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Lung Cancer Flashcards

1
Q

General features of cancer

A

malignant growth, uncontrolled replication, local invasion, metastases, non-metastatic effects

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2
Q

Another name for non-metastatic effects?

A

paraneoplastic syndrome

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3
Q

What are non-metastatic effects?

A

rare, non-metastatic manifestations of malignancy mediated by hormones, cytokines or antibodies

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4
Q

Prognosis of lung cancer?

A

90% incurable at the time of lung cancer diagnosis

50% dead after 6 months

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5
Q

Potential reasons for poor lung cancer prognosis

A

Poor health at the time of diagnosis prevents treatment
Co-morbidities
Tends not to cause symptoms until advanced or metastatic

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6
Q

Potential Red Flags for Lung Cancer (8)

A 
cough for 3 weeks or more
haemoptysis
breathless for no reason
recurrent or unresolved chest infections
unexplained weight loss 
chest or shoulder pain
unexplained tiredness or lack of energy
hoarse voice
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7
Q

Differential diagnosis of haemoptysis

A

TB, Pneumonia, Aspergillus, Lung Cancer

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8
Q

Haemoptysis presents in around 70% of patients with lung cancer - true or false?

A

true

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9
Q

Patients presenting with haemoptysis should be _______ and sent for _____

A

referred, CT scan

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10
Q

Any ___ patient with pneumonia has a repeated xray after ______. If this is not resolved then the patient should be referred to CT.

A

50+, 6 weeks

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11
Q

On an xray, the affected lung may…

A

lose volume and appear smaller

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12
Q

Stridor (in context of lung cancer)

A

swelling in the airway due to tumour pressing on bronchioles

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13
Q

Common sites of local invasion in lung cancer (6)

A 
recurrent laryngeal nerve
pericardium
oesophagus
brachial plexus
pleural cavity
SVC
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14
Q

What is the result of a tumour pressing on the recurrent laryngeal nerve?

A

hoarse voice

may cause the vocal cord not to move

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15
Q

What are the issues surrounding pericardial invasion by a tumour?

A 
breathlessness
atrial fibrillation
pericardial effusion
dysrhythmias - tamponade 
poor cardiac output
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16
Q

Tumour invasion of the oesophagus causes…

A

dysphagia

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17
Q

Pancoast tumour

A

apical lung cancer invading the brachial plexus

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18
Q

Symptoms of pancoasts tumour

A

pain, muscle wasting, sensory loss, weakness - occurring gradually in ipsilateral arm

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19
Q

Invasion of the pleural cavity causes…

A

pleural effusion - could contain answer if this is first presentation

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20
Q

Presentation of pleural effusion on examination

A

dull percussion
low - no breath sounds
white xray

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21
Q

Presentation of SVC obstruction due to lung cancer?

A

distension of jugular vein
pressure headaches and blurry vision
superficial veins

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22
Q

How might SVC obstruction be relieved in lung cancer?

A

stent or chemotherapy

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23
Q

Chest wall invasion can cause…

A

erosion of ribs, nerves and arteries

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24
Q

type of pain associated with chest wall invasion?

A

neuropathic burning sensation,
worsened by movement
localised
often described as worse at night

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25
The patient is at risk of _______ _______ if the tumour starts to invade the pulmonary artery. This type of tumour may erode through the artery and the ________ to cause a sudden death due to massive _______.
Pulmonary embolis bronchus haemoptysis
26
Common sites of metastases in lung cancer (6)
``` liver brain bone adrenal skin Lung ```
27
Features of cerebral metastases in lung cancer
``` Gradual onset of: Weakness visual disturbance headaches fits ```
28
Features of headaches due to metastases?
worse in the morning worse with sneezing not photophobic due to increase in ICP
29
Treatment for cerebral metastases?
high dose corticosteroids i.e. dexamethasone (ICP) radiotherapy (tumour) chemotherapy (tumour)
30
Particularly abnormal in Liver Metastases?
Alkaline Phosphatase
31
Clinical presentation of bone metastases?
non-specific ache away from joint unusual pain fracture during trivial mechanical stress localised pain worse at night
32
Metastases in the adrenal glands ______ cause symptoms but are indicators of ________ disease
don't | advanced
33
A CT is unable to determine if a growth on the adrenal gland is a benign adenoma or cancer. In lung cancer patients, why is it important to determine whether it is?
It is important to establish whether they can undergo further treatment.
34
Non-metastatic signs of lung cancer (7)
``` finger clubbing hypertrophic pulmonary osteoarthropathy weight loss thrombophlebitis hypercalcaemia hyponatraemia weakness ```
35
Other causes of finger clubbing (not lung cancer)
liver disease - hep C congenital cyanotic heart disease bacterial endocarditis bronchiectasis
36
What is hypertrophic pulmonary osteoarthropathy?
inflammation and expansion of the outer layer of bone
37
Presentation of hypertrophic pulmonary osteoarthropathy?
pain and tenderness of long bones due to elevation of the periosteum away from the bone surface
38
Weight loss is very non-specific. What histories are required to understand weightloss in the context of lung cancer?
GI Resp. Bones Age
39
What is thrombophlebitis?
inflammation of the veins - very common
40
What is the cause of thrombophlebitis?
increased coagulability of blood
41
What is hyponatreamia and how does it present?
low sodium causing confusion
42
Weakness is presented as Eaton Lambert Symdrome. This mimics...
myaethenia gravis which resolves if primary tumour is resected
43
I have a history of a cough, you ask...
``` How long has this occured? Do you produce sputum? What colour is the sputum? Do you always have a cough? Is there anything else associated with the cough? ```
44
Patients rarely volunteer information about...
haemoptysis
45
I come to you having coughed up some blood, what do you ask?
How much blood was it? Has this happened before? What colour is it, fresh red or dark red?
46
You are taking a history and I reveal I am a cigarette smoker, what questions might you ask?
How long have you smoked? How many a day? Am I thinking of stopping? If you have stopped, how long and how many did you smoke?
47
Differential diagnosis for breathlessness?
PE, Pleural effusion, pericardial invasion, COPD, infection, lung cancer
48
On examination in a patient you might be concerned about lung cancer, what are you look, listening and feeling for?
``` finger clubbing cough bloated face lymphadenopathy dull percussion enlarged liver breathlessness weightloss hoarse voice tracheal deviation stridor ```
49
What investigations are common when investigating a potential lung cancer?
``` FBC Spirometry - FEV1 CXR CT of thorax PET scan Bronchoscopy Endobronchial Ultrasound ```
50
What do you not test for when looking for lung cancer?
sputum cytology
51
Which FBCs and bloods do you need in lung cancer suspect?
FBC Na, K, Ca, Alk Phos LFTs Coagulation screen
52
What areas do you expect to light up in a PET scan?
Bladder and brain | highish in liver and spleen
53
Differential diagnosis in a smoker with haemoptysis and abnormal CXR
``` Lung cancer TB Vasculitis PE Secondary cancer Lymphoma Bronchiectasis ```
54
What needs to be considered with CT guided biopsy?
if lung is healthy enough to withstand 10% chance of pneumothorax
55
Options for obtaining a tissue diagnosis?
``` bronchoscopy CT guided biopsy Lymph node aspirate aspiration of pleural fluid EBUS Thoracoscopy ```
56
Benign neoplasm in the lung
hamartoma
57
Why are metastases in lung cancer very common?
the lungs get all the blood so it is easy for the cells to get around the body
58
What are common clinical presentations of patients experiencing the local effects of lung cancer?
obstruction of the airway (pneumonia) invasion of the chest wall (pain) Ulceration (haemopytsis)
59
4 common types of lung cancer
adenocarcinoma squamous carcinoma small cell carcinoma large cell carcinoma
60
TNM staging is used for lung cancer...what does this stand for?
Tumour Nodes Metastases
61
What role does immunohistochemistry have to play in identifying cancer?
can identify specific expression of tumour suppression factors or oncogenes for targeting via drugs
62
What is mutated in the marjority of adenocarcinomas particularly in non-smokers and asian populations?
EGFR
63
What is Lambert-Eaton Syndrome?
Paraneoplastic syndrome - weakness that mimics myaesthenia gravis but resolves if primary tumour is resected.
64
How much fluid does the pleura normally contain?
4ml
65
How much pleural fluid is needed to be visualised on an x-ray?
200ml
66
What type of pleural effusions should cause concern?
large unilateral effusions
67
Investigates for a pleural effusion might be?
``` PA CXR Pleural Aspirate Biochemistry Cytology Culture ?CT chest ```
68
If you are unusure if the opacity is fluid on the CXR what can you do?
repeat CXR while patient is on their side, the fluid will move and create a straight line at the top
69
What might you suspect with straw-coloured effusion?
heart failure or hypoalbunaemia
70
What might you suspect with blood in the effusion?
malignancy, trauma, infection, infarction
71
What might you suspect with a milky or turbid effusion?
empyema, chylothorax
72
Transudates are...
protein <30g/L
73
Exudates are...
protein >30g/L
74
Transudates are associated with...(5)
``` HF Liver Cirrhosis Hypoalbuminaemia Atelectasis Peritoneal dialysis ```
75
Exudates are associated with...(4)
Malignancy Infection incl. TB Pulmonary infarct Asbestos
76
A pH of less than 7.3 suggests...
pleural inflammation i.e. malignancy or RA
77
A pH of less than 7.2 must...
be draind
78
Where would glucose be expected to be low in an effusion?
Infection, RhA, Malignancy, oesophageal rupture, SLE
79
What two types of non-malignant cell type may be present in an effusion?
lymphocytes - TB, malignancy | Neutrophils - acute onset
80
apart from asbestos workers, who may also get mesothelioma?
people associated with those who worked with asbestos
81
how long does mesothelioma take to develop?
30-40 years post exposure
82
Symptoms that may present with mesothelioma (6)
breathlessness; chest pain; weight loss; fever; sweating; cough
83
Investigations in mesothelioma?
Imaging Pleural fluid aspiration Biopsy
84
Treatment options include:
Pleurodese effusions; radiotherapy; chemotherapy; surgery; palliative care
85
What might be done to relieve pleural effusions as a result of mesothelioma?
Talc slurry | Long term pleural catheters
86
Complications in the use of talc slurry (6)
pleuritic pain; fever; pneumonia; resp. failure; talc pneumonitis; secondary empyema
87
Complications of long-term pleural catheters (3)
incorrect placement; bleeding; infection
88
Which cancers particularly metastasise to the pleura?
lung; breast; upper GI; lymphoma; melanoma; ovarian
89
Median survival for mesothelioma
3-12 months
90
What score is used for predicting survival in mesothelioma?
LENT
91
L in LENT...
LDH in pleural fluid <1500 = 0 >1500 = 1
92
E in LENT...
``` ECOG PS - functioning in daily life 0=0 1=1 2=2 3-4=3 ```
93
N in LENT
Neutrophil to lymphocyte ratio <9 = 0 >9 = 1
94
T in LENT
``` Tumour type Lowest Risk (0); meso, haematological Medium risk (1); breast, gynae, renal HIgh risk (2); lung, other types ```

Y1 Respiratory (20 decks)

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