LUNG CANCER Flashcards
what are some s/s of lung cancer
haemoptysis weight loss recurrent pneumonia stridor hoarse voice breathless cough finger clubbing
what should be done if you come across new finger clubbing
CXR
what would a hoarse voice with lung cancer imply
invasion of recurrent laryngeal nerve
what would be seen if a lung cancer invaded the pericardium
breathless
AF
pericardial effusion
what would be seen if the lung cancer invaded the oesophagus
dysphagia
what structure has a lung cancer most likely invaded if there is weakness in the upper limbs
brachial plexus
what is seen if the tumour invades the pleural cavity
large volume of pleural fluid - SOB
if pain associated with lung cancer is worse at night what is the most likely reason
tumour has invaded bone
what is the initial stage in tumour development where gross appearance and histological finding are altered but there is no malignancy
squamous metaplasia
what is the final stage in tumour development before becoming malignant
carcinoma in situ
how are lung cancers diagnosed
bronchoscopy or biopsy
can bronchoscopy differentiate between small cell and non-small cell
yes
how are metastases diagnosed
biopsy or needle aspiration
when can a lung cancer cause pneumonia
airway obstruction
how would bronchial or lung carcinomas appear on radiograph
rounded solitary lesion - coin lesion
what is paraneoplastic syndrome
ectopic hormone production - biologically active molecules are released from tumour cells and mimic effects of naturally occurring hormones
what 2 hormones can small cell carcinomas secrete
ADH
ACTH
what can ectopic secretion of ADH cause
hyponatraemia
what is ACTH
corticosteroid produced by the pituitary gland in response to stress
what does ectopic release of ACTH cause
Cushing's syndrome - moon face, weight gain, buffalo hump hypertension hypercalcaemia alkalosis muscle weakness
what is lambert eaton syndrome
autoimmune disorder
paraneoplastic change, aka myasthenic syndrome caused by small cell lung cancer
what happens in lambert eaton syndrome
autoantibodies directed towards presynaptic voltage gated calcium channels lead to reduced release of neurotransmitter ACh at neuromuscular junctions
what is the result of lambert eaton syndrome
muscle weakness
depressed reflexes
autonomic dysfunction (postural hypotension)
do small cell lung cancers respond well to chemotherapy
yes
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
