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Respiratory > Lung cancer > Flashcards

Lung cancer Flashcards

1
Q

What ways can lung tumours be classified?

A

Bronchial or pleural

Malignant or benign

Primary or secondary

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2
Q

What types of malignant bronchial lung tumours are there?

Which are more common?

A

Small cell cacrinoma (15%)

Non-small cell (85%)

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3
Q

What are the causes of lung cancer?

A 
SMOKING
Asbestos
Genetics
Radon
Coal tar + coal combustion
Iron oxide
Arsenic
Many more
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4
Q

What types of non-small cell lung cancers are there?

A

Squamous cell
Adenocarcinoma
Large cell
Unspecified

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5
Q

What genetic mutations can cause lung cancer?

A

A mutation in the gene that codes for EGFR - epithelial growth factor receptor

This causes an increased risk of getting lung cancer

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6
Q

What is small cell lung carcinoma?

A

A very aggressive cancer, almost always caused by smoking

It arises from neuroendocrine cells

Secretes polypeptide hormones

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7
Q

Why did small cell carcinoma get its name?

A

Histologically the cancer cells look very small, and they are almost completely filled by their nucleus

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8
Q

What is squamous cell carcinoma?

A

A type of non-small cell lung cancer

Develops from the flat, surface covering squamous cells in the airways.

It is often found near the centre of the lung in one of the main airways, it often presents as an obstructive lesion that has led to infection

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9
Q

Does small cell lung carcinoma metastasise easily?

A

Yes

Widespread and very early on in the disease

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10
Q

Does squamous cell carcinoma metastasise easily?

A

Local metastasis common

Widespread not so much, occurs later in disease

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11
Q

What is large cell carcinoma?

A

A type of non-small cell lung cancer

It is a poorly differentiated tumour

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12
Q

Why did large cell carcinoma get its name?

A

Because the cells look large and rounded under a microscope.

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13
Q

Does large cell carcinoma metastasise easily?

A

Yes, and early

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14
Q

What is adenocarcinoma?

A

A type of non-small cell carcinoma

Develops from mucus making cells in the lining of the airways.

Often found in the outer areas of the lungs, peripheral

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15
Q

Which type of lung cancer is most commonly seen in non-smokers?

A

Adenocarcinoma

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16
Q

Which type of bronchial cancer (not pleural) is most commonly seen in people who’ve been exposed to asbestos?

A

Adenocarcinoma

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17
Q

What is secondary lung cancer?

A

Cancer in the lung that has developed due to cancer that has metastasised from another part of the body

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18
Q

Where do lung cancers commonly metastasise to?

A 
Bone
Brain
Lymph glands
Liver
Adrenal glands
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19
Q

What do you call cancer of the pleura?

A

Mesothelioma

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20
Q

What are the symptoms of lung cancer?

A 
Cough
Haemoptysis
Chest pain
Recurrent or slow to resolve pneumonia
Lethargy
Anorexia
Weight loss
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21
Q

What are the signs of lung cancer?

A

Cachexia
Anaemia
Clubbing
Supraclavicular or axillary nodes

Chest signs:

  • consolidation
  • Collapse
  • Pleural effusion

Evidence of local spreading
Evidence of metastasis

22
Q

What are the signs of metastasis in lung cancer?

A

Bone pain
Hepatomegaly
Neurological signs: confusion, fits etc.

23
Q

Where does lung cancer spread to locally?

A

Cancer may spread to

  • pleura
  • ribs
  • brachial plexus
  • left recurrent laryngeal nerve
  • oesophagus
  • IVC
24
Q

What happens if lung cancer spreads to the ribs?

A

Rib pain + fracture

25
Q

What happens if lung cancer spreads to the brachial plexus?

A

Pain in shoulder and inner arm

26
Q

What happens if lung cancer spreads to the left recurrent laryngeal nerve?

A

Hoarse voice

Bovine cough

27
Q

What is paraneoplastic syndrome?

A

A set of signs and symptoms that are the consequence of cancer in the body but not due to the local presence of cancer cells

28
Q

What are the symptoms of paraneoplastic syndrome?

A

Finger clubbing
Hypertrophic pulmonary osteoarthropathy

Anorexia
Cachexia + weight loss
Hypercalcaemia
Hyponatraemia
Peripheral neuropathy
29
Q

What is Hypertrophic pulmonary osteoarthropathy?

A

Clubbing and periostitis (inflammation of the periosteum) of small hand joints, especially distal interphalangeal joints, causing pain and swelling

30
Q

What is hyponatraemia?

Why does paraneoplastic syndrome cause it?

A

Low sodium in blood

Paraneoplastic syndrome causes SIADH: syndrome of inappropriate antidiuretic hormone secretion

Too much ADH = higher blood volume = lower conc of Na

31
Q

Why does paraneoplastic syndrome cause peripheral neuropathy?

A

Due to Eaton-Lambert syndrome

An autoimmune disease that attacks the neuromuscular junction and the ability of nerve cells to send signals to the muscle cells

32
Q

Investigation of lung cancer?

A

Cytology: sputum + pleural fluid, looks at the structure of the cells

CXR: look for nodules, hilar enlargement, consolidation, lung collapse, pleural effusion

Fine needle aspiration or biopsy

CT: stage the tumour

Bronchoscopy: assess operability

PET scan

33
Q

What is a PET scan?

A

Positron emission tomography

The radioactive dye is taken up by rapidly dividing cells and is not excreted
These rapidly dividing cells light up, they are very likely to be cancerous

34
Q

What 3 things do you need to consider when assessing a patient with possible lung cancer?

A
  1. Is it lung cancer, and if so what type?
  2. What stage is the cancer, how resectable is it?
  3. Is the patient fit for curative treatment (surgery)?
35
Q

What is the treatment for non-small cell tumours?

A

For peripheral tumours with non metastatic spread = excision

For patients with low respiratory reserve = radiotherapy

More advanced disease = chemo + radiotherapy

Sometimes biologics can be used such as cetuximab which targets epidermal growth factor receptor

36
Q

What is the treatment of small cell tumours?

A

They have usually spread by the time they’re picked up

Chemotherapy: works but they usually relapse

Palliative care

37
Q

What palliative care can you give patients with lung cancer?

A

Radiotherapy:

  • shrink tumours that are causing obstruction
  • shrink metastases
  • treat haemoptysis

Pleural drainage
- to treat pleural effusions that are causing symptoms

Drugs:

  • Analgesia
  • Anti-emetics
  • Bronchodilators
  • Anti-depressants
38
Q

How can you prevent lung cancer?

A

Stop smoking

Prevent exposure to harmful substances

39
Q

What is malignant mesothelioma?

A

Tumour of the mesothelail cells of the pleura

Associated strongly with asbestos exposure

40
Q

Where else in the body can malignant mesothelioma occur?

A

In the peritoneum or other organs that have a mesothelium - this is rare though

41
Q

What is the latency period of exposure to asbestos and developing malignant mesothelioma?

A

About 45 years

42
Q

What are the clinical features of malignant mesothelioma?

A 
Chest pain
Dyspnoea
Weight loss
Finger clubbing
Recurrent pleural effusions
Signs of metastases
43
Q

What are the signs of metastasis of malignant mesothelioma?

A

Lymphadenopathy
Hepatomegaly
Bone pain

Abdominal pain: due to peritoneal malignant mesothelioma

44
Q

What are the investigations of malignant mesothelioma?

A

CXR or CT: look for pleural thickening and pleural effusion

Pleural aspiration: fluid appears bloody

45
Q

Management of malignant mesothelioma?

A

Chemotherapy can improve survival

Surgery: rarely possible or helpful

Radiotherapy: as above

Pleurodesis and indwelling pleural drainage

46
Q

What is pleurodesis?

A

Procedure in which the pleural space is artificially obliterated
It involves the adhesion of the two pleurae.

47
Q

What two types of radiotherapy are there? Describe them

A

Radical:

  • Hope to cure
  • Don’t mind side effects
  • Concerned about long term effects

Palliative

  • No aim to cure
  • Don’t want side effects
  • No concern about long term effects
48
Q

How can lymphoma involve the lungs?

A

Sometimes lymphomas can metastasise to the lung

You can get primary lymphoma of the pleura

BALToma: aggregation of extranodal, monoclonal B- lymphoid cells near the bronchial epithelium

49
Q

What is BALToma?

A

Bronchus associated tissue lymphoma

Aggregation of extranodal, monoclonal B- lymphoid cells near the bronchial epithelium

50
Q

What is a hamartoma?

A

Irregular benign proliferations of normal tissue

  • tissue IS usually found in this location
  • it’s not normally found in this pattern however
51
Q

What is the most common type of lung hamartoma?

A

Chondroid hamartoma

Incorporates cartilage, glandular tissue, fat, fibrous tissue, blood vessels

Respiratory (17 decks)

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