Lung Cancer Flashcards
Causes of haemoptysis
Lung cancer
Pulmonary embolism
Pneumonia
Tuberculosis
Red flags in respiratory
Chest pain
Loss of appetite
Haemoptysis
Weight loss
Persistent cough
Risk factor for lung cancer
Smoking
Asbestos
Air pollution
Pulmonary fibrosis
Radon
Emphysema/COPD
Significance of fingernail clubbing
Physical sign of disease with heart and lung
What does tracheal deviation (to the left side) show
Increased pressure on right side (pneumothorax) or reduced volume on left side (lobar collapse)
What dull percussion note indicate
Air is not in that area (lobar collapse) or it is filled with consolidation
What does diminished breath sound show
The air cannot travel maybe due to collapse or consolidation is covering area leading to increased thickness of chest wall
What does reduced vocal resonance show
Decreased transmission due to increase of air/fluid outside the lung or collapse
If increased it suggests increased tissue density
What are the type of drugs used in cancer treatment
Conventional chemotherapy (cytotoxic, directly targeting DNA structure)
Targeted agents (small molecules designed to interact with a defined molecular target)
Hormonal therapies (capitalise on the biochemical pathways underlying estrogen and androgen function)
Biologic therapies (macromolecules e.g monoclonal antibodies)
What are the principles of chemotherapy
Cytotoxic agent
Work on basis of differential kill (normal cell recovers while cancer cells die when damaged)
What are the types of curative treatment
Adjuvant treatment (preventative treatment after surgery)
Neo-adjuvant treatment (primary medical, before surgery)
Concurrent treatment (with radiotherapy)
Use of cytotoxic drugs
They kill both cancer and normal cells
Generally more rapidly growing tumours are more likely to respond
Types of chemotherapy work better in different phases of the cell cycle
What are anti tumour antibiotics
Work by interfering with DNA function also inhibition of certain enzymes such as topoisomerase
How to alkylating drugs work
They form methyl cross bridges between 2 strands of dna base pairs, this prevents dna from separating in cell division
What are antimetabolites
They trick cancer cells into using the drug instead of the molecules it needs to make the genetic material to replicate, or DNA
What are the plant derived cytotoxic drugs
Vinca-alkaloids inhibit the formation of mitotic spindles by binding to the protein Tubulin e.g. Vincristine, Vindesine, Vinblastine and Vinorelbine.
Epidophyllotoxins
interfere with Topoismerase 2 action
e.g. Etoposide
Taxanes
inhibit mitosis by promoting a disorganized and stabilized
assembly of microtubules. E.g. Taxol
Side effects of chemotherapy drugs
Chemotherapy drugs not selective to cancer
cells, rapidly dividing cells most affected by
treatment
Bone Marrow Gastrointestinal tract Hair follicles Reproductive organs Skin
What is hormone therapy
• Cancers that are hormone sensitive or hormone dependent need hormones to grow or develop.
• Hormone therapies influence the hormone secreting organs and reduce their ability to produce them.
How do biological treatments work and what are the types
They may
• Stop cancer cells from dividing and growing
• Seek out cancer cells and kill them
• Encourage the immune system to attack cancer cells
Monoclonal antibodies Anti-angiogenics Cancer growth blockers Immunotherapy Cancer vaccines
How do anti-angiogenics work
Drugs that block blood vessel growth factor block vascular endothelial growth factor (VEGF). This stops the blood vessels from growing. So tumour will lack blood and die
How do cancer growth blockers work
• Block various intracellular pathways that lead to cell replication
• Continuous treatment until disease progression
How do immunotherapies (check point inhibitors work)
• Cancer can suppress the immune response which can seriously undermine the clinical efficacy of cancer therapies
• Therapies are being designed that specifically target mechanisms of cancer immune evasion.
• Attacking and ‘unblocking’ the suppressed immune response - mobilisation of T cells leading to cell kill.
Immunotherapy mechanism and methods
Mechanism:
• Stimulating innate immunity ( e.g BCG treatment)
• Removing check points of immune suppression.
Methods:
slows growth
stop spreading
helps immune system better destroy rogue cells
Types:
T cell therapy
vaccines (HPV,BCG)
oncolytic virus
monoclonal antibodies
