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Lung cancer Flashcards

1
Q

What are the risk factors for lung cancer?

A

tobacco, asbestos, granite and environmental radon,occupational exposure to chromates, hydrocarbons, nickel, air pollution, other radiation, pulmonary fibrosis , genetic factors

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2
Q

What does polycyclic aromatic hydrocarbons cause?

A

Squamous small cell lung cancer

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3
Q

What does N-nitroamines cause?

A

adenocarcinoma

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4
Q

What is multiunit theory?

A

3-12 steps that must occur in the right order

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5
Q

What is inherent polymorphism of enzymes?

A

They have variety of activation, such as various levels of host activation of pro-carcinogens, various levels of malfunction of detoxification system metabolism

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6
Q

How many primary cancer pathways there are?

A

2

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7
Q

Where does adenocarcinoma occur?

A

In the lung periphery, bronchioalveolar epithelial stem cell transformation

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8
Q

Where does squamous cell carcinoma occur?

A

In the central airways, bronchial epithelial stem cells transformation

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9
Q

What are the genes associated with the cancers not related to smoking?

A

KRAS, 35%, EGFR 15%, Braf, Her 2 2%, ALK rearrangement 2%, other

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10
Q

What are the 4 main types of lung cancer ?

A

Adenocarcinoma, squamous cell, small cell carcinoma and large cell carcinoma

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11
Q

What are other types ?

A

Carcinoid tumours, tumours of bronchial glands, lymphoma and sarcoma

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12
Q

What are carcinoma tumours?

A

Low grade malignancy tumours

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13
Q

What is sarcoma?

A

Cancer of connective non-epithelial tissue

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14
Q

What are tumours of bronchial glands?

A

Adenoid cyst carcinoma, mucoepidermoid carcinoma, benign adenomas

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15
Q

What are the local effect of lung cancer?

A

Bronchial obstruction, endogenous lipid pneumonia, increased infection risk, abscess, bronchiectasis, pleural involvement, direct spread

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16
Q

What are the complications associated with nerves?

A

diaphragmatic paralysis due to phrenic nerve, bovine cough due to L recurrent laryngeal nerve involvement, damage of brachial plexus from pan coast T1 damage, Horners syndrome from damage to cervical sympathetic nerves

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17
Q

What is Horner syndrome?

A

constricted pupil, droopy eye lid, decreased sweating

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18
Q

What other structures can be affected by spread to mediastinum?

A

Vena cava, pericardium, medistinal lymph nodes

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19
Q

What is lymphangitic carcinomatosis?

A

diffuse infiltration and obstruction of pulmonary parenchymal lymphatics

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20
Q

What are the distal effects of lung cancer?

A

liver, bone, brain, adrenal, skin metastasis, paraneoplastci effects such as clubbing, hypertrophic pulmonary osteoarthropathy, ACTH, siADH release by small cell carcinoma, PTH by squamous, genecomastia, encelopathy, cerebral degeneration

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21
Q

What is caused by ACTH?

A

Cushings syndrome

22
Q

What is caused by ADH ?

A

Duiretic syndrome

23
Q

What is caused by PTH?

A

Hypercalcaemia

24
Q

What are the signs of lung cancer?

A

Finger clubbing, swollen ancles and wrists, lymphadenopathy, pleural effusion, bovine cough, horner’s syndrome, diaphragm paralysis, weight loss

25
What are the symptoms of lung cancer?
Chest or shoulder pain, cough, haemoptysis, SOB, malaise, paraneoplastic effects, difficulty swallowing
26
What are the investigations for lung cancer?
chest X ray, bronchoscopy with biopsy, EBUS, CT, MRI, PET, Trans-thoracic fine needle aspiration, trans-thoracic core biosy, mediastinoscopy, full blood count, renal and liver function, calcium levels, spirometry
27
Why does small cell carcinoma have bad prognosis?
Usually diagnosed at later stages,good response to chemotherapy, close to hilum, very aggressive, rapid growth, great spread, metastasis, secretes hormones
28
What are the treatment options?
chemotherapy, radiotherapy, surgery, palliative treatment
29
What is pulmonary nodule?
Less than 3 cm size
30
What is pulmonary mass?
Bigger than 3 cm
31
What are other possible causes of the masses?
TB, benign tumours, pulmonary haematoma, fungal infection, malformations
32
What are investigations that can be used to specify T ?
CT with IV contrast, PET-CT, bronchoscopy
33
What investigations can be used for N stage?
CT, PET-CT, mediastinoscopy, EBUS
34
What investigations can be used for M staging?
PET-CT, CT, bone scan
35
What is PET?
Positron emission tomography, uses 18F glucose, that is taken up by cancer cells, accumulation
36
Define T0
no evidence of primary tumours
37
Define T1
< 3cm, isolated tumours, no involvement of main bronchus
38
Define T2
3 - 5 cm, main bronchus, visceral pleura are involved, not carina, can extend to hillier regions
39
Define T3
5-7 cm, invades chest wall, phrenic nerve, parietal pericardium
40
Define T4
> 7 cm, invades diaphragm, mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, oesophagus, vertebral body, carina
41
Define N0
no regional lymph node metastases
42
Define N1
Ipsilateral peribronchial, hilar, intrapulmonary
43
Define N2
Ipsilateral mediastinal, subcarinar
44
Define N3
Contralateral mediastinal, hilar, scalene, supraclavicular
45
Define M0
No distant metastases
46
Define M1
distal metastases
47
What is aortopulmonary window?
hole connecting the major artery and pulmonary artery
48
What to examine search for metastases?
laryngeal nerve palsy, brachial plexus palsy, superior vena cava obstrcution, supraclavicular LN, soft tissue nodules, chest wall masses, pleural/pericardaic effusion, hepatomegally, history of pain in bones, headaches and neurological symptoms, haematonuria
49
What tests should be carried out before surgery?
Respiratory function testing: Spirometry, diffusion studies, arterial blood gas, and fractioned V/Q scan. Cardiac assessment: ECG, ECHO, CT scan, ETT, Coronary angiogram. Psychological assessment: mental illness, chronic pain problems
50
What are the possible types of surgery ?
pneumonectomy, lobectomy, wedge resection,
51
What are the perioperative complications associated with death ?
acute respiratory syndrome, bronchopneumonia, MI, pulmonary embolism, pneumothorax, intrathoracic bleeding
52
What are perioperative complications that are non-fatal?
Post thoracotomy wound pain, empyema, wound infection, atrial fibrillation, bronchopleural fistula, gastroparesis, insufficient respiration

Respiratory system (22 decks)

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