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Respiratory > Lung cancer > Flashcards

Lung cancer Flashcards

1
Q

What is haemoptysis?

A

Coughing up blood

due to ulceration

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2
Q

What is the link between recurrent pneumonia and lung cancer?

A

Recurrent pneumonia can be a sign of lung cancer. The obstruction leads to frequent infection.

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3
Q

What is stridor?

A

Inspiratory wheeze, caused by an obstruction in the upper airway making it difficult to breathe in
(asthma and COPD produce expiratory wheeze)

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4
Q

List 6 structures that neighbour the lungs that lung cancer may effect (local invasion)

A
  • Recurrent laryngeal nerve
  • Oesophagus
  • Pericardium
  • Brachial pleuxus
  • Pleural cavity
  • Superior vena cava
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5
Q

Explain how a hoarse voice can be a symptom for lung cancer

A

The tumour may invade the reccurrent laryngeal nerve resulting in paralysis of a vocal cord

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6
Q

Give 3 symptoms of local invasion of the pericardium

A

Breathlessness
Atrial fibrillation
Pericaridial effusion

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7
Q

What symptom shows local invasion of the oesophagus?

A

Dysphagia (difficulty/uncomfortable swallowing

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8
Q

What is a Pancoast tumour?

A

Tumour of the pulmonary apex. It typically spreads to nearby tissues such as ribs and vertebrae

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9
Q

Why would a patient with lung cancer have weakness in their hand?

A

Invasion of the brachial plexus

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10
Q

What is a common presenting symptom in someone with a pleural effusion?

A

Breathlessness

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11
Q

What are symptoms of superior vena cava invasion?

A

Puffy eyelids and headache
Distension of the superficial veins, even when standing upright. Normal pulsation is lost
Anastamoses to inferior vena cava

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12
Q

How can the symptoms of invasion of the superior vena cava be palliated?

A

Insertion of a stent to open up the occluded vein - must be done before the vein is permanently occluded by thrombosis

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13
Q

What would be the presenting symptom if there was chest wall invasion?

A

Localised chest pain that is worse on movement

If the tumour has eroded through bone, the pain may be worse at night

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14
Q

Erosion of what structure would cause massive haemoptysis and ultimately death?

A

If the tumour erodes into the left pulmonary artery and into a major bronchus

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15
Q

What are the 6 commons sites of metastases from a primary lung cancer?

A 
Liver 
Brain 
Bone
Adrenal 
Skin 
Lung
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16
Q

What are the symptoms of cerebral metastases?

A

Weakness (may mimic a stroke but have gradual onset)
Visual disturbance
Headaches that are non-photophobic and are worse in the morning
Fits (if it involves the cortex)

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17
Q

What symptoms show liver metastasis?

A

May have liver pain
In rare cases the biliary can be obstructed resulting in obstructive jaundice
Abnormal liver function tests

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18
Q

What are the common presentations of bone metastases?

A

Localised pain which is worse at night

Pathological fracture due to stress on the bone

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19
Q

What kind of scan can be used to show bone metastases?

A

Isotope bone scan

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20
Q

What are signs of cancer that are non-metastatic i.e. due to the biochemically active products of the primary tumour?

A 
Finger clubbing
Hypertrophic pulmonary osteoarthropathy - HPOA
Weight loss
Thrombophlebitis
Hypercalcaemia
Hypoatraemia – SIADH
Weakness
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21
Q

What 9 key things should be asked about when taking a history for suspected lung cancer

A 
Cough 
Haemoptysis
Weight loss
Breathlessness
Chest wall pain
Cigarette smoker 
Tiredness
Recurrent infection 
Other smoking related disease
("Anything else worrying you?")
22
Q

What 11 things should be looked for on clinical examination for lung cancer?

A 
Finger clubbing
Breathless
Coughing 
Weight loss
Bloated face
Hoarse voice
Lymphadenopathy
Tracheal deviation
Dull percussion
Stridor
Enlarged liver
23
Q

What investigations may be done to diagnose lung cancer?

A 
Chest x-ray
CT scan of thorax 
PET scan
Bronchoscopy
Endobronchial ultrasound
Full blood count 
Coagulation screen
Na, K, Ca, Alk Phos
Spirometry, FEV1
24
Q

What 4 investigations are used to make a tissue diagnosis?

A

Bronchoscopy
CT guided biopsy
Lymph node biopsy
Aspiration of pleural fluid

25
Q

What are PET scans?

A

Positron emission tomography
Scan to asses function rather than structure
Analysis of tissue uptake of radiolabelled glucose
Tissues with high metabolic activity ‘light up’.

26
Q

The clinical picture is a smoker with haemoptysis and an abnormal chest x-ray, give a list of differential diagnosis

A 
Lung cancer
Tuberculosis
Vasculitis
Pulmonary embolism
Secondary cancer
Lymphoma
Bronchiectasis
27
Q

What are the 2 classifications of primary lung neoplasms?

A

Benign and malignant

28
Q

Other than smoking, what are risk factors for lung cancer?

A 
Asbestos
Nickel
Chromates
Radiation
Atmospheric pollution 
(Genetics)
29
Q

What are the common smoking-associated 4 lung cancers?

A

Adenocarcinoma
Sqaumous carcinoma
Small cell carcinoma
Large cell carcinoma

30
Q

Give 4 reasons for cancer classification

A

Prognosis
Treatment
Pathogenesis
Epidemiology

31
Q

What is small cell lung cancer?

A

The cancer cells are smaller than normal cells and are mostly filled by the nucleus. 12% of lung cancers.
Rapidly progressive disease
Early metastasises
usually caused by smoking

32
Q

What is non-small cell lung cancer?

A

Make up around 87% of lung cancers

3 common types - squamous caricinoma, adenocarcinoma and large cell carcinoma

33
Q

What does cancer prognosis depend on?

A

Tumour stage and tumour histological subtype

34
Q

What staging is commonly used in cancer?

A

TNM staging
- The size and/or extent if the primary tumour (T)
- The amount of spread to nearby lymph nodes (N)
- Presence of metastasis (M) or secondary tumours
Numbers given

35
Q

What treatment would commonly be given for small cell lung cancer?

A

Rarely suitable for surgery
Good initial response to chemotherapy (palliative treatment).
Chemo often backed up with radiotherapy.

36
Q

What treatment would commonly be given for non-small cell lung cancer?

A

Sometimes cured by surgery of radical radiotherapy

Less responsive than small cell lung cancer to chemotherapy

37
Q

What is the median survival time and percentage chance of one year survival in non-small cell cancer?

A

7.7 months

39% chance of one year survival

38
Q

What is the median survival time and percentage chance of one year survival in small cell cancer?

A

5.9 months

24%

39
Q

What are the four main treatment choices for lung cancer?

A

Surgery
Chemotherapy
Radiotherapy
Palliative care

40
Q

In pre-operative staging, what would doctors look for during a bronchoscopy that could affect surgery as a option for treatment

A

Vocal cord palsy
Proximity to the carina
Cell type

41
Q

What techniques would be used in pre-operative staging to search for metastases?

A

CT scan or the head and thorax

PET scan

42
Q

Thoracotomy

A

Surgical incision into the chest wall

43
Q

Pneumonectomy

A

Surgical removal of the lung of the lung, it may be total, partial or of a single lobe (lobectomy)

44
Q

Other that thoracotomy, how can lung cancer surgery be performed?

A

Video assisted thoracoScopic surgery (VATS)

45
Q

Explain cytotoxic chemotherapy; what does it do, what are the effects, how is it given?

A

It is rarely curative but results in longer survival
Better response in small cell
Major side effects
IV infusions every 3-4 weeks
Whole body treatment that targets rapidly dividing cells

46
Q

Why can chemotherapy not treat tumours in the brain?

A

The blood-brain barrier, so radiotherapy is given

47
Q

What are the side effects of chemotherapy?

A 
Nausea and vomiting
Tiredness
Hair loss
Bone marrow suppression - may result in opportunistic infection and anaemia
Pulmonary fibrosis
48
Q

How does radiotherapy treat cancer?

A

X-rays are ionising radiation that damage dividing cells
Palliative treatment - a delaying tactic
Useful for metastases
Well tolerated

49
Q

What are the disadvantages of radiotherapy?

A

Collateral damage
Maximum cumulative dose
Only goes where the beam is pointed

50
Q

What is endobronchial therapy?

A

Patient receives a photo-sensitising drug before this bronchoscopy
Photo-therapy to the tumour - laser activates the drug and the tumour dies within a week
However, patients then has to have limited sun exposure

51
Q

What treatment could be given for stridor caused by a tumour?

A

Stent insertion

52
Q

What 4 main things determine what cancer treatment will be given?

A

Cell type
Extent of the disease
Co-morbidity
Patients wishes

Respiratory (12 decks)

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