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Respiratory disease > Lung cancer > Flashcards

Lung cancer Flashcards

1
Q

causes

A 
1- smoking: 85% of cases  
2- environmental radon 
3- air radiation 
4-pulmonary fibrosis 
5-genetic susceptibility 
6-occupation
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2
Q

Investigations

A

1-Assessment
CXR/MRI/PET

CT- shows staging 
2-Biopsy: 
Bronchoscopy
Mediastinoscopy
3-Cytology:
FBC 
Liver function tests 
Calcium tests 
Lung function tests: Spirometry 
CT guided fine needle aspiration
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3
Q

Signs

A 
Horners: affects sympathetic nerves between brain and face- in squamous 
Lymphadenopathy 
Pancoast tumour 
Nail clubbing 
Hepatomegaly
Skin nodules 
Asthma 
Diarrhea
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4
Q

Symptoms

Explanation for symptoms

A 
1-cough: 3 weeks
2-SOB
3-wheeze 
4-raspy voice
5-haemoptysis 
6-unexplained weight loss
7-fever 
8-night sweats

1-3 tumour obstructing airway
5 tumour obstructing blood vessels and nerves
6-8 body response to tumour- releases IL8, tnk-ALPHA AND IL6 which lead to an inflammatory response

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5
Q

Treatment: how to assess who is fit for surgery based on history?

A 
Staging: TNM 
Fitness: 
1-Respiratory: 
-asthma
-smoker
-URTI
-obstructive disease-
-barrell chest 
2-CVS
-murmur
-HBP
-angina
-Stroke/TIA/MI
-Carotid bruits 
3-psychological:
-mental health
-social background 
-chronic pain conditions 
4-OTHER:
-Cirrhosis 
-Rheumatoid arthritis

Tests:
CVS- ECHO, ECG, ETT, angiogram
Respiratory: V/Q scan, arterial blood gas, spirometry, diffusion studies- involves administering small amounts of CO

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6
Q

Complications with staging and surgery (fatal and non fatal)

A

Post surgery death:

  • MI
  • Intra-thoracic bleed
  • Pneumothorax
  • PTE
  • Acute respiratory distress syndrome- waterlogged lungs
  • Bronchopneumonia

Non-fatal:

  • AF
  • MI
  • empyema
  • broncho-pleural fistula
  • wound infection
  • respiratory insufficiency

Complications in staging:

  • Other Nodules e.g, adrenal
  • collapsed lung
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7
Q

Definition?

A

The uncontrolled division of epithelial cells.
Depending on the epithelium involved it is divided into 2 major groups:
-Small cell carcinoma
-non-small cell carcinoma

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8
Q

Different types of non-small cell carcinoma and characteristics

A
  • adenocarcinoma: peripheral- not associated with smoking
  • bronchial- general-associated with smoking
  • Large cell- general
  • Squamous cell: central, associated with smoking
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9
Q

Pancoast tumour:

  • what is it
  • which types of tumour is it associated with
A

Mass of carcinogens cells which form on the upper lobes of the lungs and compress against blood vessels and nerves
Associated with squamous
Affects central nervous system and can lead to Horner’s- constricted eyelid and drooping eye

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10
Q

Characteristics of small cell carcinoma

A
  • associated with smoking
  • found centrally in the main bronchus
  • grows and metastasises very quickly- when it is diagnosed it is very advanced
  • known as limited when found in 1 lung and extended when found in both
  • cells divide so quickly they have little/no cytoplasm
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11
Q

Adenocarcinoma gene mutations and approved FDA treatments

A

-ALK rearrangement
-EGFR
-BRAF, HER2
-KRAS
treatments approved for-NIVOLUMAB
-ROS1
-BRAF
-EGFR
-ALK

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12
Q

Squamous cell gene mutations and treatment

A

No addictive oncogenes recognised
Mainly tumour suppressor gene inhibitors
Not much option for treatment

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13
Q

What is an addictive oncogene?

A

pathway which a tumour heavily depends on for progression

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14
Q

What are immune checkpoint inhibitors?

Example

A

Immune checkpoints are used by tumour cells to overcome the immune system response
Immune checkpoint inhibitors prevent the tumour cells from using these
e.g. Nivolumab

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15
Q

Advanced symptoms

A
  • Bone pain
  • Spinal cord compression: limb weakness, paraestesia, bladder and bowel problems
  • cerebral: headache, dizziness, vomiting, ataxia
  • Thrombosis
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16
Q

Paraneoplastic syndromes

A 
Hormonal
-ADH release-increased BP, concentrated urine due to water retention 
-Hypercalcemia 
-Cushing's- associated with weight gain and obesity 
Skeletal:
-Finger clubbing 
-Hypertrophic pulmonary osteoarthropathy
Neurological:
-Eaton-lambert myasthenia 
-Horner's- related to central nervous system 
-polyneuropathy 
-encephalopathy 
Haematologic: 
-granulocytosis 
-Eosonophilia
17
Q

What leads to hypercalcemia

Which type of cancer leads to it?

A

Squamous cell carcinoma:
Release of Parathyroid hormone
Deplets calcium supply from the bones
Leads to brittle bones

18
Q

What leads to Diarrea and asthma

Which type of cancer leads to it?

A

Bronchial:
Releases serotonin which:
-causes bronchioles-constriction
-increases peristalsis

19
Q

TNM staging

A

Used to diagnose how severe the tumour is
T0-T4
N0-3
M0-1

20
Q

T staging

A

T1<3cm- no involvement of the main bronchus,lobar
T2<5cm-invasion of visceral pleura, main bronchus, hilarity lymph nodes
T3<7cm- invasion of mediastinum, parental pleura, phrenic nerve

T4>7cm- invasion of carina,invasion of heart, great vessels, trachea/oesophagus, vertebra
Ipsilateral nodules

21
Q

M staging

A

Mo- no distant metastases

M1- distant metastases

22
Q

staging based on performance status

A 
0- fully active 
1- symptomatic but mobile 
2- at rest <50% of day
3- at rest >50% of day
4- bed bound
23
Q

General staging?

A
  • history/ clinical examination
  • performance status
  • Pulmonary function
  • TNM staging
24
Q

Areas to consider in radiology

A 
Mediastinum:
- hilar region
-Trachea should be central and there should be no widening 
Lungs:
-compare lobes 
-check behind the heart 
Lesions 
Lung apices
Behind the diaphragm
25
Q

Non surgical management of NSCLC

A

stage 1/2: surgery
stage 3: chemotherapy- radiation
stage 4: inoperable- palliative care

Median survival with our treatment: 8 months
Median survival with treatment: 16 months

26
Q

Non surgical management of SCLC

A

When limited: chemo is first line of therapy with a combination of drugs
When extended: 4 rounds of chemo or radiation if not responsive
Median survival: 8 months with or without treatment

27
Q

How to improve treatment of cancer

A

Education on possible symptoms
Screening programmes
Multidiscplinary team meetings
Specialist nurses

28
Q

How long does it take an NSCLC to double/ SCLC to double

A

NSCLC: 129 days
SCLC: 29 days

29
Q

Fiberoptic bronchoscopy

A

flexible tube is used

30
Q

What is thoracotomy?

A

First incision into the chest to gain access to the pleural space- lungs

31
Q

What is a lobectomy

A

Removal of a lobe of the lungs

Not performed in patients that that have tumours which have metastasised

32
Q

Which cancer is associated with ADH increase, Eaton Lambert syndrome and Cushing’s

A

Small cell carcinoma:

  • Relases cortisol- leads to Cushing’s
  • Autoimmune disease- leads to Eaton lamber syndrome
  • release of ADH associated with water retention, increased BP and increased oedema
33
Q

Which type is associated with Horner’s?

A

Squamous cell
Pancoast tumour presses against central sympathetic nerve
Leads to pupil constriction and dropping eyelid

34
Q

Eaton Lambert syndrome

A

Muscle weakness which worsens at rest

Respiratory disease (35 decks)

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