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The respiratory system > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

Describe the general features of cancer?

A
  • malignant growth
  • uncontrolled replication
  • local invasion
  • metastasis
  • non metastatic systemic effects
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2
Q

what does invasion of the recurrent laryngeal nerve cause?

A

Hoarse voice

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3
Q

what does invasion of the oesophagus cause?

A

Dysphagia

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4
Q

What does invasion of the pericardium cause?

A
  • Breathless
  • Atrial fibrillation
  • pericardial effusion
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5
Q

What can be a consequence of a pancoast tumour?

A
  • invasion of the brachial plexus

- can cause wasting of the small muscles in the hand

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6
Q

What happens when a tumour invades the superior vena cava?

A
  • blood drainage is obstructed from the head and neck

- causes rubor and visible distended veins

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7
Q

Where are common sites for lung metastases to occur?

A
  • liver
  • brain
  • bone
  • adrenal
  • skin
  • other sites on lung
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8
Q

describe symptoms of cerebral metastases?

A
  • insidious onset
  • weakness
  • visual disturbance
  • headaches
    - worse in the morning
    - not photophobic
  • fits
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9
Q

describe paraneoplastic symptoms of lung cancer?

A
  • finger clubbing
  • HPOA
  • weight loss
  • hypercalcaemia
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10
Q

Describe the treatment of hypercalcaemia

A
  • initial treatment is rehydration
  • IV bisphosphonate
  • treat underlying cancer
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11
Q

Describe the treatment of syndrome of inappropriate antidiuretic hormone?

A
  • treat underlying cause
  • restrict fluid to 1.5L per day
  • demeclocycline
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12
Q

What are the 4 lung cancers commonly associated with smoking?

A
  • Adenocarcinoma
  • squamous carcinoma
  • small cell carcinoma
  • large cell carcinoma
  • (neuroendocrine and bronchial gland tumours)
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13
Q

Which cancer type has the worst prognosis?

A

small cell (then large cell)

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14
Q

which type of lung cancer is sensitive to chemotherapy?

A

small cell

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15
Q

what is the treatment of choice for non small cell lung cancers?

A

surgery

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16
Q

what do adenocarcinomas express?

A

Thyroid transcription factor 1

17
Q

what do squamous carcinomas express?

A

nuclear antigen p63 and high molecular weight cytokines

18
Q

How can the immune response be targeted in lung cancer?

A
  • cancer expresses PD - L1
  • PD -L1 binds to the PD receptor on T lymphocytes inactivating the cytotoxic immune response
  • targeted therapy can inhibit this effect and enhance immune killing of the tumour
19
Q

describe the characteristics of small cell lung cancer?

A
  • rapidly progressive disease
  • early metastases
  • rarely suitable for surgery
  • good initial response to chemotherapy
20
Q

Describe the characteristics of non small cell lung cancer?

A
  • includes squamous and Adeno carcinomas
  • curative options are surgery or radical chemo
  • palliative chemo and new targeted treatment
  • accounts for the majority of lung cancers
21
Q

what should the doctor consider when considering surgery as a treatment option?

A
  • can we cut it out?
  • is the disease localised?
  • will the patient survive the operation?
  • what will the residual lung function be?
22
Q

What are the surgery options for lung cancer?

A
  • Pneumonectomy or lobectomy
23
Q

describe cytotoxic chemotherapy?

A
  • rarely curative but longer survival
  • better response in small cell cancer
  • major side effects
  • IV injections every 3-4 weeks
  • outpatient visits
24
Q

What is the target of cytotoxic chemotherapy?

A
  • rapidly dividing cells
25
Q

What are the side effects of chemotherapy?

A
  • nausea and vomiting
  • tiredness
  • bone marrow suppression
    - opportunistic infection
    - anaemia
  • hair loss
  • pulmonary fibrosis
26
Q

Describe radiotherapy?

A
  • ionising radiation: usually x-rays, external beam
  • radical: curative intent
  • palliative: delaying tactic, useful for metastases
  • well tolerated
27
Q

describe some of the issues with radiotherapy?

A
  • maximum cumulative dose
  • collateral damage: spinal cord, oesophagus, adjacent lung tissue
  • only goes where you point the beam: not good for subclinical metastases
28
Q

Describe stereotactic ablative radiotherapy?

A
  • many more beams
  • each beam is less powerful
  • less collateral damage
  • total dose to tumour is higher and so is more effective
  • but 4D scanning is required
29
Q

Describe endobroncial therapy?

A
  • stent insertion for stridor
  • photodynamic therapy
  • other laser therapy
30
Q

What determines treatment of lung cancer?

A
  • the cell type
  • the extent of the disease
  • co - morbidity
  • the patients wishes
31
Q

What are the co-morbitities related to lung cancer?

A

smoking related illnesses

for example: COPD, ischaemic heart disease

32
Q

What is the prognosis for lung cancer?

A
  • half die in 6 months
  • 1/20 survive for 5 years
  • very little survive over 15 years
33
Q

What are the causes of lung cancer?

A
  • tobacco smoking
  • asbestos
  • radon

The respiratory system (13 decks)

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