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Respiratory > Lung cancer > Flashcards

Lung cancer Flashcards

1
Q

What are some risk factors of lung cancer?

A

Smoking
Asbestos
Nickel
Chromates
Radiation
Atmospheric pollution
Genetics

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2
Q

What are some components of tobacco smoke that increased the risk of lung cancer?

A

Polycyclic hydrocarbons
Aromatic amines
Phenols
Nickel
Cyanates

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3
Q

What percentage of smokers will die of lung cancer?

A

Around 20%

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4
Q

How might lung cancer cause symptoms?

A

Via the primary tumour, local invasion, metastases or via its paraneoplastic syndromes

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5
Q

What are some symptoms of lung cancer?

A

Persistent cough
Haemoptysis
Shortness of breath
Dysphagia
Dysphonia
Cachexia (Weight loss)

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6
Q

How does lung cancer cause haemoptysis?

A

Invasion of the chest wall can erode blood vessels

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7
Q

How can lung cancer cause dysphonia?

A

The tumour can obstruct the recurrent laryngeal nerve

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8
Q

What are some red flag symptoms that people should go to the GP with, that may be suggestive of lung cancer?

A

For for ≥3 weeks
Breathlessness for no reason
Chest infection that doesn’t clear
Haemoptysis (Most likely chest infection)
Unexplained weight loss
Chest or shoulder pain
Unexplained tiredness or lack of energy
Hoarse voice
Recurrent pneumonia
Stridor

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9
Q

What are some clinical signs suggestive of lung cancer?

A

Fixed, monomorphic wheeze
Supraclavicular lymphadenopathy
Cervical lymphadenopathy
Finger clubbing

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10
Q

What are the 4 main types of lung tumour?

A

Adenocarcinoma (35%)
Squamous cell carcinoma (30%)
Small cell carcinoma (25%)
Large cell carcinoma (10%)

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11
Q

What type of cells do adenocarcinomas effect?

A

Glandular cells

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12
Q

What type of cell is affected by squamous cell carcinoma?

A

Keratinising, squamous epithelial cells

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13
Q

What type of cell is affected by small cell carcinoma?

A

Neuroendocrine cells

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14
Q

What type of cell is affected by large cell carcinoma?

A

Any cell type (Causes large cell formation)

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15
Q

What are some common secondary lung cancers in primary lung cancer?

A

Neuroendocrine tumours
Bronchial gland tumours

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16
Q

What is the most basic classification of lung cancer?

A

Small cell vs non-small cell

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17
Q

What are some common characteristics of small cell carcinoma?

A

They are usually rapidly progressing, metastasise early and is usually very chemosensitive early on

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18
Q

What are some common characteristics of large cell carcinoma?

A

They are usually slower growing and can sometimes be cured using surgery or radical radiotherapy

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19
Q

What is an example of a neuroendocrine neoplasm?

A

Carcinoid tumours

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20
Q

What are some examples of bronchial gland neoplasms?

A

Adenoid cystic carcinomas
Mucoepidermoid carcinoma

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21
Q

What is the usual pathogenesis of lung cancer?

A

Squamous metaplasia
Then dysplasia
Then carcinoma in situ
Then invasive malignancy
Then metastases

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22
Q

What is a common pathogenesis of peripheral adenocarcinomas?

A

Atypical adenomatous hyperplasia
Then spread of neoplastic cells along alveolar walls
Then true invasive adenocarcinoma

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23
Q

What is the most basic staging for lung cancer?

A

Stage I - Tumour <3cm, No spread
Stage II - Tumour 3-5cm, Local lymph node involvement
Stage III - Tumour >5cm, Central lymph node involvement
Stage IV - Tumour >7cm, Metastasis

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24
Q

What is the clinical method of tumour staging?

A

TNM staging
T = Tumour
N = Nodes
M = Metastasis

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25
Q

What can occur due to local invasion of the recurrent laryngeal nerve in lung cancer?

A

Paralysis of the vocal cords and hoarse voice

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26
Q

What can occur due to local invasion of the pericardium in lung cancer?

A

Breathlessness, atrial fibrillation and risk of pericardial effusion (The fluid from which can be used to diagnose cancer)

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27
Q

What can occur due to local invasion of the oesophagus?

A

Dysphagia

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28
Q

What can occur due to local invasion of the brachial plexus of nerves?

A

muscle weakness and wastage in the arm

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29
Q

What can occur due to local invasion of the pleural cavity and ribs?

A

Chest pain and pleural effusion

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30
Q

What can occur due to local invasion of the superior vena cava?

A

Congestion in the jugular and subclavian veins can lead to swelling and erythema in the head, as well as a distended internal jugular vein and superficial, visible anastomoses across the chest

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31
Q

How can local invasion and obstruction of the SVC be treated?

A

Stent implantation and palliative chemotherapy or radiotherapy

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32
Q

What can occur due to local invasion of the pulmonary arteries?

A

Increased risk of pulmonary embolism or decreased blood supply to the lungs

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33
Q

What is a Pancoast tumour?

A

A form a non-small cell tumour that invades through the chest wall of the apices and invades the brachial plexus, causing muscle wastage in the arm and hand

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34
Q

What is a common presentation of a Pancoast tumour?

A

The patient will often complain of dropping a lot of things such as cups of tea

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35
Q

What is a possible complication of a Pancoast tumour?

A

Horner’s syndrome

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36
Q

What is Horner’s syndrome?

A

A syndrome in which a Pancaost tumour compresses the sympathetic chains that supply the head

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37
Q

What are the 3 signs of Horner’s syndrome?

A

Unilateral mitosis, ptosis and anhidrosis

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38
Q

What is miosis?

A

Pupil constriction

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39
Q

What is ptosis?

A

Eyelid drooping

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40
Q

What is anhydrosis?

A

Lack of sweating

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41
Q

What are the 6 main areas to which lung cancer can metastasise?

A

Brain
Liver
Bone
Adrenal glands
Skin
Contralateral lung

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42
Q

What are some symptoms and complications of brain metastases?

A

Brain metastases will often have an insidious onset, resulting in weakness, fits, visual disturbances and headaches which are worse in the morning and are not photophobic

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43
Q

How can liver metastases present?

A

Liver metastases don’t often cause symptoms, however, it can cause a dull abdominal ache

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44
Q

What are some complications of bone metastases?

A

Bone weakness and descruction, leading to weakness and easy bone fracturing

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45
Q

What are paraneoplastic syndromes?

A

These are symptoms and effects of cancers that are not directly caused by tumour production, but are caused by genetic abnormalities, leading to production of hormones and chemicals that therefore cause effects

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46
Q

What type of cells are affected by small cell lung cancer?

A

Neuroendocrine cells

47
Q

What are some possible paraneoplastic syndromes of small cell lung cancer?

A

SIADH
Cushing’s syndrome
Lambert-Eaton syndrome

48
Q

What is meant by SIADH?

A

Syndrome of Inappropriate Anti-Diuretic Hormone

49
Q

What occurs in SIADH?

A

This is a complex paraneoplastic syndrome in which a tumour secretes large amounts of ADH, resulting in hyponatraemia as the kidneys increase excretion of sodium?

50
Q

What are some common symptoms of SIADH?

A

Nausea
Myoclonus (Sudden, brief muscle twitching)
Lethargy
Confusion
Seizures
Coma

51
Q

How can SIADH be treated?

A

Using fluid restriction and possible demeclocycline

52
Q

What occurs in Lambert-Eaton syndrome?

A

This is a condition in which the body produces antibodies against Ca2+ receptors, leading to muscle weakness

53
Q

What occurs in Cushing’s syndrome?

A

This is a condition in which there is an abnormal production of adrenocorticotrophic hormone

54
Q

What are some symptoms of Cushing’s syndrome?

A

Trunkal obesity
Thin limbs
Rounded face
Shoulder humping
Fatigue
Weakness

55
Q

What type of cell is affected in squamous cell carcinoma?

A

The keratinising squamous cells of the lungs

56
Q

Which form of cancer can cause cavitating lesions?

A

Squamous cell carcinoma

57
Q

What are some some paraneoplastic syndromes that can occur in squamous cell carcinoma?

A

Hypercalcaemia
Hypertrophic Pulmonary Osteoarthropathy (HPOA)

58
Q

How does hypercalcaemia occur in squamous cell carcinoma?

A

This occurs due to the production of parathyroid hormone-related protein, which mimics an anti-diuretic and causes calcium retention by the kidneys

59
Q

What are the symptoms of hypercalcaemia as a paraneoplastic syndrome in squamous cell carcinoma?

A

Stones - Renal/Biliary calculi
Bones - Bone pain
Groans - Abdominal pain, constipation
Thrones - Polyuria (Lots of urine)
Psychiatric Overtones - Depression, anxiety

60
Q

What is the treatment regime in hypercalcaemia as a paraneoplastic syndrome

A

Initial: rehydration
If calcium >4 : IV Bisphosphate (Pamidronate) to decrease Ca2+ levels

61
Q

What is meant by Hypertrophic Pulmonary Osteoarthropathy?

A

Inflammation and lifting of the periosteum surrounding the bone

62
Q

What are some clinical presentations of hypertrophic pulmonary osteoarthropathy?

A

Periostitis
Bone pain
Digital clubbing
Arthropathy of large joints

63
Q

Which cancer is the most common in non-smokers?

A

Adenocarcinoma

64
Q

What type of cell is affected in adenocarcinoma?

A

Mucus secreting glandular cells

65
Q

What are some paraneoplastic syndromes of adenocarcinoma?

A

Gynaecomastia
Hypertrophic pulmonary osteoarthropathy

66
Q

What is the first line investigation in suspected lung cancer?

A

Chest X-ray

67
Q

What investigation will be used for screening and further suspicion in a clear CXR?

A

Contrast-enhanced CT scan

68
Q

When is PET scanning useful in cancers?

A

If the cancer cannot be fully staged via contrast CT scanning

69
Q

How does PET scanning work?

A

PET scanning detects the intake of radio-labelled glucose and so measures areas of greatly increased respiration and glucose metabolism

70
Q

What are some ways in which tissue samples can be taken to give a full diagnosis of lung cancer?

A

Bronchoscopy
CT guided biopsy
Lymph node aspiration
Aspiration of pleural fluid
EndoBrachial UltraSound (EBUS)
Thoracoscopy

71
Q

What are the advantages and disadvantages of CT guided lung biopsy in lung cancer?

A

It is useful in tumours that invade the chest or in healthy patients, however, it does carry a risk of pneumothorax

72
Q

What occurs in a thoracoscopy?

A

The lung is deflated and a camera and sampling tool is inserted through the chest wall, and a sample of the chest wall is taken

73
Q

What is an example of an immunohistochemical marker of adenocarcinomas?

A

TTF1 (Thyroid Transcription Factor 1)

74
Q

What is an example of an immunohistochemical marker of squamous cell carcinoma?

A

Nuclear antigen p63 and high molecular weight cytokeratins

75
Q

What are some normal tests that should be carried out in lung cancer, not for staging or diagnosis, but to show the effects

A

Full blood counts
Sodium levels
Calcium levels
Alkaline phosphatase
Spirometry

76
Q

How are bone metastases shown in lung cancer?

A

Using radionucleotide bone scanning (99M Tc)

77
Q

What are some examples of lung cancer mimics?

A

Tuberculosis
Vasculitis
Pulmonary embolism
Secondary cancer
Lymphoma
Bronchiectasis

78
Q

Which treatment does small cell carcinoma have a very good initial response to?

A

Chemotherapy

79
Q

What is meant by radical treatment?

A

Treatment delivered with the intent of long term disease control

80
Q

What is meant by palliative treatment?

A

Treatment delivered without intention of cure, for the control or relief of symptoms

81
Q

What is meant by neo-adjuvent treatment?

A

Treatment delivered before the definitive treatment e.g. chemo before surgery

82
Q

What is meant be adjuvant treatment?

A

Treatment delivered after the definitive treatment to reduce the risk of recurrence e.g. chemo after surgery

83
Q

What is meant by concurrent treatment?

A

Chemotherapy and radiotherapy together

84
Q

What is meant by sequential treatment?

A

Chemotherapy then radiotherapy

85
Q

What is a gray in radiotherapy?

A

This is the unit of measurement for radiotherapy dosing
Dose delivered ÷ Dose absorbed by tissue
(Joules per kilogram)

86
Q

What is meant by a fraction in lung cancer treatment?

A

The number of daily treatments

87
Q

Which treatment is the preferred choice in lung cancer?

A

Surgery

88
Q

What is the 1 year survival rate after surgery in lung cancer?

A

81%

89
Q

How is staging for surgery carried out?

A

Bronchoscopy
Mediastinoscopy
CT scanning of brain, thorax and abdomen
PET scanning of abdomen

90
Q

What are the uses of bronchoscopy in staging for surgery in lung cancer?

A

It can check for vocal cord palsy, proximity to the carina and cell type

91
Q

What are the uses of mediastinoscopy in screening for lung cancer?

A

Check lymph node involvement

92
Q

What are some available surgical procedures in lung cancers?

A

Pneumonectomy - Lung removal
Lobectomy - Lobe removal
Lymph node removal
VATS - Video Assisted Thoracic Surgery
RATS - Robotics Assisted Thoracic Surgery

93
Q

Which form of lung cancer is more susceptible to chemotherapy?

A

Small cell lung cancers as it targets rapidly dividing cells and small cell lung cancers develop quickly

94
Q

What are some methods of screening for chemotherapy?

A

Tissue sampling
CT scanning

95
Q

What scoring system is used to calculate chemotherapy risk?

A

ECOG score

96
Q

How is the ECOG score calculated?

A

This is a scoring system from 1-5:

0 - Fully active, able to carry on all pre-disease performance without restriction

1 - Restricted in physically strenuous activity but able to carry out light work

2 - Ambulatory for >50% waking hours and capable of self care but unable to carry out work

3 - Capable of only limited self care and confined to bed or chair for >50% waking hours

4 - Completely disabled and cannot carry out any self care

5 - Dead

97
Q

What are some common side effects of chemotherapy?

A

Nausea and vomiting
Tiredness
Bone marrow suppression so infection or anaemia
Hair loss (Not in lung cancer regimes)
Pulmonary fibrosis

98
Q

What is meant by systemic therapy in lung cancer?

A

This is a combination of chemotherapy and targeted, personalised medicine

99
Q

What are some common targetable mutations in lung cancer?

A

EGFR and ALK1

100
Q

How are EGFR mutations targeted in lung cancer treatment?

A

By tyrosine kinase inhibitor (erlotinib), which is taken as a tablet
Tumours can become resistant however, but some of the more common mutations can be targeted now

101
Q

How are ALK1 mutations in brain metastases of lung cancer treated?

A

By tyrosine kinase inhibitors, which cause the brain metastases to “Melt away”

102
Q

How can EML4-ALK fusion oncogenes be targeted?

A

Crizotinib

103
Q

What is the main target of immunotherapy in lung cancer?

A

This targets PD-L1 (Programmed Death Ligand) which binds to PD receptors on T lymphocytes, which usually inactivate the cytotoxic immune response, and thus blocking this allows an immune response to be mounted

104
Q

What occurs in radiotherapy?

A

Radiotherapy involves the use of ionising radiation, usually X-rays, via a linear accelerator, to destroy or shrink the tumour

105
Q

Why is radiotherapy not classed as curative?

A

It does not remove lymph nodes, so there is always the chance that lymph node involvement is missed

106
Q

What are some structures that are at risk from radiotherapy in lung cancer?

A

The spinal cord
Oesophagus
Adjacent lung tissue

107
Q

From how many angles is radiotherapy usually given?

A

4-5 angles

108
Q

What is meant by SABR?

A

Stereotactic ablative radiotherapy
This involves targeting the tumour from many angles, giving higher dose radiation to the tumours core, while a 4D CT scan is used to tract the tumours movement while the person breaths

109
Q

What are some early symptoms of radiation toxicity after radiotherapy?

A

Nausea
Diarrhoea
Mucositis (Inflamed mouth or gut)
Skin reactions

110
Q

What are some late symptoms of radiation toxicity after radiotherapy?

A

Skin scarring
Cardiac events
Insufficiency fractures
Pulmonary fibrosis

111
Q

What are some methods of palliative care in lung cancer?

A

Endobrachial therapy
Stent implantation
Pain management
Sickness management
Anxiety management

112
Q

What is an example of endobrachial therapy?

A

Photodynamic therapy

113
Q

What occurs in photodynamic therapy?

A

A drug is given which induces photosensitivity in the tumour, before a bright light is shone on the tumour, causing a degree of apoptosis and shrinkage, allowing opening of the airways

114
Q

What are some disadvantages of photodynamic therapy?

A

This makes the person highly sensitive to light so patients may be trapped indoors during their final weeks of life

Respiratory (23 decks)

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