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Jess Resp > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

What is the primary cause of lung cancer? What are some other causes?

A

Smoking is primary cause

Occupational exposure, radiation, genetic factors

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2
Q

Name 3 general presentations of lung cancer

A

Weight loss, appetite loss, lethargy

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3
Q

Name 4 symptoms related to having a primary lesion in the lung

A
  1. cough
  2. dyspnoea
  3. wheezing
  4. hemoptysis
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4
Q

What 3 main things can occur as a result of lung cancer spreading locally in the thorax?

A
  1. Pleural/pericardial effusion
  2. Mediastinal structures; dysphagia, SVC obstruction - facial plethora
  3. Various nerve damage: a) Recurrent laryngeal nerve - hoarseness
    b) phrenic nerve - breathlessness
    c) sympathetic chain: can lead to horner’s syndrome
    d) Tumours can impact the brachial plexus
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5
Q

What are 4 symptoms of distant metastasis

A
  1. Bone pain/fractures
  2. CNS signs: seizures, personality changes, headache
  3. Liver pain
  4. Lymphadenopathy; palpable lymph nodes in neck
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6
Q

Name the most common paraneoplastic syndrome that can result from lung cancer

A

Endocrine: hormone substances released from the tumour; hypercalcemia can result as PTH is released from squamous cell carcinomas, cushing’s syndrome releases ACTH and inappropriate ADH may be released from small cell carcinomas

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7
Q

What are the other 3 paraneoplastic syndromes that can occur?

A
  1. Hematological: anemia caused by factors released by the tumour
  2. Cutaneous: dermatomyositis: inflammation of the skin and underlying muscle tissue
  3. Skeletal: finger clubbing
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8
Q

Name 3 investigations for lung cancer

A
  1. X-ray
  2. CT scan
  3. bronchoscopy; visualize and for biopsy
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9
Q

Are there blood tests specific for lung cancer?

A 
No, can do serum biochemistry instead:
Na+: identifies inappropriate ADH
Calcium: identifies hypercalcemia 
Liver function test: if there is liver metastasis
FBC: identifies anemia
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10
Q

How would you assess the patient’s ability to undergo surgery?

A

ECHO cardiogram and respiratory function test (as many lung cancer patients will be smokers and have some degree of disease in the lungs)

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11
Q

Compare the 3 radiological investigations that can be done

A

MRI: better to visualize tumours and soft tissue contrasts

PET CT: good to identify metastasis after staging a patient

Isotope Bone scan: if you suspect bone metastasis

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12
Q

What might you be able to observe from a cytology sample in lung cancer?

Where could you obtain a biopsy from?

A

Atypical cells and nucleoli may be enlarged and variable sizes

Biopsy: transthoracic, transbronchial, biopsy of the metastasis

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13
Q

How would you need to make a pathological diagnosis?

A

Using histology; need cytology material and can also do a tissue biopsy sample

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14
Q

What are the main 2 things you need to know about the tumour?

A
  1. Bronchial or metastasized

2. Tumour primary or secondary

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15
Q

Name 6 cancers that commonly spread to the lungs

A

Breast, prostate, colonic carcinomas, endometrial carcinomas, melanomas and sarcomas

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16
Q

What is the main age group of patients diagnosed with lung cancer? Which gender is it more common in?

A

65-80, men

17
Q

What 5 investigations would you do to obtain a tissue diagnosis?

A
  1. transthoracic biopsy
  2. mediastinal biopsy
  3. transbronchial biopsy
  4. EBUS fine aspiration of lymph nodes
  5. pleural tap and pleural biopsy
18
Q

What are the main types of primary lung cancer?

A
  1. Small cell carcinoma
  2. Non small cell carcinoma: squamous, adenocarcinoma and large cell carcinoma
  3. Unusual tumours
19
Q

What are the characteristics of squamous cell carcinoma?

A
  1. often central tumours
  2. angulate cells
  3. keratinization: keratin pearls
  4. eosinophilic cytoplasm
  5. intercellular bridges
20
Q

What are the characteristics of adenocarcinoma?

A
  1. often peripheral
  2. columnar/cuboidal
  3. form glands
  4. papillary structure
  5. some produce mucin
  6. can line the alveoli
21
Q

List some characteristics of small cell carcinoma

A

“Oat cell carcinoma”

  1. small nuclei and little cytoplasm
  2. very cellular
  3. nuclear moulding
  4. often necrosis and lots of mitosis
22
Q

Name 4 things that can result from the spread of lung cancer locally into the lung?

A
  1. Necrosis
  2. Ulceration: hemoptysis
  3. Infection: abscess formation
  4. bronchial obstruction; consolidation
23
Q

Which patients are deemed able to undergo surgery?

A

Fit enough (passed ECHO and/or resp function test) and have tumour is confined to the lungs with limited nodal involvement

24
Q

What is the prognosis of lung cancer? What factors does the prognosis depend on?

A

10-15% live 5 years.

Overall prognosis depends on: cell type (small cell worst), stage of disease, level of patient fitness, biochemical markers and co-morbidities

25
Q

What is the key to improving lung cancer prognosis?

A

Early diagnosis, as many cases present as emergencies

26
Q

What are the treatment options for lung cancer?

A

Involves multi-disciplinary team

  1. Surgery
  2. radiotherapy
  3. chemo
  4. palliative care
27
Q

List 4 things you could do as part of management of non small cell cancer

A
  1. Palliative radiotherapy
  2. chemo
  3. Combination chemo-radio therapy
  4. targeted agents
28
Q

Which targeting agents could you use in non small cell cancer?

A
  1. EGFR antagonists
  2. ALK inhibitors (patients with ALK mutated tumours)
  3. Immunotherapy to allow the patient’s immune system to mount a response against the tumour
29
Q

How would could you manage small cell carcinoma? What is the prognosis without treatment and where does the cancer frequently metastasize?

A

Death in 3 months with no treatment, good responsiveness to chemo - often cerebral metastasis

30
Q

What are some grounds for optimism for future lung cancer prognosis?

A
  1. Developing personalized treatment
  2. New biological targeted agents
  3. better surgical techniques
  4. more effective radiotherapy
  5. Better screening and early diagnosis

Jess Resp (20 decks)

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