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MD3001resp > lung cancer > Flashcards

lung cancer Flashcards

1
Q

what are smoking related lung diseases?

A

COPD
EMPHYSEMA
CHRONIC BRONCHITIS

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2
Q

what is the link between genetics and smoking in the development of lung disease?

A

In cigarette smoking, there are different genetic predispositions to respond to cigarette smoke. Some patients, may activate more quickly leading to more reactive oxygen species, while others may be slow at detoxification (at removing toxic metabolites). Otherwise might be in the middle, better for them.
That’s why not every smoker gets lung disease, also if they do not at the same age

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3
Q

what are factors effecting the development of cancer?

A
  • male:female 5:1
  • tobacco
  • alcohol
  • HPV
  • hygiene
  • repeated trauma
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4
Q

what are the biomarkers for cancer

A

p16 or HPV

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5
Q

why is there a delay in seeking medical advise in emphysema patients?

A

for symptoms to show, require 60% of lost lung tissue.
- before then, patients tend to adapt their lifestyle

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6
Q

what are the 5 main clinical features of chronic bronchitis?

A
  • cough
  • productive sputum
  • oedema
  • reversible or irreversible wheeze
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7
Q

what are 3 causes of chronic bronchitis?

A
  • cigarette smoking
  • industrial exposure and passive cigarette smoke
  • e cigarettes and vaping
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8
Q

define interstitial lung disease

A

this is a pulmonary disorder that is characterised by:
- interstitial inflammatory infiltrates
- decreased lung volume
- decreased oxygen diffusing capacity on pulmonary function studies.

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9
Q

what are the main interstitial lung diseases?

A
  • hypersensitivity
  • sarcoidosis
  • idiopathic pulmonary fibrosis
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10
Q

people who smoke, are more likely to use what when they stop?

A

people who stop smoking are more likely to take more caffeine to satisfy cravings, they can end up with caffeine toxicity and get the shakes.

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11
Q

emphysema?

A

loss of lung tissue and the area for gas exchange decreases

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12
Q

what are the 2 main types of emphysema?

A

panacinar emphysema = permanentant destruction to the airspace.
centrilobular emphysema = increase in size of respiratory bronchioles

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13
Q

what are the main feuures of idiopathic pulmonary fibrosis?

A
  • scarring in lower lobes
  • fibrosis is often patchy, with areas of dense scarring and honeycomb cystic change.
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14
Q

what are the 4 main features of hypersensitivity pneumonitis?

what are 2 common types of hypersensitive pneumonitis?

A

1) - inhaling antigen and getting hypersensitive reaction
- extrinsic because antigens come from outside
- acute or chronic interstitial inflammation of the lungs
- fibrosis or scarring.

2) - bird fancier (allergic to pigeons)
- farmers lung (allergic to the dust)

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15
Q

5 main features of sarcoidosis?

A

cell mediated
- granuloma and scattered in the interstitum of the lung
- the granulomatous phase of sarcoidosis can progress to a fibrotic phase
- hilar lymphadenopathy
- raised ACE

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16
Q

treatment for hypersensitive pneumonitis and sarcoidosis?

A
  • hypersensitive pneumonitis = get away from allergen

sarcoidosis = steroids or immunosuppressants

17
Q

what type of disease is idiopathic pulmonary fibrosis

A

systemic disease

18
Q

What are the characteristics of a benign lung tumor which could help you distinguish it from a malignant tumour ?

What treatment would be required in such a situation?

A

1) lack of invasiveness
- clearly defined borders
- slow growth

2) - either leave it or surgical excision

19
Q

where can a primary malignant tumour grow in the lung?

A
  • Epithelium (most common)
  • Vessels
  • Muscle
  • Cartilage
  • Lymphoid
  • Pleura
20
Q

characteristic or invasive tumour?

A
  • not well defined
  • invasion pushing and invading lymph tissue.
21
Q

Define metaplasia. How is it relevant in the lung ?

A

change in one differentiates somatic stem cell for another

  • irritation due to smoking can cause glandular columnar epithelium to chnage into squamos epthelium (metaplasia)
22
Q

define dysplasia?

how is it relevant in the lung?

A

an abnormality of development. It IS pre-malignant.

If metaplasia occurred due to cigarette smoking, and continue to expose epithelium it to carcinogens, squamous epithelium will become dysplasic. Either dysplasia superimposes original glandular (giving you adenocarcinoma) or superimposes squamous (giving you squamous carcinoma, which is likely to be central because airways larger so more likely to get direct trauma)

23
Q

Identify the main tumours which cause secondary malignant tumours in the lung.

How does it reach the lungs ?

A

-Renal carcinoma: via lymph nodes, and along renal veins
-Osteosarcoma: by blood (not lymph nodes)

24
Q

What are the main types of primary epithelial malignant tumours ?

A
  • Squamous cell carcinoma (=NSCLC)
  • Adenocarcinoma
  • Small cell undifferentiated carcinoma
  • Carcinoid tumours
25
Q

Describe the main causes, and features of small cell undifferentiated carcinoma of the lung.

A

causes = smoking, asbestos and air pollution

  • they will arise from near-endocrine stem cells
  • they will produce bioactive amines or peptides like parathrome
  • this can produce ADH, so patients will not pass urine and will present with delirium.
  • they can also have demyelination due to immune mediated reaction to the tumour.
26
Q

what are different ways we can diagnose a lung cancer?

A
  • radiology (CXR)
  • sputum cytology
  • biopsy (bronchoscopy)
  • circulating factors(blood tests)
27
Q

define and identify paraneoplastic syndromes

A

A set of signs and symptoms not directly caused by the cancer, but may be related to factors produced, and may be immunological.

-Connective Tissue/Bone: Finger Clubbing
-Haematological: Erythropoeitin production
-Skin: acanthosis nigricans (EGF)
-Kidney: immune complex glomerulonephritis

28
Q

Describe the main features of squamous cell carcinoma in the lungs:
-Cause
-Histological features
-Percentage of all lung cancers

A

-Causes: smoking, asbestos, air pollution

Histological features: After injury to the bronchial epithelium, such as occurs with cigarette smoking, squamous metaplasia occurs.
The metaplastic squamous mucosa follows the sequence of dysplasia, carcinoma in situ and invasive tumor.

Well-differentiated tumors have keratin “pearls,” small round nests of brightly eosinophilic aggregates of keratin surrounded by concentric (“onion skin”) layers of squamous cells

-Percentage of all lung cancers: 40%

29
Q

What method can we use to classify different cancers by extent of cancer development ?

A

TNM staging (stage I to IV)

30
Q

Describe the main features of adenocarcinomas in the lungs:
-Cause
-Histological features
-Percentage of all lung cancers

A

-Causes: smoking, asbestos, air pollution

-Histological features: = neoplasia of epithelial tissue that has glandular origin

pleural fibrosis and subpleural scar.

-Percentage of all lung cancers: 40%

31
Q

Do adenocarcinomas affect any gender in particular ?

A

women slightly more than men.

32
Q

Describe the main causes, and features of carcinoid tumors of the lung.
(typical and atypical)

A

-Arise from the resident neuroendocrine cells in the bronchial epithelium.

  • “Typical”- towards less aggressive end of spectrum (not so related to smoking)
  • “Atypical”–smoking related, tends towards malignant end of spectrum
33
Q

Identify commonly mutated oncogenes, and the cancers they result in.
Why is it important to know the molecular basis of different cancers ?

A

Mutated:
EGFR
BRAF (melanomas and brain cancers)
RAS (colon cancer)
BCL-2
ALK
Because the specific mutation will dictate treatment.

34
Q

Define PD-1 and PD-L1 and explain their significance in the context of lung disease.

A

Cancer express PD-L1 (Programmed death-ligand 1) which blocks PD-1 receptors on lymphocytes.

If tumor cell has lots of those, by binding lymphocyte, tells lymphocyte not to kill it, so has potential to resist effect of immune response.

Treatment target PDL1 or PD1 (typically with antibodies) trying to interrupt that communication preventing lymphocyte from killing cancer cell.

35
Q

Describe the main features of mesothelioma:
-Causes
-Incidence
-Lag period
-Demographics
-Histology
-Treatment

A

-Causes: asbestos, crocidolite
-Incidence: Rising
-Lag period: 20-40 years (long)
-Demographics: More males affected than females
-Histology: Grows along pleural surface, and encase and compress the lung
-Treatment: Mainly untreatable

36
Q

What is the link between pleural plaque and mesothelioma ?

A

Pleural plaque (thickened pleura with accumulation of material) and mesothelioma are both caused by exposure to asbestos.

However, having pleural plaques does not mean that patients have, or will go on to get, a more serious disease.

37
Q

how can mesothelioma lead to death?

A

restricted lungs, cannot expand, accumulation of fluid, death.

38
Q

define TNM?

A

T= size of tumour
N= lymph node involvement
M= metastasis

MD3001resp (41 decks)

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