Lung Cancer Flashcards
what is it called when biologically active molecules are released from tumour cells and mimic the effects of naturally occuring hormones?
paraneoplastic syndromes
compare incidence and prevalence of lung cancer?
incidence is high
prevalence is low (because patients dont live for long)
as the tumour enlarges what happens to the lung?
loses volume and gets smaller
in CXR, smallest lung is likely to be the diseased one
is stridor an inspiratroy or expiratroy sound?
inspiratory sounds
what 6 structures can a lung tumour locally invade into?
recurrent laryngeal nerve pericardium oesophagus brachial plexus pleural caivty superior vena cava
why might a patient with a lung cancer get a hoarse voice?
tumour invaded into reccurent laryngeeal nerve
what can tumour invasion into the pericardium cause?
breathlessness
AF
pericardial effusion
what can tumour invasion into the oesphagus cause?
dysphagia
what is a pancoasts tumour?
a tumour of the lung apex
why can a patient with a lung cancer present with weakness in upper limbs?
invasion of brachial plexus
what often happens when a primary tumour invades the pleural space?
generates a large volume of pleural fluid
can enhance SOB
when a tumour has invaded bone (causing bone erosion) when will the patient complain the pain is worse?
pain worse at night
where are common sites of metastases from a primary lung cancer?
liver brain bone adrenals skin lung
what 4 symptoms can be caused by brain metastases?
weakness
visual distrubances
headaches
fits
why can a headache occur in brain mets?
due to raised intracranial pressure
usually worse in the morning
what hormone does a tumour mimic to cause hypercalcaemia?
parathyroid hormone
what can hypercalcaemia cause?
headaches
confusion
thirst
constipation
what hormone does a tumour mimic to cause hyponatraemia (abnormally low Na levels)?
ADH
what is the name of a syndrome which mimics myaesthenia gravis? (and is a paraneoplastic syndrome caused by an underlying -usually small cell- lung carcinoma)
Eaton Lambert syndromeq
what can be some important symptoms of lung cancer? (name 7)
haemoptysis weight loss recurrent pneumonia stridor hoarse voice breathlessness cough
why must any patient with new finger clubbing have a CXR?
because lung cancer is the commonest cause
what paraneoplastic condition affects the bones? (not due to metastatic disease)
hypertrophic pulmonary osteoarthropathy
why is there pain and tenderness of the long bones in hypertrophic pulmonary osteoarthropathy
due to elevation of the periosteum away from the bbones surface
what is thrombophlebitis?
a blood clot in the vein
why is thrombophlebitis a paraneoplastic syndrome?
because of the increased coaguability of blood in cancer patients
what diagnostic investigation should be carried out if there is a possibility of lung cancer?
CXR \+ CT (regardless of CXR results) \+/- PET scan \+ bronchoscopy (if patient has a central lesion and is fit enough, if patient isn't fit enough- sputum cytology) \+/- percutaneous FNA biopsy
what does a PET scan allow you o see?
tissues with high metabolic activity
what are the 2 broad types of lung neoplasms?
benign (rare)
malignant (very common)
what are 6 risk factors for lung cancer?
smoking asbestor chromates radiation atmospheric pollution genetics
what local effect of a lung cancer causes pneumonia?
obstruction of airways
what local effect of a lung cancer cause localised pain?
invasion of the chest wall
what local effect of a lung cancer causes haemoptysis?
ulceration
what is the name of hormone production from a site it shouldnt be? (ie paraneoplastic syndrome)
ectopic hormone production
what hormones does a squamous carcinoma release?
PTH
parathyroid hormone
what does release of PTH from a squamous carcinoma cause?
hypercalcaemia
what hormones does a small cell carcinoma release?
ACTH
(adrenocorticotrophic hormone)
ADH
(anti-diuretic hormone)
what does release of ACTH from a small cell carcinoma cause?
cushings syndrome
what does releases of ADH from a small cell cardinoma cause?
hyponatremia
how does immunohistochemistry help to subtype lung cancers on small biopsies?
by identifying specific antigens
what factor is expressed in small cell carcinomas and adenocarcinomas?
TTF-1
thyroid transcription factor
what factor is expressed in squamous cell carcinoma?
P63
what is the worst subtype of lung cancer in terms of prognosis?
small cell carcinoma
what is the treatment of choice in non-small cell cancers?
surgery
what drug is a tyrosine kinase inhibitor which shows some activity in non-small cell lung cancer patients?
gefitnib
why is getfitnib effective in non-small cell lung cancer patients?
because non-small cell lung cancers usually have mutated epidermal growth factor receptor (EGFR) and getfitnib only works in tumours with mutated EGFR
what is the pathogenesis of a squamous carcinoma?
squamous metaplasia
dysplasia
carcinoma in situ
invasive malignancy
what are carcinoids?
neuroendocrine neoplasms of low grade malignancy
what are the 2 types of pleural neoplasia?
benign (rare)
malignant mesothelioma
what happens if a tumout suppresses the nerves to the faces?
horners syndrome
where are small cell lung cancers more likely to be found?
centrally
what are the 4 main features of small cell lung cancer which effect the method of treatment?
rapidly progressive
early metastases
rarely suitable for surgery
good initial response to chemotherapy
why are small cell carcinomas more susceptible to cytotoxic chemotherapy compared to other types of lung cancer?
because of the rapid growth
chemotherapy targets dividing cells
what is the treatment of choice in small cell lung cancer?
chemotherapy
often backed up with radiotherapy
what are the 4 major management options for lung cancer?
surgery
radiotherapy
chemotherapy
palliative care
what lung cancer patients do well with surgery?
localised disease
very little co-morbidity
what is the role of bronchoscopy within staging for cancer resection?
too look for:
vocal cord palsy
proximity to carina
cell type
what is the role of mediastinoscopy within staging for cancer resection?
to look for lymph nodes with mets
what is the role of a CT scan of the brain within staging for cancer resection?
to look for brain mets
what is the role of a CT scan of the tohorax within staging for cancer resection?
tumour size
lymph nodes affected
mets
local invasion
what is the role of PET scan within staging for cancer resection?
metastases
how distal to the carina must a lung cancer tumour be in order to be operable?
2cm
if tumour is in a main bronchus, why do you need 2cm of disease free bronchus distal to the carina?
because you need at least 2cm of disease free bronchis to close the hole that will be left from ressection
what is the name for a whole lung resecection?
pneumonectomy
for chemotherapy, how often do you need IV infusions?
every 3/4 weeks
what are the 5 major side effects from chemotherapy?
nausea and vomiting tiredness bone marrow suppression hair loss pulmonary fibrosis
what is the result of bone marrow suppression? (which can be secondary to chemotherapy)
opportunistic infection
anaemia
when is radiotherapy (x-rays usually) used as a curative method for cancer?
if target is less than 5 cm in diameter
what are the 3 major cons about radiotherapy?
maximum cumulative dose
collateral damage
only goes where you point the beam (not good for subclinical mets)
where is the most common collateral damage from radiotherapy on a lung tumour?
spinal cord
oesophagus
adjacent lung tissue
what 4 type of endobronchial therapies are good palliative techniques?
stent insertion for stridor
photodynamic therapy
other laser therapy
radioactive pellets
what is treatment of lung cancer determined by?
patients wishes
type of cancer
staging of cancer
co-morbidity
