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Respiratory KC > Lung Cancer > Flashcards

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
Q

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 _______.

A

Pulmonary embolis
bronchus
haemoptysis

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26
Q

Common sites of metastases in lung cancer (6)

A 
liver
brain
bone
adrenal
skin
Lung
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27
Q

Features of cerebral metastases in lung cancer

A 
Gradual onset of: 
Weakness
visual disturbance
headaches 
fits
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28
Q

Features of headaches due to metastases?

A

worse in the morning
worse with sneezing
not photophobic
due to increase in ICP

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29
Q

Treatment for cerebral metastases?

A

high dose corticosteroids i.e. dexamethasone (ICP)
radiotherapy (tumour)
chemotherapy (tumour)

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30
Q

Particularly abnormal in Liver Metastases?

A

Alkaline Phosphatase

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31
Q

Clinical presentation of bone metastases?

A

non-specific ache away from joint
unusual pain
fracture during trivial mechanical stress
localised pain worse at night

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32
Q

Metastases in the adrenal glands ______ cause symptoms but are indicators of ________ disease

A

don’t

advanced

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33
Q

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?

A

It is important to establish whether they can undergo further treatment.

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34
Q

Non-metastatic signs of lung cancer (7)

A 
finger clubbing
hypertrophic pulmonary osteoarthropathy
weight loss
thrombophlebitis
hypercalcaemia
hyponatraemia
weakness
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35
Q

Other causes of finger clubbing (not lung cancer)

A

liver disease - hep C
congenital cyanotic heart disease
bacterial endocarditis
bronchiectasis

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36
Q

What is hypertrophic pulmonary osteoarthropathy?

A

inflammation and expansion of the outer layer of bone

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37
Q

Presentation of hypertrophic pulmonary osteoarthropathy?

A

pain and tenderness of long bones due to elevation of the periosteum away from the bone surface

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38
Q

Weight loss is very non-specific. What histories are required to understand weightloss in the context of lung cancer?

A

GI
Resp.
Bones
Age

39
Q

What is thrombophlebitis?

A

inflammation of the veins - very common

40
Q

What is the cause of thrombophlebitis?

A

increased coagulability of blood

41
Q

What is hyponatreamia and how does it present?

A

low sodium causing confusion

42
Q

Weakness is presented as Eaton Lambert Symdrome. This mimics…

A

myaethenia gravis which resolves if primary tumour is resected

43
Q

I have a history of a cough, you ask…

A 
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
Q

Patients rarely volunteer information about…

A

haemoptysis

45
Q

I come to you having coughed up some blood, what do you ask?

A

How much blood was it?
Has this happened before?
What colour is it, fresh red or dark red?

46
Q

You are taking a history and I reveal I am a cigarette smoker, what questions might you ask?

A

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
Q

Differential diagnosis for breathlessness?

A

PE, Pleural effusion, pericardial invasion, COPD, infection, lung cancer

48
Q

On examination in a patient you might be concerned about lung cancer, what are you look, listening and feeling for?

A 
finger clubbing
cough
bloated face
lymphadenopathy
dull percussion
enlarged liver
breathlessness
weightloss
hoarse voice
tracheal deviation
stridor
49
Q

What investigations are common when investigating a potential lung cancer?

A 
FBC 
Spirometry - FEV1
CXR
CT of thorax
PET scan
Bronchoscopy
Endobronchial Ultrasound
50
Q

What do you not test for when looking for lung cancer?

A

sputum cytology

51
Q

Which FBCs and bloods do you need in lung cancer suspect?

A

FBC
Na, K, Ca, Alk Phos
LFTs
Coagulation screen

52
Q

What areas do you expect to light up in a PET scan?

A

Bladder and brain

highish in liver and spleen

53
Q

Differential diagnosis in a smoker with haemoptysis and abnormal CXR

A 
Lung cancer
TB
Vasculitis
PE
Secondary cancer
Lymphoma
Bronchiectasis
54
Q

What needs to be considered with CT guided biopsy?

A

if lung is healthy enough to withstand 10% chance of pneumothorax

55
Q

Options for obtaining a tissue diagnosis?

A 
bronchoscopy
CT guided biopsy
Lymph node aspirate
aspiration of pleural fluid
EBUS
Thoracoscopy
56
Q

Benign neoplasm in the lung

A

hamartoma

57
Q

Why are metastases in lung cancer very common?

A

the lungs get all the blood so it is easy for the cells to get around the body

58
Q

What are common clinical presentations of patients experiencing the local effects of lung cancer?

A

obstruction of the airway (pneumonia)
invasion of the chest wall (pain)
Ulceration (haemopytsis)

59
Q

4 common types of lung cancer

A

adenocarcinoma
squamous carcinoma
small cell carcinoma
large cell carcinoma

60
Q

TNM staging is used for lung cancer…what does this stand for?

A

Tumour
Nodes
Metastases

61
Q

What role does immunohistochemistry have to play in identifying cancer?

A

can identify specific expression of tumour suppression factors or oncogenes for targeting via drugs

62
Q

What is mutated in the marjority of adenocarcinomas particularly in non-smokers and asian populations?

A

EGFR

63
Q

What is Lambert-Eaton Syndrome?

A

Paraneoplastic syndrome - weakness that mimics myaesthenia gravis but resolves if primary tumour is resected.

64
Q

How much fluid does the pleura normally contain?

A

4ml

65
Q

How much pleural fluid is needed to be visualised on an x-ray?

A

200ml

66
Q

What type of pleural effusions should cause concern?

A

large unilateral effusions

67
Q

Investigates for a pleural effusion might be?

A 
PA CXR
Pleural Aspirate
Biochemistry
Cytology
Culture
?CT chest
68
Q

If you are unusure if the opacity is fluid on the CXR what can you do?

A

repeat CXR while patient is on their side, the fluid will move and create a straight line at the top

69
Q

What might you suspect with straw-coloured effusion?

A

heart failure or hypoalbunaemia

70
Q

What might you suspect with blood in the effusion?

A

malignancy, trauma, infection, infarction

71
Q

What might you suspect with a milky or turbid effusion?

A

empyema, chylothorax

72
Q

Transudates are…

A

protein <30g/L

73
Q

Exudates are…

A

protein >30g/L

74
Q

Transudates are associated with…(5)

A 
HF
Liver Cirrhosis
Hypoalbuminaemia
Atelectasis
Peritoneal dialysis
75
Q

Exudates are associated with…(4)

A

Malignancy
Infection incl. TB
Pulmonary infarct
Asbestos

76
Q

A pH of less than 7.3 suggests…

A

pleural inflammation i.e. malignancy or RA

77
Q

A pH of less than 7.2 must…

A

be draind

78
Q

Where would glucose be expected to be low in an effusion?

A

Infection, RhA, Malignancy, oesophageal rupture, SLE

79
Q

What two types of non-malignant cell type may be present in an effusion?

A

lymphocytes - TB, malignancy

Neutrophils - acute onset

80
Q

apart from asbestos workers, who may also get mesothelioma?

A

people associated with those who worked with asbestos

81
Q

how long does mesothelioma take to develop?

A

30-40 years post exposure

82
Q

Symptoms that may present with mesothelioma (6)

A

breathlessness; chest pain; weight loss; fever; sweating; cough

83
Q

Investigations in mesothelioma?

A

Imaging
Pleural fluid aspiration
Biopsy

84
Q

Treatment options include:

A

Pleurodese effusions; radiotherapy; chemotherapy; surgery; palliative care

85
Q

What might be done to relieve pleural effusions as a result of mesothelioma?

A

Talc slurry

Long term pleural catheters

86
Q

Complications in the use of talc slurry (6)

A

pleuritic pain; fever; pneumonia; resp. failure; talc pneumonitis; secondary empyema

87
Q

Complications of long-term pleural catheters (3)

A

incorrect placement; bleeding; infection

88
Q

Which cancers particularly metastasise to the pleura?

A

lung; breast; upper GI; lymphoma; melanoma; ovarian

89
Q

Median survival for mesothelioma

A

3-12 months

90
Q

What score is used for predicting survival in mesothelioma?

A

LENT

91
Q

L in LENT…

A

LDH in pleural fluid
<1500 = 0
>1500 = 1

92
Q

E in LENT…

A 
ECOG PS - functioning in daily life 
0=0
1=1
2=2
3-4=3
93
Q

N in LENT

A

Neutrophil to lymphocyte ratio
<9 = 0
>9 = 1

94
Q

T in LENT

A 
Tumour type 
Lowest Risk (0); meso, haematological
Medium risk (1); breast, gynae, renal
HIgh risk (2); lung, other types

Respiratory KC (20 decks)

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