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Respiratory > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

What are the four major aspects of lung cancer presentation?

A
  • primary tumour
  • local invasion
  • metastases
  • paraneoplastic
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2
Q

Describe the effects of a primary tumour

A
  • Haemoptysis (coughing up blood)
  • Recurrent pneumonia
  • Stridor (wheeze on inspiration)
  • Shortness of breath
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3
Q

Why does the primary tumour cause haemoptysis?

A

It is very fragile and has a disordered blood supply so it bleeds easily

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4
Q

Why does a primary tumour cause pneumonia?

A

Compressed airway is a good environment for bacteria

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5
Q

Why does a primary tumour cause SOB?

A

The tumour reduces air getting into the lungs

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6
Q

Describe presentation of local invasion

A
  • recurrent laryngeal nerve - hoarse voice
  • pericardium - SOB & atrial fibrillation
  • oesophagus - dysphagia
  • brachial plexus - muscle wasting
  • pleural effusion
  • superior vena cava - obstruction causes gorging blood vessels in the neck
  • lump on the chest
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7
Q

Where can metastases be found?

A
  • cerebral
  • liver
  • bone
  • adrenal
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8
Q

Describe cerebral metastases

A

insidious onset, weakness, visual disturbances, headache, fits

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9
Q

Describe liver metastases

A

unusual particular capsule pain caused by stretching of the capsule

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10
Q

Describe bone &adrenal metastases

A

Bone - can press against spinal cord but most likely asymptomatic
Adrenal - y shaped above the kidneys

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11
Q

Describe paraneoplastic presentation

A
  • finger clubbing
  • hypertrophic pulmonary osteoarthropathy
  • thrombophlebitis (inflammation of superficial veins)
  • weight loss
  • hypercalcaemia
  • SIADH
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12
Q

What is hypertrophic pulmonary osteoarthropathy?

A

Periosteum lifts & enlarges as a reaction to the lung cancer the patients presents with pain

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13
Q

Where can hypercalcaemia be found?

A
  • stones (renal/biliary)
  • bones
  • groans (abdominal pain/constipation)
  • thrones (polyuria)
  • overtones (depression, anxiety)
  • cardiac arrhythmias
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14
Q

What is the treatment for hypercalaemia?

A

Rehydration or IV bisphosphate treatment of cancer

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15
Q

What does SIADH stand for?

A

Syndrome of inappropriate antidiuretic hormone

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16
Q

What does SIADH result in?

A

Low sodium

17
Q

Describe the treatment for SIADH

A

Treating the cancer, restricting fluid and sometimes use of democlocyline

18
Q

State nine important features of lung cancer history

A
  1. cough
  2. haemopytsis
  3. smoker
  4. breathless
  5. weight loss
  6. chest wall pain
  7. tiredness
  8. recurrent infection
  9. COPD or other lung related illness
19
Q

State eleven features of a lung cancer examination

A
  1. finger clubbing
  2. resp rate
    3 cough
  3. weight loss
  4. bloated face
  5. hoarse voice
  6. lymphadenopathy
  7. tracheal deviation
  8. dull percussion
  9. stridor
  10. enlarged liver
20
Q

What investigation would you carry out to diagnose lung cancer?

A
  • blood count
  • coagulation
  • Na, K, Ca, Alk phos
  • Spirometry
  • CXR
  • CT of thorax
  • PET scan
  • Bronchoscopy
  • Endobronchial ultrasound
21
Q

What is a PET scan?

A

Positron emission tomography - looks for metabolic activity by picking up labelled glucose

22
Q

What are the four common smoking associated types of neoplasm?

A
  • adenocarcinoma
  • squamous cell carcinoma
  • small cell carcinoma
  • large cell carcinoma
23
Q

Describe small cell carcinomas

A

They have the worst survival rate and almost always result in death within one year. They are rarely suitable for surgery but respond well to chemotherapy. Produced ACTH

24
Q

Describe non-small cell carcinomas

A

Squamous & adenocarcinoma have curative options involving surgery or radiotherapy

25
Q

What are the four treatments for lung cancer?

A
  • Surgery
  • Radiotherapy
  • Chemotherapy
  • Palliative Care
26
Q

State four questions asked before surgery

A
  1. can we cut it out?
  2. is the disease localised?
  3. will the patient survive the operation?
  4. what will the residual lung function be?
27
Q

What are the two types of lung surgery?

A

Pneumonectomy - lung out

Lobectomy - lobe out

28
Q

What tests must be done before surgery?

A
  • bronchoscopy
  • mediastinoscopy
  • CT brain scan
  • CT thorax
  • PET scan
29
Q

What tests must be done before chemotherapy?

A
  • bronchoscopy
  • CT scan
  • Performance status - ECOG score
30
Q

Describe cytotoxic chemotherapy

A

Rarely curative but longer survival, better response in small cell cancer but has major side effects. It is given as an IV infusion every 3/4 weeks as an outpatient visit. Whole body treatment targets rapidly dividing cells

31
Q

State five side effects of chemotherapy

A
  • nausea & vomitting
  • tiredness
  • bone marrow suppression
  • hair loss
  • pulmonary fibrosis
32
Q

Describe radiotherapy

A

Ionising radiation can have curative or palliative intent. It is well tolerated but has a maximum cumulative dose. It can have collateral damage and only goes where you point the beam so no use for treating mets.

33
Q

Explain SABR

A

Stereotactic ablative radiotherapy - alters the target while the patient breathes

34
Q

Name two treatments during palliative care

A

Cryotherapy

Endobronchial therapy - infusion of a stent to help with stridor

35
Q

What symptoms may be treated in palliative care?

A
  • pain
  • breathlessness
  • cough
  • anxiety
  • poor mobility
36
Q

Describe adenocarcinoma

A

Associated with mucous cells, TTF1, most common. Usually non-smokers, found in the peripheries

37
Q

What is the significance of ACTH secretion?

A

It is produced in the pituitary gland to increase secretion of corticosteroids, therefore the cancer may present as Cushing’s syndrome

38
Q

Describe squamous cell carcinoma

A

Central, associated with smoking, produces parathyroid hormone. May present as pneumonia.

39
Q

What is the significance of producing parathyroid hormone?

A

It causes calcium to leave the bone leading to hypercalcaemia

Respiratory (20 decks)

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