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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
What is the treatment of choice for stage I or II NSCLC?
Lobar resection surgery
25
What should patients undergoing lobar resection have aswell?
Hilar and mediastinal lymph node sampling - provide accurate pathological staging
26
When should radiotherapy be offered for NSCLC?
Whne surgery not an option and stage I-III
27
When is chemo offered for NSCLC? What is its purpose?
Stage III - IV + good performance status Improve survival, disease control and quality of life
28
When are tyrosine kinase inhibitors indicated?
Metastatic NSCLC in individuals with epidermal growth factor receptor mutation
29
Examples of tyrosine kinase inhibitors
Afatini b, erlotinib, gefitinib
30
What is 1st line managemenet for SCLC?
Chemotherapy Surgery often not possible as early mets SCLC much more sensitive to chemo than NSCLC Multi drug treatments often used
31
What features of lung cancer suggest that radiotherapy should be used palliatively?
Bronchial obstruction, cough, chest paun, haemoptysis, SVC obstruction, bone and brain mets, spinal cord compression
32
What do you treat bone mets with medically?
Bisphosponates
33
Management of palliative lung cancer
Radiotherapy, palliative care team Debulking surgery Stent insertion Opiates Aspiration or drainage +/- pleurodesis -
34
When is debulking surgery vs stent insertion used in palleative lung cancer?
Debulking - Bronchial obstruction, haempoptysis Stent insertion - bronchial OR SVC obstruction
35
Aside from pain relief, what is morphine useful for in lung cancer?
Breathlessness, cough
36
What is a mesothelioma?
Malignancy of mesothelial cells, occurs in pleura, peritoneum, pericardium and testes
37
What are the main risk factors for mesothelioma?
Male Age - over 75 Asbestos exposure - crocidolite/blue os most dangerous
38
Clinical features of mesothelioma
SOB Chest pain Fatigue, sweats, fever Finger clubbing Signs of pleural effusion Palpable chest wall mass Signs of metastases
39
Signs of metastases
Lymphadenopathy, hepatomegaly, bone pain, bone tenderness, abdominal pain, GI obstruction
40
Investigations for mesothelioma
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
Stage determining investigations mesothelioma
Mediastinoscopy and vide assisted thorascopy
42
What see on CXR or CT thorax in mesothelioma
Pleural effusion, ,obulated or nodular pleural thiclenign, pleural mass and rib destruction
43
Management for mesothelioma
Surgery - only possible in stage I Chemotherapy - palliative for unresectable Radiotherapy? little evidence supporting
44
What legal information can ypu give someone with asbestos indiced mesothelioma?
Uk industrial injuries act - compensation
45
What is the staging and prognosis used for mesothelioma?
TNM 1 year

A- Resp and cardio (58 decks)

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