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The Respiratory System > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

What are the 3 types of lung cancer?

A
  1. Small cell
  2. Non-small cell
  3. Unknown - patients too ill to undergo full diagnostics
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2
Q

Describe small cell cancer and what treatment is best used against it?

A

Rapidly prograssive and metastasises early

Rarely suitabe for surgery as a result

Responsive to chemotherapy

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3
Q

Describe non-small cell cancer and the best treatment against it?

A

Includes squamous and adeno carcinomas

Slower to proliferate compared with small cell

Surgery and chemotherapy are the best treatment options

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4
Q

Which cancers have the best chance of survival?

A

Non-small cell

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5
Q

In terms of cancer what can a PET scan determine?

A

Positron emission tomography

Shows metastasis by highlighting highly metabolically active areas

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6
Q

What are the two main types of lung cancer surgery?

A

Pneumonectomy - lung removed

Lobectomy - lobe removed

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7
Q

What is a thoracotomy?

A

An incision into the chest wall

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8
Q

What is cytotoxic chemotherapy?

A

Whole body IV treatment that targets rapidly dividing cells

Good for small cell

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9
Q

What are some side effects of cytotoxic chemotherapy?

A
  • Nausea and vomiting
  • Tiredness
  • Bone marrow suppression - opportunistic infection, anaemia
  • Hair loss
  • Pulmonary fibrosis
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10
Q

Describe radiotherapy

A

Ionising radiation with eother a curative or palliative intent is directed at tumour

Useful for metastases

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11
Q

What is a maximum accumulated dose?

A

This is the maximum amount of radition that a patient can be exposed to before it can be damaging

This is why it is important to use this dose strategically

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12
Q

How can the exposure to radiotherpy me minimised in surrounding tissues, but maximised at the tumour site?

A

By using multiple beam angles aimed at the tumour

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13
Q

What is photodynamic therapy?

A

A photosensitizer (drug) is taken, when it coincides with light of a certain wavelength it released reactive oxygen species

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14
Q

Which palliative treatment is commonly used to extend patients’ lives?

A

Palliative radiotherapy

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15
Q

What can cause lung cancer?

A
  • Smoking
  • Asbestos
  • Radon gas
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16
Q

How can lung cancer be prevented?

A

Not smoking

Avoiding risk factors

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17
Q

What is a rhabdomyosarcoma?

A

Malignant tumour of skeletal muscle

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17
Q

What is a rhabdomyosarcoma?

A

Malignant tumour of skeletal muscle

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18
Q

What affect does parathyroid hormone (PTH) have on blood calcium concentration?

A

It acts to increase blood calcium concentration

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19
Q

n a patient over 40 with an unexplained haemoptysis what referral should be made?

A

Suspected lung cancer pathway referral (appointment within 2 weeks)

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20
Q

What molecule sometimes secreted by small cell lung cancers can result in Cushing’s syndrome?

A

ACTH

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21
Q

Topic: Lung Cancer

Question: Signs

A

Cachexia
Finger Clubbing
Hypertrophic pulmonary osteoarthropathy
Anaemia
Horner’s syndrome (if the tumour is apical)
Examination of the chest: consolidation (pneumonia); collapse (absent breath sounds, ipsilateral tracheal deviation); pleural effusion (Stony dull percussion, decreased vocal resonance and breath sounds)
Enlargement of supraclavicular and axillary lymph nodes
Paraneoplastic syndromes: Cushing’s syndrome, SIADH, and Lambert-Eaton syndrome (suggest small-cell), hyperparathyroidism (suggests squamous cell)

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22
Q

Topic: Lung Cancer

Question: Symptoms

A

Cough
Haemoptysis
Dyspnoea
Chest Pain
Weight loss
Nausea and Vomiting
Anorexia

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23
Q

What molecule can squamous cell carcinomas secrete that results in a paraneoplastic syndrome?

A

Parathyroid hormone-related peptide (PTHrP)

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24
Q

How does small-cell lung cancer cause Cushing’s syndrome?

A

Ectopic secretion of ACTH by the tumour

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25
Q

What is the prognosis of mesothelioma?

A

Between 12-22 months depending on the stage of the disease at presentation. Less than 10% of patients survive 5 years (it take longer to diagnose than other cancer types )

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26
Q

Topic: Lung Cancer

Question: Small-cell lung cancer management

A

Generally palliative chemotherapy, as tumours are disseminated on presentation.

27
Q

How is lung cancer definitively diagnosed?

A

Biopsy

https://www.youtube.com/watch?v=QcjGCBO83DQ

28
Q

What proportion of patients with small-cell lung cancer will have metastases at presentation?

A

Over 70% of patients with small cell lung cancer present with metastatic disease. Common sites for metastasis include adrenals, brain, bone and liver

29
Q

Where are small-cell lung cancers more commonly located on imaging of the lungs?

A

Perihilar/ central region

30
Q

Which antibodies are present in myasthenia gravis?

A

Acetylcholine receptor antibodies

31
Q

Topic: Lung Cancer

Question: Non-metastatic manifestations of bronchial carcinoma

It is important to recognise non-metastatic complications of bronchial carcinoma, which can arise due to local invasion. These complications can include:

A

Shortness of breath: people with lung cancer can experience shortness of breath if the cancer invades major airways.
Haemoptysis: the invasion of cancer into the airways which is friable tissue may lead to bleeding.
Pain: advanced lung cancer may cause local invasion affecting the lining of pleural cavity or bone causing pain.
Pleural effusion: lung cancer can cause inflammatory reactions which lead to the accumulation of fluid in the pleural space.
Superior vena cava obstruction: the cancer may invade into surrounding tissues leading to compression of the drainage of the superior vena cava leading to dyspnea and facial plethora due to venous congestion.
Pneumothorax: invasion of the tumour may lead to a communication between the lung parenchyma and the pleural cavity resulting in the collapse of the lung.
Atelectasis (collapse of a lung or lobe): the invasion of a tumour may lead to total obstruction of the airway leading to collapse of that lobe.

32
Q

Which signs are present in Horner’s syndrome?

A

Miosis, partial ptosis, enophthalmos and anhidrosis

33
Q

How does Lambert-Eaton myasthenic syndrome (LEMS) differ from myasthenia gravis (MG)?

A

LEMS is associated with proximal weakness that improves with exertion whereas MG is associated with muscle weakness that gets worse with activity. MG also predominantly involves the eye muscles.

34
Q

Which treatment modalities are available for lung cancers?

A

Chemotherapy, immunotherapy, radiotherapy, surgery

35
Q

What is meant by syndrome of inappropriate ADH?

A reduced serum osmolality and sodium due to dilution with water, together with a high urine sodium and osmolality due to over-secretion of antidiuretic hormone (ADH) either from the posterior pituitary or from an ectopic source

A

A reduced serum osmolality and sodium due to dilution with water, together with a high urine sodium and osmolality due to over-secretion of antidiuretic hormone (ADH) either from the posterior pituitary or from an ectopic source

36
Q

Topic: Lung Cancer

Question: Important Features of Adenocarcinoma

A

Arises from mucous cells in the bronchial epithelium
Commonly invades the mediastinal lymph nodes and the pleura, and spreads to the brain and bones
Does not usually cavitate
Proportionally more common in non-smokers, women and in the Far Eastleast likely to be related to smoking
Most likely to cause pleural effusion (as are mesotheliomas)

37
Q

Which type of lung cancer is strongly associated with cavitation?

A

Squamous cell carcinoma

38
Q

Topic: Lung Cancer

Question: Important Features of Squamous cell carcinoma

A

Second most common type of lung cancer in the UK (previously was the most common)
Usually present as obstructive lesions of the bronchus leading to infection.
Occasionally cavitates (10% at presentation) Lung Ca that most commonly cavitates
On X-ray it is not possible to tell whether it is an abscess or a cancer (the border’s definition cannot be easily seen) but on the CT there is obviously a jagged border – indicating cancer.
Local spread is common, but metastasis are normally late (but frequent)
Often causes hypercalcaemia – by bone destruction or production of PTH analogues (PTHrp).
Also associated with clubbing and HPOA (Hypertrophic pulmonary osteoarthropathy)

39
Q

From which part of the lung do adenocarcinomas arise?

A

Alveolar epithelium

40
Q

Where are adenocarcinomas of the lungs most commonly located?

A

Peripherally

41
Q

Which antibodies are present in Lambert-Eaton myasthenic syndrome?

A

Voltage gated calcium channel (VGCC) antibodies.

42
Q

What is meant by the term Pancoast tumour?

A

A tumour of the lung apex, most commonly non-small cell carcinoma

43
Q

What type of lung cancer is the most common?

A

Adenocarcinoma

44
Q

.

A

,

45
Q

Topic: Lung Cancer

Question: Subtypes

A

Lung cancers can be divided into small-cell and non-small cell tumours. The most common histological type of tumour is squamous cell cancer, followed by adenocarcinoma.

46
Q

What is the most common clinical manifestation of asbestos-related lung disease?

A

Pleural plaques, seen as discrete circumscribed areas of fibrosis on the parietal pleura. They are almost always asymptomatic and do not impair lung function

47
Q

Topic: Lung Cancer

Question: Non-small cell lung cancer (NSCLC) management

A

First-line: lobectomy
Curative radiotherapy can also be offered to patients with stage I, II and III NSCLC.
Chemotherapy should be offered to patients with stage III and IV NSCLC to control the disease and improve quality of life.

48
Q

What type of scan can be used to investigate bone density in patients with hyperparathyroidism?

A

DEXA scan

49
Q

What are the major classifications of lung cancer?

A

Small cell lung cancer (SCLC) and non small cell lung cancer (NSCLC). Within the category of NSCLC there is adenocarcinoma, squamous cell carcinoma and large cell carcinoma

50
Q

What is the current main risk factor for developing lung cancer?

A

Smoking cigarettes

51
Q

What is the lag period between asbestos exposure and the development of mesothelioma?

A

Typically 40 years

52
Q

Topic: Lung Cancer

Question: Risk factors

A

Lung cancer has a diverse range of risk factors and it is important to be aware of these when seeing and taking a history from patients in order to elicit these. These risk factors include:

Smoking (tobacco and cannabis)
Passive smoking
Occupation exposure (asbestos, silica, welding fumes, coal)
HIV
Organ transplantation
Radiation exposure (X-ray, gamma rays).
Beta-carotene supplements in smokers.

53
Q

Which type of lung cancer is associated with a paraneoplastic cause of hypercalcaemia?

A

Squamous cell carcinoma

54
Q

Which type of lung cancer classically presents as a cavitating lesion?

A

Squamous-cell carcinoma.

55
Q

Topic: Lung Cancer

Question: Important Features of Small cell carcinoma

A

Arise from endocrine cells (Kulchitsky cells). These are APUD cells, and as a result, these tumours will secrete many poly-peptides mainly ACTH.
They can also cause various presentations such as Addison’s and Cushing’s disease.
Small cell carcinoma spreads very early and is almost always inoperable at presentation.
These tumours do respond to chemotherapy, but the prognosis is generally poor.

56
Q

What is the mechanism by which squamous cell carcinoma causes hypercalcaemia?

A

Due to the production of parathyroid hormone-related protein.

57
Q

Name the four most common cancers in the UK

A

Breast

Prostate

Lung

Bowel

58
Q

. Mesothelioma is associated with asbestos inhalation , small cell lung cancer and is associated with smoking . What is adenocarcinoma is associated with

A

psammoma bodies in histology slide

59
Q

How would tunour causes hoarseness

A

. The recurrent laryngeal nerve provides motor to almost all of the intrinsic muscles of the larynx and damage to this nerve by a tumour can cause a persistently hoarse voice. The recurrent laryngeal nerve branches off the descending vagus nerve in the mediastinum. The left recurrent laryngeal nerve loops under the aortic arch

60
Q

Features of Squamous cells carcinoma

A

Painless secrete PTHrP -> high Ca->

61
Q

A 70-year-old man presents to the GP with a 2 month history of an irritating cough.

Recently he has noticed that he has stopped sweating on the right side of his face. On examination,

you notice that his right eyelid is drooping and his right pupil is abnormally constricted.

The man is subsequently diagnosed with lung cancer.
Which of the following best describes the pathophysiology of this patient’s symptoms?

A

This man likely has Horner’s syndrome which can be caused by a Pancoast tumour (apical tumour) invading the sympathetic chain.

62
Q

A 75-year-old woman with lung cancer presents to A&E with breathlessness and palpitations.
Her ECG shows atrial fibrillation.

Two months ago, she was diagnosed with lung cancer.

Tumour invasion of which anatomical structure is likely to be causing this patient’s symptoms?

A

Tumour invasion of the pericardium can result in breathlessness, AF and pericardial effusion.

63
Q

Small cell lung cancer

A

1.Secrete ▪ ADH-
▪ ACTH-
2.Lambert-Eaton syndrome-
3.Spreads early and is almost always inoperable
o Fast growing due to autocrine function, feeds on cells
o Highly malignant
o Responds to chemotherapy and radiotherapy but overall the prognosis is very poor

64
Q

Lung apical has good ventilation but poor prefusion

A

True / which is why TB present mostly where oxygen is in the top

65
Q

what is different between NSCLC and SCLC

A

NSCLC is slowly to proliferate thus surgery can be an option

The Respiratory System (19 decks)

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