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Lung cancer Flashcards

1
Q

Pathology of neoplasia can present in 3 ways, what are they?

A 
Local effects (obstruction of airway etc.)
Metastases (nodes etc. )
Systemic effect (weight loss etc.)
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2
Q

What is the most common site of metastases of lung cancer?

A

the brain

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3
Q

A patient presents with pneumonia, how is this a presentation of lung cancer?

A

tumour partially obstructs bronchus of lobe, causing recurrent pneumonia infections

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4
Q

Localised chest wall pain, how could this be lung cancer?

A

Tumour invades chest wall, it can grow through intercostal spaces and the mass would lie deep to the pectoralis muscle.

Localised chest pain, worse with movement, if there is bone erosion, the pain can be described as worse at night.

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5
Q

A red flag for lung cancer is haemoptysis, what can cause this?

A

Fresh haemoptysis from the tumour which is ulcerating through the surface of the bronchial mucosa.

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6
Q

What are the neighbouring structures of the main bronchus which are prone to local invasion?

A 
Recurrent laryngeal nerve
Pericardium 
Oesophagus
Brachial plexus
Pleural cavity
Superior Vena Cava
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7
Q

Invasion of what would cause a hoarse voice?

A

recurrent laryngeal nerve - paralysis of vocal cord, tumour in upper lobe

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8
Q

Signs that a tumour has invaded the pericardium?

A

Atrial fibrillation
breathlessness
Pericardial effusion

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9
Q

Invasion of the oesophagus results in?

A

Dysphagia, particularly to solids

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10
Q

Which structure is invaded to cause weakness in the hand and what is the tumour called?

A

brachial plexus - Pancoast tumour

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11
Q

Lung cancers can cause ‘ectopic’ hormone production, give an example of this.

A

SIADH - Syndrome of Inappropriate antidiuretic hormone.

Results in low sodium concentration.

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12
Q

Which type of lung cancer is likely to cause SIADH?

A

small cell

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13
Q

What are signs of cerebral metastases?

A 
Insidious onset
Weakness 
Visual disturbance
Headaches - worse in morning
Fits
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14
Q

Which type of lung cancer is most common in smokers?

A

small cell

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15
Q

What are the types of carcinoma that make up NSCCs?

A

Large cell carcinoma
Squamous cell carcinoma
Adenocarcinoma

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16
Q

Which type of lung cancer is most common in non-smokers?

A

adenocarcinoma

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17
Q

How do you histologically diagnose lung cancer?

A

bronchoscopy + biopsy of tumour (if seen)

Biopsy ot needle aspiration of metastases - guided by USS. (mediastinal or supraclavicular lymph nodes)

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18
Q

Which cells do squamous cell carcinomas arise from?

A

epithelial cells

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19
Q

Hypercalcaemia due to ectopic production of PTH is associated with which carcinoma?

A

squamous cell

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20
Q

Which cells do adenocarcinomas arise from?

A

mucus-secreting glandular cells

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21
Q

Which cells do small cell carcinomas arise from?

A

endocrine cells

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22
Q

Which cells do large cell carcinomas originate from?

A

transformed epithelial cells

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23
Q

Which carcinoma is keratinising?

A

squamous

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24
Q

Which is the most malignant?

A

small cell

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25
Q

Which carcinoma is most likely to cavitate?

A

squamous cell

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26
Q

Which carcinoma is diagnosed by exclusion?

A

large cell

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27
Q

Which carcinoma is poorly differentiated?

A

large cell

28
Q

Which carcinoma has the worst prognosis?

A

small cell

29
Q

Which out of the NSCCs has the worst prognosis?

A

large cell

30
Q

What are the prognostic indicators?

A

tumour stage and histological subtype

31
Q

Which atypical hyperplasia is becoming commoner?

A

peripheral adenocarcinoma

- the spread of neoplastic cells along alveolar walls - bronchioalveolar carcinoma

32
Q

What is a CT scan used for in the prognosis?

A

TNM staging

33
Q

What is the primary malignant pleural neoplasm?

A

mesothelioma

34
Q

What is a mesothelioma?

A

An uncommon malignant tumour of the lining of the lung

35
Q

What increases the likelihood of developing mesothelioma?

A

The degree and length of time exposed to asbestos.

36
Q

What are some of the presenting signs of mesothelioma?

A

Used to work near asbestos (30-40 years ago).

SOB, chest pain, weight loss, fever, sweating & cough.

37
Q

What would imaging investigations find of mesothelioma?

A

Pleural nodularity
Circumferential pleural thickening
Local invasion
Lung entrapment

38
Q

What is the management of mesotheliomas?

A 
Radiotherapy
Surgery
Chemotherapy
Palliative care
Report deaths to fiscal
39
Q

What is a pleural effusion?

A

Abnormal collection of fluid in the pleural space

40
Q

Which types of effusion should raise concern?

A

large, unilateral effusion

41
Q

Which is the workup process of a pleural effusion?

A 
History + exam
PA CXR
Pleural aspirate (if not convincingly cardiac failure)
Biochemistry (transudate/exudate)
Cytology
Culture
42
Q

What is the protein content of a transudate effusion?

A

<30g/L

43
Q

What is the protein content of an exudative effusion?

A

> 30g/L

44
Q

What are some of the causes of transudate effusions?

A 
Heart failure
Liver cirrhosis 
Hypoalbuminaemia 
Hypothyroidism 
Peritoneal dialysis - renal failure
ITU / post-surgery
45
Q

Cardiac failure and hypoalbuminaemia would cause what colour of pleural fluid appearance?

A

straw-coloured

46
Q

What are some of the causes of exudative effusion?

A

malignancy
infection, including TB
pulmonary infarct
asbestos

47
Q

Trauma, malignancy, infection and infarction … what colour of pleural fluid?

A

bloody

48
Q

What causes a mild coloured pleural fluid?

A

empyema

chylothorax

49
Q

Food particles would be found in the pleural fluid if…?

A

the oesophagus was ruptured

50
Q

What would cause the pleural fluid to smell bad?

A

anaerobic empyema

51
Q

What would cause bilateral effusion?

A

LVF
PTE
drugs
systemic pathology

52
Q

What is the main/palliative treatment for malignant pleural effusions?

A

long-term pleural catheters

53
Q

What score is used to predict survival or malignant pleural effusions?

A 
LENT score
L- LDH 
E - ECOG PS (patient fitness score)
N - (serum) Neutrophil to lymphocyte ratio
T - tumour type
54
Q

In which type of cancer can surgery be curative?

A

early stage NSCC

55
Q

What is the treatment for SCC?

A

chemo + radiotherapy

56
Q

What is the treatment for NSCC?

A

surgery ± chemo

57
Q

What are the deciding factors for surgery to be a viable option?

A

Tumour not too near hilum
No evidence of metastases
FEV1 > 1.5L
No vocal cord paralysis

58
Q

What is the less invasive version of a thoracotomy?

A

minimal access VATS

59
Q

What is the intent of radical radiotherapy?

A

curative

60
Q

What is the aim of palliative radiotherapy?

A

delaying tactic - useful when metastasised

61
Q

Radiotherapy is well tolerated but what is the disadvantage?

A

Collateral damage; oesophagus, spinal cord, adjacent lung tissue

62
Q

What are the main things palliative treatment aims to improve/reduce in order to improve the patient’s quality of life?

A 
pain
breathlessness
cough 
anxiety
poor mobility
63
Q

What is the purpose of endo-bronchial palliative therapy?

A

Stent placement for stridor.

Stridor is distressing difficulty breathing (rope tightening) accompanied by an audible inspiratory wheeze.

64
Q

What are the signs that a tumour has invaded the SVC?

A

Puffy eyelids
Headache
Distended external jugular vein

65
Q

What are the signs of hypercalcaemia?

A 
Stones - renal/biliary stones
Bones - bone pain
Groans - abo pain, constipation
Thrones - polyuria
Psychiatric overtones - depression, anxiety, reduced GCS, coma

+ cardiac arrhythmias

66
Q

What is the treatment for hypercalcaemia?

A

Rehydration
If calcium still high and unchanged by fluids -> IV Bisphosphate
Treat underlying cancer (squamous)

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