Lung cancer Flashcards
1
Q
Lung cancer
A
malignant epithelial tumour arising from cells lining the lower respiratory tract
2
Q
Lung cancer signs and symptoms
A
- cough
- chest pain
- haemoptysis
- dyspnoea
- weight loss
- hoarse voice
- clubbing
- metastatic symptoms
3
Q
Lung cancer investigations
A
- FBC and bloods
- sputum cytology, bronchoscopy
- chest X-ray, CT TAP
- biopsy
- thoracentesis
- thoracoscopy
- CT/MRI brain
- bone scan
- PET
4
Q
Small cell lung cancer risk factors
A
- smoking (strong link)
- smoke exposure
- radon
5
Q
Small cell lung cancer pathophysiology
A
- arise from Kulchitsky cells (part of the amine precursor uptake + decarboxylation endocrine system)
- histology - small, densely packed, scant cytoplasm, finely granular nuclear chromatin, absence of nucleoli
6
Q
Small cell lung cancer associations
A
- ectopic ADH secretion
- ACTH secretion
- Lambert-Eaton syndrome
7
Q
Small cell lung cancer management
A
- limited - concurrent chemo and radio
- extensive/mets - chemo, immunotherapy and palliative radiotherapy for mets
- consider prophylactic cranial irradiation
8
Q
Small cell lung cancer complications
A
- pneumonia
- haematological toxicity
- radiation-induced oesophageal injury
- SVC syndrome
- paraneoplastic - SIADH, Cushing’s, Lambert-Eaton, cerebellar
- 5-year survival rates ~12% to 24% for limited stage and 1% to 5% for extensive
9
Q
Non small cell lung cancer risk factors
A
- smoking
- smoke exposure
- COPD
- family history
- radon exposure
- increasing age
10
Q
Non small cell lung cancer locations
A
- adenocarcinoma - peripheral
- large cell - peripheral, poorly differentiated, β-HCG secretion
- squamous cell - central, PTHrp, hypercalcaemia, clubbing, HPOA
11
Q
Non small cell lung cancer management
A
- I to IIIA curable
- surgery (lobectomy) or SABR + adjuvant chemotherapy
- if not suitable use external beam radiotherapy + double platinum chemo
- IIIB to IV
- drug treatment for e.g. EGFR or ALK re
arrangement positive - weigh pros and cons - treatment side effects
12
Q
Non small cell lung cancer complications
A
- pneumonia
- SVC syndrome
- paraneoplastic syndromes
- poor performance status, weight loss, mets and increasing age are poor prognostic indicators
13
Q
Mesothelioma definition
A
- aggressive epithelial neoplasm from lining of the lung
- rare but can occur in peritoneum, pericardium, tunica vaginalis
14
Q
Mesothelioma risk factors
A
- asbestos (latent for 30-40 years)
- more common in males
- occupation - shipyard, construction, mechanics etc
15
Q
Mesothelioma pathophysiology
A
- asbestos uptake by alveolar macrophages, neutrophils
- production of reactive oxygen and nitrogen species
- DNA damage affects gene expression
16
Q
Mesothelioma signs and symptoms
A
- dyspnoea
- dry cough
- chest pain
- clubbing
- weight loss
- painless pleural effusion
17
Q
Mesothelioma investigations
A
- CXR shows pleural thickening
- CT with contrast
- thoracocentesis
- cytology
- biopsy
- thoracoscopy
- if considering surgery: lung function tests, echo, mediastinoscopy
18
Q
Mesothelioma management
A
- extra-pleural pneumonectomy
- pleurectomy with decortication
- platinum based chemotherapy
- adjuvant radiotherapy
- palliation, e.g. talc pleurodesis
19
Q
Pleural plaques
A
- develop 20-40 years after asbestos
- benign with no malignant change
20
Q
Asbestosis
A
- lower lobe fibrosis due to asbestos exposure
- dyspnoea, clubbing, bilateral end-inspiratory crackles, restrictive pattern
- investigate as mesothelioma
- conservative management as no benefit in treating
