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year 1 > LUNG CANCER > Flashcards

LUNG CANCER Flashcards

1
Q

what are some s/s of lung cancer

A 
haemoptysis
weight loss
recurrent pneumonia
stridor
hoarse voice
breathless
cough
finger clubbing
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2
Q

what should be done if you come across new finger clubbing

A

CXR

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3
Q

what would a hoarse voice with lung cancer imply

A

invasion of recurrent laryngeal nerve

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4
Q

what would be seen if a lung cancer invaded the pericardium

A

breathless
AF
pericardial effusion

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5
Q

what would be seen if the lung cancer invaded the oesophagus

A

dysphagia

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6
Q

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

A

brachial plexus

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7
Q

what is seen if the tumour invades the pleural cavity

A

large volume of pleural fluid - SOB

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8
Q

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

A

tumour has invaded bone

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9
Q

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

A

squamous metaplasia

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10
Q

what is the final stage in tumour development before becoming malignant

A

carcinoma in situ

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11
Q

how are lung cancers diagnosed

A

bronchoscopy or biopsy

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12
Q

can bronchoscopy differentiate between small cell and non-small cell

A

yes

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13
Q

how are metastases diagnosed

A

biopsy or needle aspiration

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14
Q

when can a lung cancer cause pneumonia

A

airway obstruction

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15
Q

how would bronchial or lung carcinomas appear on radiograph

A

rounded solitary lesion - coin lesion

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16
Q

what is paraneoplastic syndrome

A

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

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17
Q

what 2 hormones can small cell carcinomas secrete

A

ADH

ACTH

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18
Q

what can ectopic secretion of ADH cause

A

hyponatraemia

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19
Q

what is ACTH

A

corticosteroid produced by the pituitary gland in response to stress

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20
Q

what does ectopic release of ACTH cause

A 
Cushing's syndrome - moon face, weight gain, buffalo hump
hypertension
hypercalcaemia
alkalosis
muscle weakness
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21
Q

what is lambert eaton syndrome

A

autoimmune disorder

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

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22
Q

what happens in lambert eaton syndrome

A

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

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23
Q

what is the result of lambert eaton syndrome

A

muscle weakness
depressed reflexes
autonomic dysfunction (postural hypotension)

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24
Q

do small cell lung cancers respond well to chemotherapy

A

yes

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25
Q

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

A

immunohistochemistry

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26
Q

what antigen is expressed in small cell lung cancers

A

nuclear antigen p63

high molecular weight cytokeratins

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27
Q

cannonball metastases are usually from what type of cancer

A

renal carcinoma

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28
Q

where are small cell cancers more likely to be found

A

centrally

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29
Q

where are large cell cancers more likely to be found

A

peripheral

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30
Q

how do large cell cancers appear

A

large cells

prominent nuclei

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31
Q

true / false

necrosis and haemorrhage are frequent in large cell cancers as well as inflammation

A

true

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32
Q

what is meant by large cell cancers being anaplastic

A

poorly differentiated tumours with a poor prognosis

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33
Q

what may large cell cancers release

A

beta-HCG

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34
Q

where do squamous cells usually occur

A

near larger airways - centrally

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35
Q

what can squamous cells sometimes lead to due to their location

A

obstruction –> lobar pneumonia

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36
Q

what 2 hormones can squamous cells secrete

A

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

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37
Q

what does ectopic release of PTH cause

A

hypercalcaemia - headaches, confusion, thirst, constipation

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38
Q

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

A

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

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39
Q

how does a squamous cell lung cancer appear

A

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

40
Q

what is hypertrophic pulmonary osteoarthropathy (HPOA)

A

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

41
Q

do squamous cells metastasise earlier or later than small cells

A

later

42
Q

do squamous cells present earlier or later than small cells

A

earlier due to obstructive symptoms

43
Q

what 2 things might squamous cells produce

A

keratin pearls

thyroid transcription factor

44
Q

what antigen is associated with squamous cell carcinoma

A

p63

45
Q

what can ectopic production of TSH cause

A

hyperthyroidism

46
Q

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

A

adenocarcinoma

47
Q

where is adenocarcinoma usually found in the lungs

A

peripherally

48
Q

what are 3 features of adenocarcinomas

A

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

49
Q

true/false

adenocarcinoma causes gynaecomastia

A

true

50
Q

what does immunohistochemistry of adenocarcinoma show

A

expressed TTF1

51
Q

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

A

bronchioalveolar carcinoma

52
Q

which subtype of bronchioalveolar carcinoma produces mucin

A

Mucinous tumours

53
Q

what is another subtype of bronchioalveolar carcinoma

A

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

54
Q

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

A

carcinoid tumour

55
Q

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

A

bronchial gland tumours

more often seen in salivary glands

56
Q

what is a pancoast tumour

A

tumour of the lung apex

57
Q

what do pancoast tumours frequently cause and how

A

horner’s syndrome

tumour suppresses the sympathetic nerves on the ipsilateral side of neck

58
Q

what are some s/s of hornet’s syndrome

A

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

59
Q

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

A

increased coagulability of blood

60
Q

what is a mesothelioma

A

tumour of lining of lungs

assoc. asbestos

61
Q

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

A

EGFR over expression

62
Q

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

A

RAS

63
Q

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

A

BRAF

64
Q

when is the EGFR mutation seen

A

almost exclusively in adenocarcinomas

especially in non-smokers and in asian populations

65
Q

how is the EGFR gene mutated

A

specific point mutations

gene active in absence of ligand binding (epidermal growth factor)

66
Q

how can EGFR mutations be seen

A

identified in DNA extracted from biopsy or cytology samples

67
Q

what is erlotinib / gefitinib

A

tyrosine kinase inhibitor

68
Q

what kind of cancer is erlotinib /gefitinib particularly effective for

A

lung adenocarcinomas with mutated EGFR

69
Q

what kind of cancer is crizotinib particularly effect for

A

cancers involving EML4-ALK fusion oncogene

70
Q

in what kind of cancer is the immune system targeted

A

NSCLC

71
Q

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

A

surgery

72
Q

when is radiotherapy used

A

if target is < 5cm diameter

73
Q

what are some examples of palliative lung cancer treatments

A

stent insertion for stridor
photodynamic / laser therapy
radioactive pellets

74
Q

what can a CT of thorax show

A

tumour size
lymph nodes
mets
local invasion

brain mets (not thorax obv)

75
Q

what does M0 mean

A

no distant mets

76
Q

what does T1 mean

A

< 3cm

77
Q

what does T2 mean

A

3-7cm

78
Q

what does T3 mean

A

> 7cm + invasion of other structure

79
Q

what does T4 mean

A

any size + invasion of other structure

80
Q

what does N1 mean

A

ipsilateral hilar or peribronchial lymph nodes

81
Q

what does N2 mean

A

ipsilateral mediastinal or subcarinal lymph nodes

82
Q

what does a bronchoscopy look for

A

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

83
Q

what does a mediastinotomy look for

A

lymph nodes with mets

84
Q

what are some complications of lung tumours

A 
S -  SVC obstruction --> malar flush
P - Pancoast tumour
H - Horner's syndrome
E - Endocrine neoplastic syndrome
R - Recurrent laryngeal damage
E - effusions
85
Q

what is the most common lung cancer in smokers

A

squamous cell

86
Q

true/false

small cell lung cancers are associated with neuroendocrine

A

true

87
Q

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

A

ACTH release indirectly caused high cortisol levels leading to hypokalaemic alkalosis

88
Q

what type of cancer makes up 80% of cases

A

non-small cell

89
Q

what type of cancer has gynaecomastia as a symptom

A

adenocarcinoma

90
Q

what is the most common non-small cell lung cancer

A

adenocarcinoma
then squamous cell carcinoma
then large cell

91
Q

what is seen on the CXR of mesothelioma

A

pleural thickening

92
Q

what is seen on the biopsy of mesothelioma

A

blood filled pleural fluid

93
Q

what is the treatment of mesothelioma

A

chemo

94
Q

what do brain mets from lung cancer appear as

A

ring enhancing lesions

95
Q

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

A

visual weakness and headaches
comes on slowly
worse in morning

96
Q

what is a s/s bone mets

A

low impact fractures

97
Q

what tumours are most likely to cavitate

A

squamous

then adeno

year 1 (45 decks)

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