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RW Respiratory > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

What does tobacco smoke contain?

A

• polycyclic hydrocarbons • aromatic amines • phenols • nickel • cyanates

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2
Q

What is the clinical presentation of lung cancer?

A

Local: • Obstruction of airway (pneumonia) • Invasion of chest wall (pain) • Ulceration (haemoptysis) Systemic: • Weight loss • Ectopic hormone production • PTH • ACTH

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3
Q

What are the 4 different types of lung cancer?

A
  • adenocarcinoma (35%)
  • squamous carcinoma (30%)
  • small cell carcinoma (25%)
  • large cell carcinoma (10%)
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4
Q

Which type of cancer is most common in non-smokers?

A

Adenocarcinoma

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5
Q

What is characteristic about squamous cell lung cancer?

A
  • Very common despite there being no squamous cells in the lung
  • Produces keratin
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6
Q

What is characteristic about adenocarcinoma?

A

Produces mucous

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7
Q

What is characteristic about small cell carcinoma?

A

Not much cytoplasm but lots of nuclei - this is what makes them look like small cells

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8
Q

What is characteristic about large cell carcinoma?

A
  • Large cells with large nuclei
  • Diagnosis made on surgical excision
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9
Q

What is the prognosis of the 4 types of lung cancer in order of worst to best?

A
  • Small cell lung cancer - Large cell lung cancer - Squamous cell lung cancer - Adenocarcinoma
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10
Q

What 2 classifications are the 4 types of lung cancer normally divided into?

A

Small cell lung cancer (SCLC) vs. Non-small cell lung cancer (NSCLC)

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11
Q

What is the treatment of choice of small cell lung cancer?

A

Chemotherapy (though growing resistance)

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12
Q

What is the treatment of choice for non-small cell lung cancer?

A

Surgery or radical radiotherapy

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13
Q

What do adenocarcinoma express?

A

Thyroid transcription factor 1 (TTF1)

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14
Q

Which oncogene abnormalities are associated with SCLC?

A

myc

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15
Q

Which tumour suppressor gene abnormalities are associated with SCLC?

A

P53, Rb, 3p

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16
Q

Which oncogene abnormalities are associated with NSCLC?

A

Myc, K-ras, her2(neu)

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17
Q

Which tumour suppressor gene abnormalities are associated with NSCLC?

A

P53, 1q, 3p, 9p, 11p, Rb

18
Q

Which mutation is seen almost exclusively in adenocarcinomas and what targeted treatment can therefore be used?

A

Specific point mutations render the EGFR gene active in the absence of ligand (epidermal growth factor) binding. These tumours respond to tyrosine kinase inhibitors (erlotinib).

19
Q

What is the pathogenesis of bronchial tumours?

A

• Squamous metaplasia • Dysplasia • Final stage before invasive cancer • Carcinoma in situ • Invasive malignancy

20
Q

What is the pathogenesis of peripheral adenocarcinomas?

A

• Atypical adenomatous hyperplasia • Spread of neoplastic cells along alveolar walls (bronchioloalveolar carcinoma) • True invasive adenocarcinoma

21
Q

What are the other, less common neoplasms?

A
  • Carcinoid: Neuroendocrine neoplasms of low grade malignancy - Bronchial gland neoplasms: tumours more often seen in salivary glands - Pleural Neoplasia: mesothelioma
22
Q

What investigations are done to stage lung cancer?

A
  • CT scan of thorax
    • Tumour size - want clear margins
    • Lymph nodes
    • Metastases
  • CT scan of brain - Metastase
  • PET scan - Metastase

Then use following to get sample:

  • Bronchoscopy
    • Vocal cord palsy
      • Cant operate because we know its spread to laryngeal nerve
    • Proximity to carina
      • Cannot operate, would leave a huge hole
    • Cell type
  • Mediastinoscopy/EBUS
23
Q

What are the surgical options for lung cancer?

A
  • Pneumonectomy or lobectomy
    • Thoracotomy: Major surgery involving a long incision around the length of the sixth rib to gain access to the lung in question
    • Minimal access VATS (Video Assisted Thoracic Surgery)
      • This is far less traumatic and has the benefit of a much faster recovery.

*

24
Q

What performance staging system is used for chemotherapy?

A

Performance status ECOG score - determines if patients are fit enough to withstand chemotherapy

25
Q

What are the disadvantages of radiotherapy?

A
  • Maximum cumulative dose
    • Too much can give you another cancer
    • And if that happens, then is hard to treat because they are at their max dose already
  • Collateral damage
    • Spinal cord
    • Oesophagus - Temporary oesophagitis is a common side effect of radiotherapy
    • Adjacent lung tissue - Normal lung tissue can undergo post radiation fibrosis.
  • Only goes where you point the beam
26
Q

Endobronchial therapy

A
  • Patient receives a photo-sensitising drug a few days before this bronchoscopy.
  • Then recieves phototherapy to the tumour in the bronchus with laser light down a fibreoptic bundle.
  • Only works for tumours in the bronchial mucosa
27
Q

Incidence

A

number of new cases eg. 1 in 100

28
Q

Prevalence

A

Total number of people that actually have it

29
Q

Why does lung cancer have such a poor prognosis?

A

One reason for the poor prognosis is that lung cancer tends not to cause any symptoms until the disease has become too advanced for any hope of cure

30
Q

How can lung cancer cause lobar pneumonia?

A

If there is a tumour in a lobe of the lung then it can cause a partial obstruction. This means that is doesn’t get cleared so once the antibiotics finish, it just comes back - leading to recurrent episodes of pneumonia

31
Q

True or False: With growing lung cancer, the affected lung shrinks

A

When a lobe becomes obstructed, all of the air beyond the obstruction is absorbed and the lung tissue shrinks down to a much smaller size. The net effect is a reduction in size.

32
Q

Stridor

A

Wheeze on inspiration (wheeze on expiration is normal in COPD and asthma etc)

33
Q

Pancoast tumour

A

If a lung tumour is high in the apex of the lung and encroaches on the brachial plexus, T1 nerve root affected and causes wasting of the small muscles of the hand and also weakness

34
Q

What does localised joint pain which is worse at night suggest?

A

Possible bone metastases

35
Q

Paraneoplastic Syndromes

A

All of these features result from the effects of biochemically active products from the primary tumour. They are NOT indicative of metastatic disease.

36
Q

What parasneoplastic syndromes are associated with lung cancer?

A
  • Finger clubbing
  • Hypertrophic pulmonary osteoarthropathy (HPOA) -Occurs with expansion of the superficial layers of the bone
  • Weight loss
  • Thrombophlebitis
  • Hypercalcaemia
  • Hyponatraemia – SIADH
  • Weakness - Eaton Lambert syndrome (Mimics myaesthenia gravis)
37
Q

How does lung cancer cause a cough?

A

the sensation which triggers a desire to cough is distortion of the normal bronchial mucosa by the tumour.

38
Q

How does lung cancer cause haemoptysis?

A

When the tumour ulcerates through the mucosa, it is prone to bleed

39
Q

How does lung cancer cause breathlessness?

A

Breathlessness in lung cancer is usually due to obstruction of a major branch of the bronchial tree by the tumour

40
Q

What techniques are used to make a definitive diagnosis of lung cancer?

A
  • Bronchoscopy (with biopsy and brush-cytology)
    • Video bronchoscopy or Endobronchial Ultrasound
  • CT guided biopsy
  • Lymph node aspirate
  • Aspiration of pleural fluid
41
Q

What are the 3 most important questions when determining treatment for lung cancer?

A
  1. Which cell type of lung cancer is it?
  2. What stage is it?
  3. How fit is the patient?
42
Q

How do you assess the fitness of the patient for treatment?

A
  • Spirometry
  • WHO performance status scale

RW Respiratory (17 decks)

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