Superior vena cava obstruction is a potential extrapulmonary manifestation of lung cancer.

Describe how lung cancer causes this?

A

Caused by direct compression of the tumour on the superior vena cava

Presents with facial swelling, difficulty breathing and distended veins in the neck and upper chest.

“Pemberton’s sign” is where raising the hands over the head causes facial congestion and cyanosis

36
Q

Superior vena cava obstruction is a potential extrapulmonary manifestation of lung cancer.

What are the symptoms of this?

A

Presents with facial swelling, difficulty breathing and distended veins in the neck and upper chest.

37
Q

What are the 4 common sites for lung cancer metastasis

A

Brain

Breast

Adrenals

Bone

38
Q

Refer people using a suspected cancer pathway referral for lung cancer.

How long does a patient have to wait for an appointment

A

Appointment within 2 weeks

39
Q

What is the gold standard investigation for lung cancer

A

Chest X-Ray

40
Q

What are the 4 key findings on chest x-ray for lung cancer

*

A

Hilar enlargement

“Peripheral opacity” – a visible lesion in the lung field

Pleural effusion – usually unilateral in cancer

Collapse

41
Q

Biopsy is required for histology of the lung cancer.

What two ways are we able to acquire biopsy samples

A

Either taken by bronchoscopy or percutaneous biopsy (through the skin)

42
Q

Imaging is important aspect of investigating lung cancer.

Name the 3 imaging modalities that are important in investigating lung cancer

A

Chest X-Ray

Staging CT (chest, abdomen and pelvis)

Bronchoscopy (endoscopy)

43
Q

Consider an urgent chest X-ray (to be performed within 2 weeks) to assess for lung cancer in people aged 40 years and over with any of the following.

Name the 5 following things

A
  1. Persistent or recurrent chest infection
  2. Finger clubbing
  3. Supraclavicular lymphadenopathy or persistent cervical lymphadenopathy.
  4. Chest signs consistent with lung cancer
  5. Thrombocytosis (high platelet count)
44
Q

What is the staging tool used in lung cancer

A

TNM staging

45
Q

The options for managing lung cancer include: chemotherapy, radiotherapy, surgery, palliative

What options are used in managing small cell lung cancer

A

chemotherapy, radiotherapy, palliative

Surgery is not useful as the cancer has poor prognosis – usually metastatic disease by time of diagnosis

46
Q

What is the first line management option for non small cell lung cancer

A

Surgery

47
Q

What are the management options for non small cell lung cancer

A

Chemo, radio, palliative and surgery are all options

1st line management is surgery

Consider adjuvant chemotherapy and radiotherapy to improve outcomes in certain patients or as part of palliative treatment to improve quality of life

Radiotherapy may be curative alone if caught early enough

48
Q

What are the management options for small cell lung cancer

A

Poor prognosis – usually metastatic disease by time of diagnosis

Receive combination of chemotherapy and radiotherapy

Palliative in a lot of cases

49
Q

Several options for surgical removal of a lung cancer.

First line surgical option for lung cancer

A

Lobectomy (removing the lung lobe containing the tumour)

50
Q

Several options for surgical removal of a lung cancer.

Name the 3 surgical options

A

Lobectomy (removing the lung lobe containing the tumour)

Segmentectomy or wedge resection (taking a segment or wedge of lung to remove the tumour)

Pneumonectomy (removal of entire lung)

51
Q

What is Lobectomy

A

Surgical removal of the lung lobe containing the tumour

52
Q

What is Segmentectomy or wedge resection

A

Surgical option taking a segment or wedge of lung to remove the tumour

53
Q

What is Pneumonectomy

A

Surgical removal of entire lung

54
Q

Name three palliative treatment options for lung cancer

A

Chemotherapy

Radiotherapy

Endobronchial treatment with stents or debulking can be used to relieve bronchial obstruction caused by lung cancer

finals: medicine (91 decks)

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