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A- Resp and cardio > Lung cancer > Flashcards

Lung cancer Flashcards

1
Q

Investigations for lung cancer

A

Biopsy vua bronchoscope, EBUS, or CT
Pleural fluid samples
PET scan
MRI - more advanced, check for metastases
Lung function tests eg spirometry
6 minute walk test
ECHO if indicated
Baseline bloods

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2
Q

What are the two types of lung cancer

A

Small cell lung carcinoma
Non-small cell lung carcinoma
Depending on histology

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3
Q

Features of SCLC

A

Rapidly growing
Highly malignant

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3
Q

Features of SCLC

A

Rapidly growing
Highly malignant

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4
Q

What do the membrane bound chemosecretory granules release in SCLC?

A

Caclitonin, ADH, ACTH, PTH released peptide

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5
Q

Types of NSCLC

A

Squamous cell carcinoma - 42%
Adenocarcinoma - 39%
Large cell carcinoma - 8%

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6
Q

Where do SCLC arise from?

A

Kulchitsky cells

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7
Q

Where do squamous cell carcinomas arise in lung?

A

Proximal segmental bronchi, most present at obstructive lesions bronchus

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8
Q

Where do adenocarcinomas originate from?

A

Mucous cells of brochal epithelium

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9
Q

Which lung cancer is ass with asbestos/non-smokers?

A

Adenocarcinomas

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10
Q

Which lung cancer is likely to metastasise early? Where?

A

adenocarcinoma, brain and bone

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11
Q

What do large cell carcinomas consist of? Where arise and how differentiated?

A

Sheets of large, round polygonal cells w large nuclei and prominent nucleoli
Arise centrally and poorly differentiated

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12
Q

Bloods for lung cancer

A

FBC - anaemia, raised platelets
U+Es - May show hyponatremia in ADH -producing tumours
Calcium - May increase in PTHrP secreting tumours or bone metastases
Albumin may be low

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13
Q

Imaging lung cancer

A

CXR - 1st investigation done in patients with sus lung cancer
CT chest - investgiate suspected
PET scan - NSCLC

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14
Q

What are PET scans used for in lung cancer?

A

Assess eligibility for curative treatment in NSCLC

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15
Q

Histology investigations lung cacner

A

Bronchoscopy - obtain biopsies and washings for biopsy
Pleural effusion analysis
Sputum - centrally placed nodules or masses who decline/can’t tolerate bronchoscopy
Transthoracic fine needle aspiration biopsy - histology peripheral lesions

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16
Q

Risk factors for lung cancer

A

Cigarette smoking - 90%
COPD
Previous malignancy - head and neck
Industrial dust diseases - asbestos, chromium, arsenic, radon gas
FH
Increasing age

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17
Q

Symptoms of lung cancer

A

Cough
Haemoptysis
Dyspnoea
Chest pain
Recurrent or slow resolving pneumonia
Anorexia
Weight loss

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18
Q

Signs lung cancer - locoregional spread

A

Shoulder/inner arm pain/weakness - brachial plexus compression
Horner syndrome - sympathetic ganglion compression
Hoarseness - recurrent laryngeal nerve
Upper limb oedema, facial congestion + distended neck veins (SVC obstruction)

19
Q

Signs of paraneoplastic syndrome

A

Finger clubbing
Signs of hypercapnia - bone metastases, release of PTHrP release
Hypertrophic osteoarthropathy

20
Q

Which cancers release PTHrP

A

Small cell carcinoma or squamous cell carcinoma

21
Q

What is used for staging in lung cancer?

A

Tumour
Nodal
Mets

22
Q

What investigation should be used to stage lung cancer

A

Contrast CT of chest, liver, adrenal glands and symptomatic area

23
Q

Which lung cacner has a poorer prognosis?

A

SCLC has a much poorer prognois than NSCLC
65-70% patients have disseminated or extensive disease at presentation

24
Q

What is the treatment of choice for stage I or II NSCLC?

A

Lobar resection surgery

25
Q

What should patients undergoing lobar resection have aswell?

A

Hilar and mediastinal lymph node sampling - provide accurate pathological staging

26
Q

When should radiotherapy be offered for NSCLC?

A

Whne surgery not an option and stage I-III

27
Q

When is chemo offered for NSCLC? What is its purpose?

A

Stage III - IV + good performance status
Improve survival, disease control and quality of life

28
Q

When are tyrosine kinase inhibitors indicated?

A

Metastatic NSCLC in individuals with epidermal growth factor receptor mutation

29
Q

Examples of tyrosine kinase inhibitors

A

Afatini b, erlotinib, gefitinib

30
Q

What is 1st line managemenet for SCLC?

A

Chemotherapy
Surgery often not possible as early mets
SCLC much more sensitive to chemo than NSCLC
Multi drug treatments often used

31
Q

What features of lung cancer suggest that radiotherapy should be used palliatively?

A

Bronchial obstruction, cough, chest paun, haemoptysis, SVC obstruction, bone and brain mets, spinal cord compression

32
Q

What do you treat bone mets with medically?

A

Bisphosponates

33
Q

Management of palliative lung cancer

A

Radiotherapy, palliative care team
Debulking surgery
Stent insertion
Opiates
Aspiration or drainage +/- pleurodesis -

34
Q

When is debulking surgery vs stent insertion used in palleative lung cancer?

A

Debulking - Bronchial obstruction, haempoptysis
Stent insertion - bronchial OR SVC obstruction

35
Q

Aside from pain relief, what is morphine useful for in lung cancer?

A

Breathlessness, cough

36
Q

What is a mesothelioma?

A

Malignancy of mesothelial cells, occurs in pleura, peritoneum, pericardium and testes

37
Q

What are the main risk factors for mesothelioma?

A

Male
Age - over 75
Asbestos exposure - crocidolite/blue os most dangerous

38
Q

Clinical features of mesothelioma

A

SOB
Chest pain
Fatigue, sweats, fever
Finger clubbing
Signs of pleural effusion
Palpable chest wall mass
Signs of metastases

39
Q

Signs of metastases

A

Lymphadenopathy, hepatomegaly, bone pain, bone tenderness, abdominal pain, GI obstruction

40
Q

Investigations for mesothelioma

A

CXR + CT scan
MRI/PET scan for more detail
Pleural fluid, pleural biopsy - US or CT guided percutaneous
Mediastinoscopy and vide assisted thorascopy - stage determining

41
Q

Stage determining investigations mesothelioma

A

Mediastinoscopy and vide assisted thorascopy

42
Q

What see on CXR or CT thorax in mesothelioma

A

Pleural effusion, ,obulated or nodular pleural thiclenign, pleural mass and rib destruction

43
Q

Management for mesothelioma

A

Surgery - only possible in stage I
Chemotherapy - palliative for unresectable
Radiotherapy? little evidence supporting

44
Q

What legal information can ypu give someone with asbestos indiced mesothelioma?

A

Uk industrial injuries act - compensation

45
Q

What is the staging and prognosis used for mesothelioma?

A

TNM
1 year

A- Resp and cardio (58 decks)

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