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Respiratory 2 > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

What is the commonest cause of lung cancer?

A

Smoking

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2
Q

How does horners syndrome present?

A

Ptosis
Miosis - constricted pupil
Anhidrosis - loss of hemi facial sweating.

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3
Q

How does phrenic nerve palsy present?

A

Dyspnoea and orthopnoea

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4
Q

How does lung cancer originate?

A

Originates from epithelial cells in the respiratory tract. There are two main categories:
Small cell
Non-small cell

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5
Q

What do basal cells in the respiratory tract do?

A

Differentiate into other cells e.g goblet and ciliated.

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6
Q

What do club cells in the respiratory tract do?

A

Protect the bronchiolar epithelium.

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7
Q

What do neuroendocrine cells in the respiratory tract do?

A

Secrete hormones into the blood in response to neuronal signals.

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8
Q

What defines a malignant tumour?

A

A tumour able to break through the basement membrane.

> some detach metastasising.

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9
Q

What are some of the risk factors of lung cancer?

A 
Smoking
Radon gas
Asbestos
X-ray
CT scans
Genetics
Air pollution
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10
Q

What sites are prone to metastasis of lung cancer?

A

Mediastinum and hilar lymph nodes due to proximity to the lungs.

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11
Q

Small cell carcinomas form from what cells?

A

Small immature neuroendocrine cells - not that common.

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12
Q

What are the four categories of Non-small cell lung carcinomas?

A
  1. Adenocarcinomas - form glandular structures that generate mucin.
  2. Squamous cell - produce keratin
  3. Carcinoid tumours - form from mature neuroendocrine cells.
  4. Large cell carcinomas - lack glandular and squamous differentiation.
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13
Q

Outline small cell carcinomas.

A 
From small immature neuroendocrine cells.
> associated with smoking.
> develops near main bronchus.
> grows fast and rapidly metastasizes.
> Commonly large and in multiple sites.
> can secrete hormones
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14
Q

What is meant by paraneoplastic syndrome?

A

The secretion of hormones from a tumour e.g release of ACTH by lung small cell carcinoma causing release of cortisol from the adrenal glands.

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15
Q

Excess cortisol =

A

Cushing’s syndrome

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16
Q

What hormones can small cell carcinomas of the lung release and what effect will that have?

A

ACTH - cushings, inc blood glucose.

ADH - inc water retention, inc blood pressure, oedema.

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17
Q

How can small cell carcinomas of the lung cause lambert-eaton myasthenic syndrome?

A

The small cell carcinoma secretes autoantibodies which destroy neurons in a type 2 hypersensitivty reaction, causing LEMS.

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18
Q

Squamous cell carcinoma usually affect where in the lung?

A

Central lung

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19
Q

Adenocarcinoma usually affect where in the lung?

A

Peripheral lung

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20
Q

Large cell carcinoma and bronchial carcinoma usually affect where in the lung?

A

Throughout the lung - both centrally and peripherally.

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21
Q

Pancoast tumour

A

Tumours of the upper lung that can compress the blood vessels and nerves there - formed from squamous cell carcinoma and adenocarcinoma.

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22
Q

What condition can pancoast tumours cause?

A

Horner’s syndrome

23
Q

How can pancoast tumours cause Horner’s syndrome?

A

Pancoast tumours can damage:
Thoracic inlet
Brachial plexus - causes shooting arm pain and weakness.
Cervical sympathetic nerve

24
Q

How does Horner’s syndrome present?

A

Constricted pupil
Drooping upper eyelid
Loss of ability to sweat on the same side of the body as the dysfunctional sympathetic nerve.

25
Q

What is the classic neoplastic syndrome associated with squamous cell lung carcinoma and how does this present?

A

Release of parathyroid hormone - depletes calcium in bone leading to osteoporosis.

26
Q

What is the classic neoplastic syndrome associated with bronchial carcinoid tumours and how does this present?

A

Secretion of serotonin causing increased peristalsis and diarrhoea aswell as bronchoconstriction causing asthma.

27
Q

Explain the staging of lung cancer.

A

TNM Staging:
T umour size (T0-T4)
N spread to lymph Nodes (N0-N3)
M etastasis (M0-M1)

28
Q

Define cancer.

A

An abnormal growth of cells which tend to proliferate in an uncontrolled way and, in some cases, to metastasize (spread) - malignant.

29
Q

Define neoplasia.

A

The presence or formation of new, abnormal growth of tissue.

30
Q

What do the symptoms of lung cancer depend on?

A

Size of the tumour, location and whether it secretes hormones.
> symptoms tend to present late.

31
Q

What are some of the generalised systemic symptoms of lung cancer and how do they come about?

A

Weight loss, fever and night sweats.
> occur because the body mounts an immune response to the tumour cells causing release of cytokines, TNFa, IL1B and IL-6.

32
Q

What symptoms are seen if the tumour obstructs the airway?

A

Cough
Shortness of breath
Pneumonia

33
Q

How may nerve compression due to lung cancer present?

A

Pain
Compression of the recurrent laryngeal nerve may result in a change in voice.
Compression of the phrenic nerve may result in difficulty breathing.

34
Q

How may compression of blood vessels due to lung cancer present?

A

Compression of the superior vena cava for example may cause a backup of blood leading to facial swelling and shortness of breath.

35
Q

If a lung cancer invades into a blood vessel how may it present?

A

Blood tinged mucus

Coughed up blood clots

36
Q

How are lung cancers identified on X-ray / CT?

A

Coin lesion on x-ray.

Non-caclified nodule on a chest CT scan.

37
Q

How are lung cancers diagnosed?

A

Coin lesion on X-ray, however these can also appear due to infection.
> Thus tissue biopsy from bronchoscopy and CT-guided fine needle aspiration are used to gain a histopathological diagnosis.

38
Q

What are the treatment options available to treat lung cancer?

A

Surgery
Chemotherapy
Immunotherapy
Radiation therapy

39
Q

How is pain managed in lung cancer?

A

Yoga and guided imagery

Pain medication

40
Q

Minority of lung cancers are

Majority of lung cancers are

A

Minority of lung cancers are small cell.

Majority of lung cancers are non-small cell.

41
Q

Small cell lung cancers are located…

A

Centrally

42
Q

SVC syndrome

A

Tumour compresses the superior vena cava resulting in facial swelling and shortness of breath.

43
Q

A pancoast tumour can causes Horner’s syndrome by damaging what nerve bundle?

A

Cervical sympathetic chain.

44
Q

If a lung cancer has invaded the pleura what may you see?

A

Pleural effusion and a dull sound on percussion.

45
Q

Explain the pathology of lambert-eaton myasthenic syndome.

A

Antibodies secreted by small-cell lung cancers attack the presynaptic Ca2+ channels of the neuromuscular junction.
> causes muscle weakness

46
Q

Explain the presentation of hypertrophic osteoarthropathy

A

Adenocarcinomas of the lung can cause hypertrophic osteoarthropathy which presents with finger clubbing and joint pain and bone pain.

47
Q

What paraneoplastic syndrome may been seen with large-cell carcinomas?

A

Secretion of Beta-hCG which causes gynecomastia in males, and galactorrhea in females.

48
Q

How are small lung cell cancers treated and why?

A

Small lung cell cancers metastasise quickly and so have likely already metastasised by diagnosis. Therefore they are treated with a combination of radiotherapy and chemotherapy.

49
Q

Where does lung cancer most commonly metastasise?

A

Brain, liver, bone and adrenals - extrathoracic metastases.

Breast, gut, genitourinary, sarcomas - pulmonary metastases.

50
Q

What can cause clubbing of the fingers?

A

Lung cancer is the most common cause of clubbing. Clubbing often occurs in heart and lung diseases that reduce the amount of oxygen in the blood.

51
Q

What lung cancer markers may you test for?

A

EGFR and PD-L1

52
Q

PD-L1

A

PDL1 is a protein that helps keep immune cells from attacking non-harmful cells in the body.

53
Q

EGFR

A

Epidermal growth factor receptor.

54
Q

What is the most common form of lung cancer?

A

Squamous cell

Respiratory 2 (22 decks)

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