Lung Cancer Flashcards
is a lung cancer more likely to be benign or malignant
malignant
what percentage of smokers die of lung cancer
20%
what are the risk factors for lung cancer
smoking, asbestos, nickel, chromates, radiation, atmosphere pollution
what are the local effects of a pulmonary neoplasia (3)
obstruction of airway (pneumonia), invasion of chest wall (pain), ulceration (haemoptysis)
what are the systemic effects of lung cancer
weight loss, eptopic hormone production
what hormone is produced in squamous cancer
parathyroid hormone (PTH)
what hormone is produced in small cell cancer
adrenocorticotropic hormone (ACTH)
what are the four most common smoking associated lung tumour classifications
adenocarcinoma, squamous carcinoma, small cell carcinoma, large cell carcinoma
what are the types of lung tumour less associated with smoking
neuroendocrine, bronchial gland
what is a squamous cell carcinoma definitely caused by
smoking
what type of lung cancer is most common in non smokers
adenocarcinoma
what methods are used to diagnose a tumour histologically
bronchoscopy and biopsy
why is classification of tumours important
for prognosis, treatment, pathogenesis/ biology, epidemiology
what is the type of lung cancer with the quickest mortality rate
small cell
which is worst; large cell, squamous or adenocarcinoma
large cell
what is the simplest classification of lung cancer
small cell lung cancer (SCLC) vs non (NSCLC)
how is lung cancer treated
surgical intervention, chemotherapy, new targeted treatments based on DNA
how can immunohistochemistry help distinguish between types of tumours
adenocarcinoma expresses thyroid factor 1, scc expresses nuclear antigen p63 + have high molecular weight
what mutation is seen exclusively in adencarcinoma
point mutations that render the EGFR gene active in the absence of a ligand
what do mutations with a EGFR gene mutation respond to
tyrosine kinase inhibitors
how can targeting the immune response be used in treat NSCLC
as it enhances the immune’s tumour killing response
list the two types of pulmonary epithelium from which carcinomas can arise and gives examples of each
bronchial (ciliated, mucous, neuroendocrine, reserve)
bronchioles/alveoli (clara cells, type 1 and 2 alveolar lining cells)
name the 4 bronchial (large airway) tumours
squamous metaplasia, dysplasia, carinoma in situ, invasive malignancy
what would you call the spread of neoplastic cells along alveolar walls
bronchioloalveolar carcinoma
what are the two prognosis indicators in lung cancer
tumour stage, tumour histological subtype
what is a primary malignant neoplasm called
mesothelioma
what type of tumours don’t tend to spread
carcinoid
what is cancer
uncontrolled growth of tumour cells
how can cancer spread
blood, lymph, serous cavities
what are paraneoplastic effects
systemic effect from biologically active molecules released from the tumour cell that mimic the effects of naturally occurring hormones
why does lung disease have such a poor prognosis
as symptoms don’t tend to develop until disease has reached an incurable stage
how is lung cancer presented
primary tumour, local invasion, metastases, non-metastatic (paraneoplastic)
what is haemoptysis
coughing up blood- tumour creates own fragile and leaky blood supply
why does a lung become smaller as a tumour grows
as the proximal divisions of the bronchial tree get obstructed and the lung tissue shrinks
what are the early symptoms of lung cancer (8)
haeoptysis, cough for more than 3 weeks, breathlessness, recurrent pneumonia/ chest infection that doenst clear up, weight loss, chest/ shoulder pains, tiredness, hoarse voice
what is stirdor
harsh inspiratory wheeze
what are the neighbouring structures that can be affected by local invasion (6)
recurrent laryngeal nerve, pericardium, oesophagus, brachial plexus, pleural cavity, superior vena cava
what causes a hoarse voice
paralysis of the vocal chords by invasion of the recurrent laryngeal nerve
what does local invasion of the pericardium cause
breathlessness, atrial fibrillation, pericardial effusion- fluid build up around heart, squashing it
what does invasion of the oesophagus cause
dysphagia- difficulty swallowing
what can muscle wasting of the hand be cause by
local invasion of the brachial plexus
what does pancoast mean
high up in lung
what is a pleural effusion
build up of fluid around lung
what is anasamoses
when the blood supply has to find an alternative route due to a blockage- invasion of the s.v.c
where are the common sites for primary lung cancer metastases (6)
liver, brain, bone, adrenal, skin, lung
what is the clinical presentation of a cerebral metastases
insidious onset- weakness (mimics stroke), visual disturbance, fits (epileptic when involves cortex) , headaches (raised intracranial pressure)
what are presentations of a bone metastases
pain, clinical fracture
what are presentations of a liver metastases
pain, in rare cases jaundice
what symptoms does adrenal metastases produce
usually none
what can metastatic deposits help identify
the original source
what are the non-metastatic symptoms of lungs cancer (paraneoplastic) (7)
finger clubbing, weight loss, thrombophlebitis, hypercalcaemia, hyponatraemia, weakness, hypertrophic pulmonary osteoarthropathy- HPOA
what can spinal metastases cause
paralysis
what is hyperthrophic pulmonary osteoarthropathy
pain caused by elevation of the periosteum from bone surface
why does thrombophlebitis occur in cancer patients
increased coagulability
hypercalcaemia;
stones
renal/biliary calculi
hypercalcaemia;
bones
bone pain
hypercalcaemia;
groans
abdominal pain/ constipation
hypercalcaemia;
thrones
polyuria
hypercalcaemia;
psychiatric overtones
anxiety, depression, coma
what type of cancer usually causes hypercalcaemia
squamous
how is hypercalcaemia treated
hydration, if severe iv bisphophonate
what is a cause of the weight loss associated with lung cancer
COPD/ pulmonary fibrosis
what is SIADH
syndrome of inappropriate antidiuretic hormone
what is hypercalcaemia caused by
hormones released by tumour
what type of cancer usually causes SIADH
small cell
what does SIADH
low sodium conc, generalised symptoms (nausea, seizures etc)
how id SIADH treated
treat cancer, fluid restriction
what investigations are used to diagnose lung cancer
full blood count, spirometry, chest x ray, ct scan of thorax, bronchoscopy, endobronchial ultasound, coagulation screen, PET
what investigation is not used to diagnose lung cancer
sputum cytology
what is a PET and what does it do
positron emission tomography- assesses function rather than structure via tissue uptake of radiolabelled glucose
what are the most common methods of making a tissue diagnosis (6)
bronchoscopy, CT guided biopsy, lymph node aspirate, aspiration of pleural fluid, endobonchial ultrasound, thoracoscopy
what is a commonly misdiagnosed for lung cancer
tuberculosis
what is another fusion oncogene that identifies a target for specific drug treatment
EML4-ALK
how can a cancer be staged for surgery
bronchoscopy, CT scan of brain and thorax, PET scan, mediastinoscopy/EBUS
describe small cell cancer
rapidly progressive, early metastases
how does small cell cancer respond to treatment
rarely suitable for surgery, good initial response to chemotherapy
describe how non small cell lung cancer (squamous and adeno carcinomas) are treated
curative options- surgery or radical radiology
palliative chemotherapies and new targeted treatment
what does PET stand for
positron emission tomography
outline the treatment for lung cancer after diagnosis
surgery, radiotherapy, chemotherapy, supportive care, palliative care
name two types of small cell cancer
squamous and andeno carcinoma
what needs to be considered before surgery
can it be removed, is it localised, will the patient survive, what will be the residual lung function
when is a pneumonectomy possible
when there is 2cm of disease free bronchus to close the hole
what is a pneumonectomy
removal of entire lung
what is a lobectomy
removal of a lobe
what is a thoracotomy
surgery to open chest
what is a VATS
video assisted thoracic surgery
what is the choice of chemotherapy drugs determined by
the cell type
describe staging for chemotherapy (3)
bronchoscopy/ tissue sampling (determines small cell/non), CT scan (tumour size, local invasion, nodes, metastases, performance status/ ECOG score (fit to cope with stress)
is cytotoxic chemotherapy curative
rarely, but longer survival
what type of cancer responds best
small cell
what is the biggest con of cytotoxic chemotherapy
major side effects
describe how cytotoxic chemotherapy is administered and what it entails
IV infusions every 3-4 weeks, outpatient visits
what does cytotoxic chemotherapy target
whole body- targets rapidly dividing cells
can cytotoxic chemotherapy pass the blood brain barrier
yes
what are the side effects of chemotherapy
nausea and vomiting, tiredness, bone marrow suppression (opportunistic infection and anaemia), hair loss, pulmonary fibrosis
what do new lung cancer treatments target
genetic mutations
describe radiotherapy (4)
ionising radiation- usully x rays, damage dividing cells
Radical- curative intent
palliative- useful for metastases, delaying
well tolerated
what is the collateral damage of radiotherapy
spinal chord, oesophagus (oesophagitis), adjacent lung tissue
what are two other cons of radiotherapy
maximum cumulative dose, only goes where its pointed- not god for sub clinical metastases
what is SABR
stereotactic ablative radiotherapy
compare SABR to normal radiotherapy
many more beams- each less powerful
what is the benefits of SABR
less collateral damage, total dose delivers to tumour higher- more effective
what is required for SABR
4D scanning
what are endobronchial therapies used to do
remove blockages and help with symptoms
how are endobronchial therapies completed?
with a bronchoscopy
name three palliative endobronchial therapies
stent insertion for stridor, photodynamic therapy, other laser therapy
what is co morbidity
presence of one or more diseases/disorders co-occurring with the primary disease
what determines lung cancer treatment
cell type, extent of the disease, co-morbidity, patients wishes
what is common co-morbidity in lung disease
smoking related diseases’ COPD, ischemic heart disease, peripheral vascular disease
what are 5 priorities in palliative care
pain, breathlessness. cough, anxiety, poor mobility
what is the average prognosis for lung cancer
half dead in 6 months, 1 in 20 survive for 5 years
apart from smoking what can cause lung cancer
asbestos and radon
