LUNG CANCER Flashcards by Emma Hill

what are some s/s of lung cancer

haemoptysis
weight loss
recurrent pneumonia
stridor
hoarse voice
breathless
cough
finger clubbing

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what should be done if you come across new finger clubbing

CXR

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what would a hoarse voice with lung cancer imply

invasion of recurrent laryngeal nerve

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what would be seen if a lung cancer invaded the pericardium

breathless
AF
pericardial effusion

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what would be seen if the lung cancer invaded the oesophagus

dysphagia

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what structure has a lung cancer most likely invaded if there is weakness in the upper limbs

brachial plexus

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what is seen if the tumour invades the pleural cavity

large volume of pleural fluid - SOB

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if pain associated with lung cancer is worse at night what is the most likely reason

tumour has invaded bone

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what is the initial stage in tumour development where gross appearance and histological finding are altered but there is no malignancy

squamous metaplasia

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what is the final stage in tumour development before becoming malignant

carcinoma in situ

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how are lung cancers diagnosed

bronchoscopy or biopsy

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can bronchoscopy differentiate between small cell and non-small cell

yes

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how are metastases diagnosed

biopsy or needle aspiration

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when can a lung cancer cause pneumonia

airway obstruction

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how would bronchial or lung carcinomas appear on radiograph

rounded solitary lesion - coin lesion

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what is paraneoplastic syndrome

ectopic hormone production - biologically active molecules are released from tumour cells and mimic effects of naturally occurring hormones

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what 2 hormones can small cell carcinomas secrete

ADH

ACTH

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what can ectopic secretion of ADH cause

hyponatraemia

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what is ACTH

corticosteroid produced by the pituitary gland in response to stress

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what does ectopic release of ACTH cause

Cushing's syndrome - moon face, weight gain, buffalo hump
hypertension
hypercalcaemia
alkalosis
muscle weakness

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what is lambert eaton syndrome

autoimmune disorder

paraneoplastic change, aka myasthenic syndrome caused by small cell lung cancer

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what happens in lambert eaton syndrome

autoantibodies directed towards presynaptic voltage gated calcium channels lead to reduced release of neurotransmitter ACh at neuromuscular junctions

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what is the result of lambert eaton syndrome

muscle weakness
depressed reflexes
autonomic dysfunction (postural hypotension)

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do small cell lung cancers respond well to chemotherapy

yes

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what method can be used to subtype lung cancers on small biopsies by identifying specific antigens

immunohistochemistry

what antigen is expressed in small cell lung cancers

nuclear antigen p63 | high molecular weight cytokeratins

cannonball metastases are usually from what type of cancer

renal carcinoma

where are small cell cancers more likely to be found

centrally

where are large cell cancers more likely to be found

peripheral

how do large cell cancers appear

large cells | prominent nuclei

true / false | necrosis and haemorrhage are frequent in large cell cancers as well as inflammation

true

what is meant by large cell cancers being anaplastic

poorly differentiated tumours with a poor prognosis

what may large cell cancers release

beta-HCG

where do squamous cells usually occur

near larger airways - centrally

what can squamous cells sometimes lead to due to their location

obstruction --> lobar pneumonia

what 2 hormones can squamous cells secrete

PTH - controls the distribution of calcium and phosphate in the body TSH

what does ectopic release of PTH cause

hypercalcaemia - headaches, confusion, thirst, constipation

what is meant by ectopic release of PTH causing stones bones groans and moans

stones - renal/biliary bones - pain groans - abdominal pain, nausea, vomiting moans - depression/anxiety

how does a squamous cell lung cancer appear

cavitating lung lesion - a gas or fluid filled space within a tumour mass or nodule

what is hypertrophic pulmonary osteoarthropathy (HPOA)

Bamberger-Marie Syndrome - clubbing and periostitis of the small hand joints, especially the distal interphalangeal joints pain and tenderness of long bones due to elevation of periosteum away from bone surface

do squamous cells metastasise earlier or later than small cells

later

do squamous cells present earlier or later than small cells

earlier due to obstructive symptoms

what 2 things might squamous cells produce

keratin pearls | thyroid transcription factor

what antigen is associated with squamous cell carcinoma

p63

what can ectopic production of TSH cause

hyperthyroidism

what is the most common type of lung cancer in non-smokers

adenocarcinoma

where is adenocarcinoma usually found in the lungs

peripherally

what are 3 features of adenocarcinomas

form mucous secreting glands (mucin) contain carbon pigment may show marred scarring

true/false | adenocarcinoma causes gynaecomastia

true

what does immunohistochemistry of adenocarcinoma show

expressed TTF1

what is the name of the variant of adenocarcinoma where the tumour cells spread along the alveolar walls

bronchioalveolar carcinoma

which subtype of bronchioalveolar carcinoma produces mucin

Mucinous tumours

what is another subtype of bronchioalveolar carcinoma

non-mucinous tumours - Clara or Type II cells with eosinophilic ciliated cytoplasm

what is the name of the low-grade malignant lung mass that is often in the central airways of the lung

carcinoid tumour

adenoid cystic carcinomas and mucoepidermoid carcinomas are types of what and are more often seen where

bronchial gland tumours | more often seen in salivary glands

what is a pancoast tumour

tumour of the lung apex

what do pancoast tumours frequently cause and how

horner's syndrome | tumour suppresses the sympathetic nerves on the ipsilateral side of neck

what are some s/s of hornet's syndrome

unilateral. .. - ptosis: droopy eyelid - miosis: contracted pupil - anhydrosis: lack of sweating

why is thrombophlebitis (blood clot in vein) more common in lung cancer patients

increased coagulability of blood

what is a mesothelioma

tumour of lining of lungs | assoc. asbestos

what mutation of the MAPK/ERK pathway is often seen in non-smokers

EGFR over expression

what mutation of the MAPK/ERK pathway is often seen in smokers

RAS

what is another kind of mutation seen in lung cancer in the MAPK/ERK pathway

BRAF

when is the EGFR mutation seen

almost exclusively in adenocarcinomas | especially in non-smokers and in asian populations

how is the EGFR gene mutated

specific point mutations | gene active in absence of ligand binding (epidermal growth factor)

how can EGFR mutations be seen

identified in DNA extracted from biopsy or cytology samples

what is erlotinib / gefitinib

tyrosine kinase inhibitor

what kind of cancer is erlotinib /gefitinib particularly effective for

lung adenocarcinomas with mutated EGFR

what kind of cancer is crizotinib particularly effect for

cancers involving EML4-ALK fusion oncogene

in what kind of cancer is the immune system targeted

NSCLC

what is the treatment of choice for non-small cell lung cancer

surgery

when is radiotherapy used

if target is < 5cm diameter

what are some examples of palliative lung cancer treatments

stent insertion for stridor photodynamic / laser therapy radioactive pellets

what can a CT of thorax show

tumour size lymph nodes mets local invasion brain mets (not thorax obv)

what does M0 mean

no distant mets

what does T1 mean

< 3cm

what does T2 mean

3-7cm

what does T3 mean

>7cm + invasion of other structure

what does T4 mean

any size + invasion of other structure

what does N1 mean

ipsilateral hilar or peribronchial lymph nodes

what does N2 mean

ipsilateral mediastinal or subcarinal lymph nodes

what does a bronchoscopy look for

vocal cord palsy proximity to carina - must be atleast 2cm disease free bronchus to be operable cell type

what does a mediastinotomy look for

lymph nodes with mets

what are some complications of lung tumours

``` S - SVC obstruction --> malar flush P - Pancoast tumour H - Horner's syndrome E - Endocrine neoplastic syndrome R - Recurrent laryngeal damage E - effusions ```

what is the most common lung cancer in smokers

squamous cell

true/false | small cell lung cancers are associated with neuroendocrine

true

Why does hypokalaemic alkalosis sometimes occur with a small cell lung cancer?

ACTH release indirectly caused high cortisol levels leading to hypokalaemic alkalosis

what type of cancer makes up 80% of cases

non-small cell

what type of cancer has gynaecomastia as a symptom

adenocarcinoma

what is the most common non-small cell lung cancer

adenocarcinoma then squamous cell carcinoma then large cell

what is seen on the CXR of mesothelioma

pleural thickening

what is seen on the biopsy of mesothelioma

blood filled pleural fluid

what is the treatment of mesothelioma

chemo

what do brain mets from lung cancer appear as

ring enhancing lesions

what are some s/s of brain mets from lung cancer

visual weakness and headaches comes on slowly worse in morning

what is a s/s bone mets

low impact fractures

what tumours are most likely to cavitate

squamous | then adeno