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8. Respiratory > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

List 7 risk factors for lung cancer.

A 
Smoking (causes 90%)
Environmental pollution
Ionising radiation
Asbestos exposure
Pulmonary fibrosis
HPV infection
Genetic conditions, e.g.
-CYP450 polymorphisms
-EGFR mutations
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2
Q

Briefly describe the pathogenesis of lung cancer. (4)

A
  1. Carcinogens cause chronic irritation and stimulation of lung cells
    a. This causes increased cell turnover
  2. Progressive accumulation of genetic abnormalities cause increased cell proliferation and abnormal cell signalling
  3. This causes hyperplasia, then metaplasia, then dysplasia
  4. Dysplasia forms a carcinoma in situ
    a. This may later spread
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3
Q

Describe the symptoms of lung cancer. (6)

A 
Chronic cough
Haemoptysis
Chest pain
Effects of metastasis
Effects depending on location of lung tumour
Paraneoplastic syndromes
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4
Q

Describe the symptoms of a central lung tumour. (2)

A 
Bronchial obstruction (breathlessness)
Retention pneumonia
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5
Q

Describe the symptoms of a peripheral lung tumour. (2)

A 
Fewer symptoms
Pleuritic pain (if pleura involved)
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6
Q

Describe the signs found on examination in lung cancer. (3)

A

Dullness to percussion
Opacity on CXR
Appearance on other imaging

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7
Q

List 7 non-metastatic effects of lung cancer.

A 
Endocrine effects
Encephalopathy
Cerebellar degeneration
Neuropathy
Myopathy
Eaton-Lambert (myasthenia-like) syndrome
Cancer associated retinopathy
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8
Q

List 3 endocrine paraneoplastic effects caused by lung cancer.

Briefly describe the symptoms you would see in each.

A

ACTH secretion: Cushing’s syndrome

  • Moon face
  • Easy bruising
  • Buffalo hump

ADH secretion: SIADH

  • Water retention
  • Hyponatraemia

Parathyroid hormone related peptide (PTHrP) secretion

  • Osteoporosis
  • Hypercalcaemia
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9
Q

List 10 effects of local metastasis of lung cancer.

A

PLEURA:
Malignant pleural effusion
Haemorrhagic pleural effusion

BLOOD VESSELS:
Invasion into blood vessels

PERICARDIUM:
Pericardial effusion
Arrhythmias

LUNG APICES:
Horner’s syndrome

MEDIASTINUM:
Superior vena cava obstruction
Recurrent laryngeal nerve invasion
Phrenic nerve palsy
Hilar lymph node enlargement
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10
Q

How does lung cancer spread? (2)

List some common sites of metastases.

A

Haematogenous, e.g.

  • Liver
  • Bone
  • Brain
  • Adrenal glands

Lymphatic, e.g.
-Cervical lymph nodes

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11
Q

What are the 3 main types of lung cancer?

A

Small cell
Non-small cell
Other

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12
Q

What are the 3 types of non-small cell lung cancer?

A

Squamous cell carcinoma
Adenocarcinoma
Large cell carcinoma

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13
Q

Apart from small cell and non-small cell, what are the 4 other types of lung cancer?

A

Carcinoid tumours (neuroendocrine cells)
Mesothelioma (pleura)
Lymphoma
Chondroid hamartoma

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14
Q

If a tumour is central, what types of cancer is it likely to be? (2)

A

Squamous cell carcinoma

Small cell carcinoma

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15
Q

If a tumour is peripheral, what type of cancer is it likely to be? (1)

A

Adenocarcinoma

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16
Q

Describe the features of small cell carcinoma. (4)

A

Most aggressive type of lung cancer
Good response to treatment BUT frequent relapses
White, fleshy tumour
Usually central

17
Q

Describe the histology of small cell carcinoma. (5)

A 
Oval/spindle shaped cells
Inconspicuous nucleoli
Scant cytoplasm
Nuclear moulding
Many mitotic bodies
18
Q

Describe the features of squamous cell carcinoma. (4)

What type of lung cancer is this?

A

Non-small cell

May be cavitating, with central necrosis
Usually central
Slow growing
Metastasise late

19
Q

Describe the histology of squamous cell carcinoma. (4)

A

Malignant epithelial tumour
Keratinisation
Intercellular bridges
In situ squamous cell carcinoma in adjacent airway mucosa

20
Q

Describe the features of adenocarcinoma. (2)

What sort of lung tumour is this?

A

Non-small cell

Usually peripheral
May have EGFR/ALK gene mutations

21
Q

Describe the histology of adenocarcinoma. (3)

A

Glandular, solid, papillary or lepidic
Mucin production
Signet ring cells

22
Q

Describe the features of large cell carcinoma. (3)

What type of lung cancer is this?

How would you diagnose it?

A

Non-small cell

Usually central
May have EGFR/ALK mutations
Undifferentiated tumour

Diagnosis of exclusion

23
Q

Describe the histology of large cell carcinoma. (2)

A

Undifferentiated

Lacking features of other types of cancer

24
Q

What are the 3 main types of metastatic cancer found in the lungs?

A

Carcinoma
Sarcoma
Teratoma

25
Q

Where do metastatic carcinomas in the lung commonly originate? (2)

A

Colon

Breast

26
Q

Where do metastatic sarcomas in the lung commonly originate? (1)

A

Muscles

27
Q

How would you treat lung cancer? (4)

Where relevant, give some examples.

A 
Chemotherapy
Radiotherapy
Immunotherapy (e.g. gefitinib for EGFR mutations)
Surgery, e.g.
-Metastatectomy
-Total pneumonectomy

8. Respiratory (14 decks)

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