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Y4 Cancer care > Lung cancer > Flashcards

Lung cancer Flashcards

1
Q

What is a targeted therapy used for non small cell carcinoma?

A

Osimertinib (JS on oncology ward/lady who lived by herself, didn’t smoke but had exposure in a pub)

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2
Q

Osimertinib side effects

A

Diarrhoea
Rash
Pneumonitis
Arrhythmias
Deranged liver function tests

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3
Q

How can you tell on a CT scan what an artery is?

A

Arteries follow the bronchial trees
CT can be timed so contrast is still in systemic circulation- timed within seconds.

Pulmonary veins are outside

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4
Q

Are thymomas malignant?

A

Yes all of them- however on a spectrum
1/3 of people will have myasthenia gravis
Thymectomy will not cure myasthenia gravis

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5
Q

Classifications for thymomas

A
  • WHO staging
  • TNM
  • Masaoka-Koga
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6
Q

What is the Masaoka-Koga staging based on

A

The Masaoka-Koga Staging system is based on the local micro- and/or macroscopic invasion of the tumor and the presence of lymphogenous or hematogenous metastasis.

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7
Q

Are thymomas chemosensitive?

A

No- don’t grow that quickly. Doubling every day- no one would call them a thymoma.

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8
Q

What is the advantage of adjuvant over neo-adjuvant?

A

Neo-adjuvant you can measure the response
More likely to get complications from neo-adjuvant therapy

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9
Q

How do you know whether adjuvant has worked?

A

You can never really measure response

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10
Q

What percentage of lung cancer patients receive adjuvant therapy?

A

40% of patients eligible go onto receive it

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11
Q

What is the benefit of neo-adjuvant?

A

You can measure a response
More people can start it- not as many patients will be fit enough after surgery to have adjuvant therapy

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12
Q

Benefits of MRI of the thymus

A

Shows cystic vs normal thymic tissue

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12
Q

What part of the heart lights up on a PET scan?

A

Only the left ventricle- most metabolically active part of the heart

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13
Q

What is the most common site of metastasis from thymoma

A

Droplet metastasis to the pleura

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14
Q

Are all biopsies accurate?

A

30-40% of biopsies may not be accurate.
False negatives

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15
Q

What treatment is given to prevent a myasthenic crisis?

A

IV IG

Neutralises harmful antibodies: IVIG helps reduce the autoantibodies attacking the acetylcholine receptors, improving nerve-muscle communication.

Reduces inflammation: It blocks the immune system’s damaging actions, particularly by preventing complement system activation, which helps reduce muscle damage.

Provides short-term relief: IVIG quickly improves muscle strength, often used during severe symptoms or crises, but the effect is temporary, lasting weeks to months.

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16
Q

When do you get symptoms with lung cancer?

A

Advanced stages
Early stages of lung cancer- very asymptomatic

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17
Q

Important question to ask in a lung cancer history

A

Cannabis use- lung damage is a worse driver of emphysema than tobacco smoking
Vanishing lungs

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18
Q

Units of brightness on PET scan

A

SUV max

19
Q

How to quantify risk of a nodule being cancer?

A

BROC/HERDER
Population risk and individual risk- important to tell patients about the different risks.

20
Q

Disadvantage of cytology?

A

Doesn’t tell you anything about architecture
Difficult to diagnose cancer without architecture

21
Q

Risk of percutaneous biopsy

A

Air embolism- negative pressure in a pulmonary vein

22
Q

Considerations for radiotherapy in the lungs

A

Proximity to the heart- cardiomyopathy, oesophagitis

23
Q

What is DIPNECH?

A

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare lung disease that can be a precursor to lung carcinoid tumors:

Definition
DIPNECH is a condition where neuroendocrine cells in the bronchiolar epithelium multiply in a multifocal way. It can be associated with carcinoid tumorlets, obliterative bronchiolitis, or a carcinoid tumor.

24
Q

Explain the 2WW criteria for lung cancer

A

NICE red flags
- >40 with two or more
- Cough
- Fatigue
- SOB
- Chest pain
- Weight loss
- Appetite loss

Then you are on the 2WW referral. If ever smoked in your life, you only need one of those symptoms to be referred on.

HOWEVER
If >40 with hemoptysis/CXR showing cancer- 2WW to see a chest physician/rapid access clinic

25
Q

Why is a sputum culture not always sensitive enough for lung cancer?

A

Lung cancer has to actually have invaded the airway.
Most cancer cells have been swallowed.
Cytopathology

26
Q

Investigations for lung cancer

A
  • Suspected tumour on CXR
  • CT CAP- see if it has spread beyond the chest, look for emphysematous changes
27
Q

What is the difference between pleomorphic and dysplastic?

A

Pleomorphic= cells look different to one another

Dysplasia= changes that are confined to the epithelium

28
Q

What is the half life of Apixaban?

A

12 hours- BD
Takes about two days to be cleared from the system

29
Q

What is mainly asked on ward round after surgery?

A
  • CXR
  • Weight
  • Bowels
  • Pain
  • Post-op drainage of blood
30
Q

Why would you do a CXR after a lung cancer operation?

A
  • Shift of mediastinum
  • Haemathorax
  • Pneumothorax
  • Make sure the drain is in the right place
31
Q

What is surgical emphysema

A

Surgical emphysema is a condition characterised by the accumulation of air in the subcutaneous tissues due to the introduction of air or gas, typically following surgical manipulation or injury.

32
Q

Indications for Nefopam

A

Post-operative pain
Pain from musculoskeletal disorders
Pain in conditions such as fibromyalgia or tension-type headaches

33
Q

What is the difference in action between Amiloride and Spironolactone?

A

Amiloride acts at the distal tubule
Spironolactone acts at the collecting duct

34
Q

Why do you worry about constipation in patients who have just had lung cancer surgery?

A
  • Increased pressure on sutures/reduced healing
  • Constipation can push against the diaphragm making breathing more difficult
  • Makes it harder for patients to take full breaths
35
Q

How is a tension pneumothorax diagnosed and managed in the context of thoracic surgery?

A
  • Tension pneumothorax presents with respiratory distress, hyper-resonance, and tracheal deviation away from the affected side.
  • Immediate needle decompression followed by chest drain insertion is required.
  • In a post-pneumonectomy patient, a sudden absence of lung markings on CXR may indicate a pneumothorax.
36
Q

What considerations are important when assessing a patient for thoracic surgery?

A
  • Performance status is critical to assess a patient’s ability to tolerate surgery and postoperative recovery.
  • Nodal status is the most important prognostic factor in lung cancer; patients with N3 nodal involvement are not suitable for surgery.
37
Q

What is the role of robotic bronchoscopy in thoracic surgery?

A
  • Robotic bronchoscopy is an emerging technique for minimally invasive lymph node biopsies.
  • It offers precision in accessing nodal tissue, which is crucial for staging lung cancer and planning treatment.
38
Q

What is the importance of manual heart massage in thoracic patients experiencing cardiac arrest?

A
  • In thoracic surgery patients, the chest may be opened, allowing direct access to the heart.
  • Manual heart massage through an open thoracotomy can be life-saving during cardiac arrest in this context.
39
Q

What are the indications and benefits of a sleeve pneumonectomy?

A
  • A sleeve pneumonectomy involves resection of a lobe and part of the bronchus, followed by re-anastomosis of the remaining lung to the trachea.
  • It is indicated in cases of central lung tumours to preserve lung function while removing the tumour.
40
Q

What is the commonest cause of cancer death?

A

Lung cancer

41
Q

What would you be looking for on examination suspecting lung cancer?

A
  • Finger clubbing
  • Cachexia
  • Anaemia
  • Horner’s syndrome
  • SVCO
  • Chest: pleural effusion, consolidation, collapse
  • Supraclavicular/cervcical/axillary lymphadenopathy
42
Q

Symptoms from primary tumour

A
  • Cough
  • Wheezing
  • Dyspnoea
  • Chest pain
  • Recurrent chest infections
  • Haemoptysis
  • Weight loss
43
Q

Symptoms from regional spread

A
  • SVC obstruction
  • Pancoast tumour
  • Phrenic nerve palsy
  • Dysphagia
44
Q

Symptoms from distant metastases

A
  • Bone pain
  • Brain mets
45
Q

Presentation of non small cell lung cancers

A
  • Pancoast tumour- recurrent laryngeal
  • Hypercalcaemia
46
Q
A

Y4 Cancer care (15 decks)

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