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Respiratory medicine > Lung cancer > Flashcards

Lung cancer Flashcards

1
Q

Lung cancer : Aetiology

A
  • Smoking - increases risk by 10x
  • Asbestos exposure - increases risk by 5x
  • Radon gas - radioactive decay product of uranium
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2
Q

Lung cancer : Criteria for 2 week Lung ca referral pathway

A
  • have chest X‑ray findings that suggest lung cancer
    OR
  • are *aged 40 and over with *unexplainedhaemoptysis
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3
Q

Lung cancer : Criteria for 2ww CXR

A

Offer *CXR *within 2 weeks if aged over 40 AND

  1. Smoker with 1> symptom

OR

  1. Non smoker with > 2 of the following sx
  • New chronic cough
  • Fatigue
  • SOB
  • Chest pain
  • Weight loss
  • Appetite loss
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4
Q

Lung cancer : Criteria to consider a CXR

A

Consider CXR if >40 and any 1 symptom

  1. *persistent or recurrent chest infection
  2. *fingerclubbing
  3. *supraclavicular lymphadenopathy or persistent cervical lymphadenopathy
  4. *chest signs consistent with lung cancer
  5. *thrombocytosis : raised platelets secondary to inflammatory immune response and cytokine/growth factor release by lung cancer tumours.
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5
Q

Lung cancer : Clincal symptoms

A
  1. *persistentcough
  2. *haemoptysis
  3. *dyspnoea
  4. *chest pain
  5. *weight lossandanorexia
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6
Q

Lung cancer : Clinical signs

A
    • a fixed, monophonic wheeze may be noted
    • supraclavicular lymphadenopathy or persistent cervical lymphadenopathy
    • clubbing
    • Horner’s syndrome
    • Distended neck veins from vena cava obstruction
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7
Q

Lung cancer : Investigations - Blood tests

A
  1. FBC : Thrombocytosis, anaemia secondary to cancer,
  2. Raised LFTs - liver mets
  3. Hyponatremia - ADH from SIADH
  4. Hyperglycaemia, hypokalaemia : Excess ACTH
  5. ALP raised : Bone metastases
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8
Q

Lung cancer : Investigations - Imaging

A
  1. Chest XR : well defined consolidation
  2. CT chest and adrenal glands : Check for metastasis
  3. Flexible bronchoscopy : histology and biopsy
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9
Q

What are the different types of lung cancer?

A
  1. Non small cell lung cancer
    - Adenocarcinoma
    - Squamous cell carcinoma
  2. Small cell lung cancer
  3. Large cell lung cancer
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10
Q

Which is the most common type of lung cancer?

A

Non small cell carcinoma : accounts for 80% of all lung cancers

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11
Q

Lung cancer: NSCC : Adenocarcinoma : Histology

A
  • form from glandular structures and can generate mucin
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12
Q

Lung cancer: NSCC : Adenocarcinoma - causes

A

Most common lung cancer in never smokers

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13
Q

Lung cancer: NSCC : Adenocarcinoma - location in the lungs

A
  • Arise peripherally in the lungs
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14
Q

Lung cancer: NSCC : Adenocarcinoma - Clinical features

A

Paraneoplastic syndrome

  1. Gynaecomastia :
    * Due to release of oestrogen which can increase breast tissue development in males
  2. Hypertrophic pulmonary osteoarthropathy
    * Clubbing of the fingers and toes
    * Secondary to release of cytokines and growth factors stimulating osteoblast production
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15
Q

Lung cancer: NSCC : Squamous cell carcinoma - location in the lungs

A

Arises centrally in the lungs

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16
Q

Lung cancer: NSCC : Squamous cell carcinoma - causes

A

Very strongly associated with smoking

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17
Q

Lung cancer: NSCC : Squamous cell carcinoma - Histology

A

Squamous square shaped and can produce keratin

18
Q

Lung cancer: NSCC : Squamous cell carcinoma - Clinical features

A

Paraneoplastic syndrome

  1. Hypercalcaemia;
    Secondary to parathyroid hormone released from tumour
  2. Hyperthyroidism:
    Secondary to ectopic TSH release
  3. Hypertrophic pulmonary osteoarthropathy :
    - Clubbing of the fingers and toes
    - Secondary to release of cytokines and growth factors stimulating osteoblast production
19
Q

Lung cancer: NSCC : Horner’s syndrome - Pathophysiology

A

Adenocarcinoma and Squamous cell cancer can cause pan coast tumours
* Pancoast tumours cause compression of brachial plexus
* leading to the due to dysfunctional sympathetic nerve.

20
Q

Lung cancer: NSCC : Horner’s syndrome - Symptoms

A

Triad of of symptoms are;
* Constricted pupils,
* Drooping upper eye lid
* Loss of ability to sweat of that side of the face

21
Q

Lung cancer: NSCC : Recurrent laryngeal nerve palsy

A

Compression of the recurrent laryngeal nerve due to tumour
*Sx *: Hoarseness of voice

22
Q

Lung cancer: NSCC : Stage 1-4

A
  • Stage 1 - small tumour and no spread
  • Stage 2 - >4cm and with local lymph nose spread
  • Stage 3 - Extensive lymphoid spread
  • Stage 4 - metastasises 1 area other than lung
23
Q

Lung cancer: NSCC : Stage 1-2} Management

A

Curative intent
* Surgical lobectomy with lymph node resection
* Adjuvant chemotherapy or radiotherapy

24
Q

Lung cancer: NSCC : Stage 3-4} Management

A

Chemotherapy to improve survival and quality of life

25
Q

Lung cancer : Small cell lung cancer : Incidence

A
  • 15% of lung cancer
  • Strong association with smoking
26
Q

Lung cancer : Small cell lung cancer : Prognosis

A
  • Aggressive malignancy, 2/3 of patient have evidence of distal metastasis at presentation
  • Develops and metastasis quickly
27
Q

Lung cancer : Small cell lung cancer : Histology

A
  • Malignant epithelial tumor arising from cells lining the lower respiratory tract
  • Tumor cells are small and densely packed
28
Q

Lung cancer : Small cell lung cancer : Location in the lungs

A
  • Arise central lung with mediastinal involvement
29
Q

Lung cancer : Small cell lung cancer : Paraneoplastic syndrome

A
  1. Excess ACTH release
    * Triggers excess release of cortisol from the adrenal glands causing Cushing’s like symptoms
    * Hypertension, hyperglycaemia, hypokalaemia }
  2. Lambert - Eaton myasthenia syndrome
    * neurological symptoms from type 2 hypersensitivity reaction caused by the production of auto antibodies which bind and destroy neurone
30
Q

Lung cancer : Small cell lung cancer : Management

A
  1. Limited stage - confined to ipsilater hemithorax
    * Radiotherapy + chemotherapy ; can be encompassed within radiation field
  2. Extensive stage - systemic metastasis
    * Chemotherapy and immunotherapy
  3. Surgery : only 20% of patients are suitable due to advanced nature of the disease
31
Q

Lung cancer : Large cell lung cancer : features

A
  • Lack both glandular and squamous differentiation
  • Can arise centrally
32
Q

Mesothelioma : Definition

A

Cancer of the mesothelial layer of the pleural lining that is strongly associated with asbestos exposure

33
Q

Mesothelioma : Clinical features

A
  • Dyspnoea, weight loss, chest wall pain
  • Clubbing
  • 30% present as painless pleural effusion
  • Hx of Asbestos exposure
  • Metastasis to contralateral lung and peritoneum
34
Q

Mesothelioma : Investigation

A
  1. CXR : Pleural effusion or thickening
  2. Second line : Pleural CT
  3. Pleural fluid aspiration or biopsy of pleura
35
Q

Asbestosis : Definition

A

chronic lung condition caused by prolonged exposure to asbestos fibers.

the severity of asbestosis is related to the length of exposure.

36
Q

Asbestosis : Clinical features

A
  • dyspnoea and reduced exercise tolerance
  • clubbing
37
Q

Asbestosis : Investigations

A
  1. CXR
    * lower lobe fibrosis - bilateral end-inspiratory crackles
    * Pleural plaques are benign and do not undergo malignant change. They, therefore don’t require any follow-up.
    * 2. lung function tests show a restrictive pattern with reduced gas transfer
38
Q

Asbestosis : Management

A

It istreated conservatively- no interventions offer a significant benefit.

39
Q

Nicotine replacement therapy : SE

A
  • adverse effects include nausea & vomiting, headaches and flu-like symptoms
40
Q

Varenicline : MOA

A
  • a nicotinic receptor partial agonist
  • should be started 1 week before the patients target date to stop
  • the recommended course of treatment is 12 weeks
  • nausea is the most common adverse effect. Other common problems include headache, insomnia, abnormal dreams
  • varenicline should be used with caution in patients with a history of depression or self-harm.
  • contraindicated in pregnancy and breast feeding
41
Q

Bupropion : MOA

A
  • a norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist
  • should be started 1 to 2 weeks before the patients target date to stop
  • small risk of seizures (1 in 1,000)
  • contraindicated inepilepsy, pregnancy and breast feeding. Having an eating disorder is a relative contraindication

Respiratory medicine (18 decks)

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