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Respiratory system > Lung cancer > Flashcards

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
Q

What are the symptoms of lung cancer?

A

Chest or shoulder pain, cough, haemoptysis, SOB, malaise, paraneoplastic effects, difficulty swallowing

26
Q

What are the investigations for lung cancer?

A

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
Q

Why does small cell carcinoma have bad prognosis?

A

Usually diagnosed at later stages,good response to chemotherapy, close to hilum, very aggressive, rapid growth, great spread, metastasis, secretes hormones

28
Q

What are the treatment options?

A

chemotherapy, radiotherapy, surgery, palliative treatment

29
Q

What is pulmonary nodule?

A

Less than 3 cm size

30
Q

What is pulmonary mass?

A

Bigger than 3 cm

31
Q

What are other possible causes of the masses?

A

TB, benign tumours, pulmonary haematoma, fungal infection, malformations

32
Q

What are investigations that can be used to specify T ?

A

CT with IV contrast, PET-CT, bronchoscopy

33
Q

What investigations can be used for N stage?

A

CT, PET-CT, mediastinoscopy, EBUS

34
Q

What investigations can be used for M staging?

A

PET-CT, CT, bone scan

35
Q

What is PET?

A

Positron emission tomography, uses 18F glucose, that is taken up by cancer cells, accumulation

36
Q

Define T0

A

no evidence of primary tumours

37
Q

Define T1

A

< 3cm, isolated tumours, no involvement of main bronchus

38
Q

Define T2

A

3 - 5 cm, main bronchus, visceral pleura are involved, not carina, can extend to hillier regions

39
Q

Define T3

A

5-7 cm, invades chest wall, phrenic nerve, parietal pericardium

40
Q

Define T4

A

> 7 cm, invades diaphragm, mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, oesophagus, vertebral body, carina

41
Q

Define N0

A

no regional lymph node metastases

42
Q

Define N1

A

Ipsilateral peribronchial, hilar, intrapulmonary

43
Q

Define N2

A

Ipsilateral mediastinal, subcarinar

44
Q

Define N3

A

Contralateral mediastinal, hilar, scalene, supraclavicular

45
Q

Define M0

A

No distant metastases

46
Q

Define M1

A

distal metastases

47
Q

What is aortopulmonary window?

A

hole connecting the major artery and pulmonary artery

48
Q

What to examine search for metastases?

A

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
Q

What tests should be carried out before surgery?

A

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
Q

What are the possible types of surgery ?

A

pneumonectomy, lobectomy, wedge resection,

51
Q

What are the perioperative complications associated with death ?

A

acute respiratory syndrome, bronchopneumonia, MI, pulmonary embolism, pneumothorax, intrathoracic bleeding

52
Q

What are perioperative complications that are non-fatal?

A

Post thoracotomy wound pain, empyema, wound infection, atrial fibrillation, bronchopleural fistula, gastroparesis, insufficient respiration

Respiratory system (22 decks)

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