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Respiratory > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

what is it called when biologically active molecules are released from tumour cells and mimic the effects of naturally occuring hormones?

A

paraneoplastic syndromes

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2
Q

compare incidence and prevalence of lung cancer?

A

incidence is high

prevalence is low (because patients dont live for long)

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3
Q

as the tumour enlarges what happens to the lung?

A

loses volume and gets smaller

in CXR, smallest lung is likely to be the diseased one

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4
Q

is stridor an inspiratroy or expiratroy sound?

A

inspiratory sounds

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5
Q

what 6 structures can a lung tumour locally invade into?

A 
recurrent laryngeal nerve
pericardium
oesophagus
brachial plexus
pleural caivty
superior vena cava
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6
Q

why might a patient with a lung cancer get a hoarse voice?

A

tumour invaded into reccurent laryngeeal nerve

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7
Q

what can tumour invasion into the pericardium cause?

A

breathlessness
AF
pericardial effusion

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8
Q

what can tumour invasion into the oesphagus cause?

A

dysphagia

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9
Q

what is a pancoasts tumour?

A

a tumour of the lung apex

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10
Q

why can a patient with a lung cancer present with weakness in upper limbs?

A

invasion of brachial plexus

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11
Q

what often happens when a primary tumour invades the pleural space?

A

generates a large volume of pleural fluid

can enhance SOB

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12
Q

when a tumour has invaded bone (causing bone erosion) when will the patient complain the pain is worse?

A

pain worse at night

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13
Q

where are common sites of metastases from a primary lung cancer?

A 
liver
brain
bone
adrenals
skin
lung
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14
Q

what 4 symptoms can be caused by brain metastases?

A

weakness
visual distrubances
headaches
fits

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15
Q

why can a headache occur in brain mets?

A

due to raised intracranial pressure

usually worse in the morning

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16
Q

what hormone does a tumour mimic to cause hypercalcaemia?

A

parathyroid hormone

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17
Q

what can hypercalcaemia cause?

A

headaches
confusion
thirst
constipation

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18
Q

what hormone does a tumour mimic to cause hyponatraemia (abnormally low Na levels)?

A

ADH

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19
Q

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)

A

Eaton Lambert syndromeq

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20
Q

what can be some important symptoms of lung cancer? (name 7)

A 
haemoptysis
weight loss
recurrent pneumonia
stridor
hoarse voice
breathlessness
cough
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21
Q

why must any patient with new finger clubbing have a CXR?

A

because lung cancer is the commonest cause

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22
Q

what paraneoplastic condition affects the bones? (not due to metastatic disease)

A

hypertrophic pulmonary osteoarthropathy

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23
Q

why is there pain and tenderness of the long bones in hypertrophic pulmonary osteoarthropathy

A

due to elevation of the periosteum away from the bbones surface

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24
Q

what is thrombophlebitis?

A

a blood clot in the vein

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25
Q

why is thrombophlebitis a paraneoplastic syndrome?

A

because of the increased coaguability of blood in cancer patients

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26
Q

what diagnostic investigation should be carried out if there is a possibility of lung cancer?

A 
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
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27
Q

what does a PET scan allow you o see?

A

tissues with high metabolic activity

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28
Q

what are the 2 broad types of lung neoplasms?

A

benign (rare)

malignant (very common)

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29
Q

what are 6 risk factors for lung cancer?

A 
smoking
asbestor
chromates
radiation
atmospheric pollution
genetics
30
Q

what local effect of a lung cancer causes pneumonia?

A

obstruction of airways

31
Q

what local effect of a lung cancer cause localised pain?

A

invasion of the chest wall

32
Q

what local effect of a lung cancer causes haemoptysis?

A

ulceration

33
Q

what is the name of hormone production from a site it shouldnt be? (ie paraneoplastic syndrome)

A

ectopic hormone production

34
Q

what hormones does a squamous carcinoma release?

A

PTH

parathyroid hormone

35
Q

what does release of PTH from a squamous carcinoma cause?

A

hypercalcaemia

36
Q

what hormones does a small cell carcinoma release?

A

ACTH
(adrenocorticotrophic hormone)
ADH
(anti-diuretic hormone)

37
Q

what does release of ACTH from a small cell carcinoma cause?

A

cushings syndrome

38
Q

what does releases of ADH from a small cell cardinoma cause?

A

hyponatremia

39
Q

how does immunohistochemistry help to subtype lung cancers on small biopsies?

A

by identifying specific antigens

40
Q

what factor is expressed in small cell carcinomas and adenocarcinomas?

A

TTF-1

thyroid transcription factor

41
Q

what factor is expressed in squamous cell carcinoma?

A

P63

42
Q

what is the worst subtype of lung cancer in terms of prognosis?

A

small cell carcinoma

43
Q

what is the treatment of choice in non-small cell cancers?

A

surgery

44
Q

what drug is a tyrosine kinase inhibitor which shows some activity in non-small cell lung cancer patients?

A

gefitnib

45
Q

why is getfitnib effective in non-small cell lung cancer patients?

A

because non-small cell lung cancers usually have mutated epidermal growth factor receptor (EGFR) and getfitnib only works in tumours with mutated EGFR

46
Q

what is the pathogenesis of a squamous carcinoma?

A

squamous metaplasia
dysplasia
carcinoma in situ
invasive malignancy

47
Q

what are carcinoids?

A

neuroendocrine neoplasms of low grade malignancy

48
Q

what are the 2 types of pleural neoplasia?

A

benign (rare)

malignant mesothelioma

49
Q

what happens if a tumout suppresses the nerves to the faces?

A

horners syndrome

50
Q

where are small cell lung cancers more likely to be found?

A

centrally

51
Q

what are the 4 main features of small cell lung cancer which effect the method of treatment?

A

rapidly progressive
early metastases
rarely suitable for surgery
good initial response to chemotherapy

52
Q

why are small cell carcinomas more susceptible to cytotoxic chemotherapy compared to other types of lung cancer?

A

because of the rapid growth

chemotherapy targets dividing cells

53
Q

what is the treatment of choice in small cell lung cancer?

A

chemotherapy

often backed up with radiotherapy

54
Q

what are the 4 major management options for lung cancer?

A

surgery
radiotherapy
chemotherapy
palliative care

55
Q

what lung cancer patients do well with surgery?

A

localised disease

very little co-morbidity

56
Q

what is the role of bronchoscopy within staging for cancer resection?

A

too look for:
vocal cord palsy
proximity to carina
cell type

57
Q

what is the role of mediastinoscopy within staging for cancer resection?

A

to look for lymph nodes with mets

58
Q

what is the role of a CT scan of the brain within staging for cancer resection?

A

to look for brain mets

59
Q

what is the role of a CT scan of the tohorax within staging for cancer resection?

A

tumour size
lymph nodes affected
mets
local invasion

60
Q

what is the role of PET scan within staging for cancer resection?

A

metastases

61
Q

how distal to the carina must a lung cancer tumour be in order to be operable?

A

2cm

62
Q

if tumour is in a main bronchus, why do you need 2cm of disease free bronchus distal to the carina?

A

because you need at least 2cm of disease free bronchis to close the hole that will be left from ressection

63
Q

what is the name for a whole lung resecection?

A

pneumonectomy

64
Q

for chemotherapy, how often do you need IV infusions?

A

every 3/4 weeks

65
Q

what are the 5 major side effects from chemotherapy?

A 
nausea and vomiting
tiredness
bone marrow suppression
hair loss
pulmonary fibrosis
66
Q

what is the result of bone marrow suppression? (which can be secondary to chemotherapy)

A

opportunistic infection

anaemia

67
Q

when is radiotherapy (x-rays usually) used as a curative method for cancer?

A

if target is less than 5 cm in diameter

68
Q

what are the 3 major cons about radiotherapy?

A

maximum cumulative dose
collateral damage
only goes where you point the beam (not good for subclinical mets)

69
Q

where is the most common collateral damage from radiotherapy on a lung tumour?

A

spinal cord
oesophagus
adjacent lung tissue

70
Q

what 4 type of endobronchial therapies are good palliative techniques?

A

stent insertion for stridor
photodynamic therapy
other laser therapy
radioactive pellets

71
Q

what is treatment of lung cancer determined by?

A

patients wishes
type of cancer
staging of cancer
co-morbidity

Respiratory (10 decks)

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