Lung cancer Flashcards
What is a paraneoplastic association with small cell lung cancer that produces a type II hypersentivity reaction against neurmuscular junctions?
Lambert - Eaton syndrome
Anti bodies against the Ca2+ channels in the PREsynaptic neuron
What are the most common Mutations in lung cancer?
p53
- squamous cell carcinoma
- small cell carcinoma
KRAS oncogene
- adenocarcinoma
PDL1
AML4 ALK
- non- small cell carcinnoma
- FISH identifies
EGFR:
non small cell - often adenocarcinoma
What other factors may be implicated outwith smoking?
Ionising radiation
Air pollution
Asbestos
What are some common symptoms of lung cancer?
Cough
Haemoptysis
Recurrent Pneumonia
Shortness of breath
Atelectasis
List some paraneoplastic disorders associatted with lung cancer:
SIADH
- small cell
Ectopic ACTH
- small cell
Hypercalcemia
- squamous cell
What investigations should be done when lung cancer is suspected?
Chest x-ray
Rule out TB
CT Scan
Fibreoptic Bronchoscopy
- with biopsy
Transthoracic fine needle aspiration
Bloods
- looking for paraneoplastic effects
Bronchial Washing
Video assisted thoracoscopic surgery
What are some emergency complications of lung cancer?
paraneoplastic
Spinal cord compression
SVC compression
What cells do small cell carcinomas derive from and what is their appearance?
neuroendocrine
small cells
hyperdense nuclei
very little cytoplasm
ovale shaped
What are the stages of small cell lung cancer?
limited
- confined to one hemithorax
- 30% of cases
Extensive:
- all other patients
What cells do sqaumous cell carcinomas derive from and what is their appearance?
where do they usually develop?
Central bronchial cells
- often from metasplastic squamous cells that were columnar
Stain pink - high keratin
Around the bronchi
- around the cartilage
What cells do Adenocarinoma derive from?
what is their appearance?
where do they usually develop?
Glandular cells such as mucus/ goblet cells.
large mucin glands
usually around the peripheral of the lungs.
- pleuritic pain
What cells do Large cell carcinoma derive from? what is their appearance and where do they usually develop?
poorly differentiated cells, mixture of SCC and adenocarcinomas.
Centrally located. highly aggressive.
Prior to treatment, what things need to be considered?
Heart functioning
Lung functioning
- to see if they are able survive without a lung.
- lung function
- ECG
- Echo
List some genetic treatments for lung cancer?
EGFR drugs:
- cetuximab
- Erlotinib
EML4 ALK inibitors
- Crizotinib
PDL1
- nivolumab
What cancers develop around the pleura of the lung?
Mesothelioma
most commonly associated with asbestos
What lung cancer is most likely to produce PTH like hormone, leading to hypercalcaemia?
Squamous Cell
What paraneoplastic syndromes are most associated with Small Cell lung cancer?
ATCH - Cushings
SIADH
What is the most common lung cancer over all?
adenocarcinoma
What cancer is least likely to metastasis?
Squamous cell
Which cancer produces large amounts of mucin?
Adenocarcinoma
What mutation is common associated with adenocarcinoma?
KRAS
Which type of lung cancer tends to undergo nuclear moulding?
Small cell carcinoma
What initial investigations are done in suspicion of lung cancer?
X-ray
CT - looking for nodal involvement
PET CT - looking for metastasis
Biopsy
- transthoracic aspiration
- bronchoscopy
- CT guided if on peripheral
- ultra sound guided of lymph nodes
Spudem
Bronchial wash
What cancers are highly associated with central masses?
Small cell
Squamous
Which cancers are most associated with smoking?
Small cell
Squamous
What cancer is TTF-1 positive?
Adenocarcinoma
What are the treatment options for Non small cell lung cancer, and which stages are operated on?
Surgery
- stages I and II (only some of 2 though)
Platinum based chemotherapy or Radiotherapy or Both
Name some side effects of radiation therapy for the lung:
Radiation pneumonitis
Radiation fibrosis
One of the types of cancer is also genetically tested, and there are three relatively common mutations found, which have medications. Which are they?
Adenocarcinoma
EGFR
- Erlotinib
ALK
- Crizotinib
PDL1
- Nivolumab
What is the treatment for Small cell Carcinoma?
Radiotherapy
Chemotherapy
Palliative care
Outwith chemotherapy and radiation what other palliative care treatments could be given?
Bronchial Stents
What are some common metastasis points of lung cancer?
Lymph nodes - mediastinal
Pleural space
Adrenal glands
Liver
Bone
Brain
What are the symptoms of Superior vena cava syndrome and how is it treated?
Dyspnea
Swollen face
Swollen Arm
Venous neck congestion
Steroids Vascular stents Anti-coagulation Surgery Chemotherapy
Which cancer is linked to p53 mutation
Squamous cell
