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MB1: Respiratory > Lung cancer > Flashcards

Lung cancer Flashcards

1
Q

How common is lung cancer

A

3rd in the UK

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2
Q

How many people survive lung cancer (%)

A

10%

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3
Q

where can a primary lung cancer invade locally

A 
Pericardium
Oesophagus 
Recurrent laryngeal nerve 
brachial plexus 
pleural cavity 
SVC
Chest wall
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4
Q

Common sites of metastases

A 
Brain
Liver
Bone 
Adrenal gland 
Skin 
Lung
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5
Q

paraneoplatic presentation of lung cancer

A

finger clubbing
HPOA - aches in legs due to thickening and detachment of periosteum from rest of bone
Weight loss
Hypercalcaemia

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6
Q

What condition can small cell cancer bring about

A

DIADH - syndrome of inappropriate antidiuretic hormone

low sodium Concn

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7
Q

what does SIADH present as and how is it treated

A 
Lethargy/confusion
Nausea and vomiting 
Seizures/coma 
Myoclonus 
Fluid restriction
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8
Q

How is cancer commonly presented

A 
Cough > 3 weeks
Weight loss
Hoarseness
Stridor
Haemoptysis
Unexplained tiredness 
breathlessness
Chest infection that doesn't clear 
Chest/shoulder pain
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9
Q

What would lung cancer patients present with on examination

A 
finger clubbing 
stridor 
dull percussion
tracheal deviation
hoarseness
weight loss
bloated face
cough 
breathless
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10
Q

How can a PET scan help to diagnose cancer

A

analyses tissue uptake of radiolabelled glucose, so shows areas of high metabolic activities such as cancers

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11
Q

What investigations can be carried out to look for cancers

A 
CT/CXR/PET
bronchoscopy
CT guided biopsy - risky
Endobronchial ultrasound 
thoracoscopy
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12
Q

Symptoms of hypercalcaemia

A 
Bones
Stones
Groans
Thrones 
Psychiatric overtones
Cardiac arrythmia
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13
Q

What type of cancer usually causes hypercalcaemia

A

squamous cell

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14
Q

breathlessness, AF and pericardial effusion suggests a tumour has infiltrated the _________

A

pericardium

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15
Q

if a tumour invades the oesophagus what would it potentially cause

A

dyspagia

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16
Q

a pancoast tmour is one that has invaded the _________ and causes ______

A

Brachial plexus

Muscle wasting

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17
Q

True/false - a pleural effusion can be causes when a tumour infiltrates the pleural cavity

A

true

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18
Q

SVC invasion would cause

A

engorged veins in neck and distended abdominal veins

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19
Q

if a patient had a PC of chest wall pain it is likely the tumour has infiltrated?

A

yes

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20
Q

if a lung metastasis entered the brain what could it cause

A

fits, weakness, visual disturbance, not photophobic headaches

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21
Q

if a lung metastasis entered the liver what could it cause

A

jaundice
enlarged liver
pain

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22
Q

How common is a benign primary lung tumour

A

rare

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23
Q

how common is a malignant primary lung tumour

A

common

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24
Q

how common is a secondary metastatic lung tumour

A

common

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25
Q

what can cause lung cancer

A 
tobacco smoke - polycyclic hydrocarbons
Asbestos
Radiation
Genes
Pollutants
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26
Q

What hormone does squamous cell cancer produce

A

PTH

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27
Q

What hormone does small cell cancer produce

A

ACTH

28
Q

4 types of smoking related lung cancer

A

Adenocarcinoma
Large cell carcinoma
Small cell carcinoma
squamous cell carcinoma

29
Q

how does ademocarcinoma appear

A

forming a gland

30
Q

how does squamous cell carcinoma appear

A

ketatinising

31
Q

how does large cell carcinoma appear

A

less dense and more spread out

32
Q

how does small cell carcinoma appear

A

small

tightly packed and dense

33
Q

What type of carcinoma has the worst prognosis

A

small cell carcinoma

34
Q

what type of carcinoma is most common

A

adenocarcinoma

35
Q

true/false - small cell carcinoma is the only carcinoma that can be surgically removed

A

false - all others can be surgically removed but small cell

36
Q

what carcinoma has initial response to chemo but rapid resistance

A

small cell

37
Q

what does adenocarcinoma express that is useful for immunohistochemistry

A

TTF1

38
Q

what does squamous carcinoma express that is useful for immunohistochemistry

A

p63

high molecular weight cytokeratins

39
Q

Treatment targets for small cell carcinoma

A

oncogenes - myc

Tumour suppressor - p53, Rb, 3p

40
Q

Treatment targets for non small cell carcinoma

A

oncogenes - myc, K-ras, EGFR

Tumour suppressor - p53, Rb, 1,3,9,11q

41
Q

what oncogene is often activates by non smokers in adenocarcinoma and how is it identified

A

EGFR

biopsy or cytology, treated with tyrosine kinase inhibitors

42
Q

What fusion oncogene can be used to identify a drug treatment target

A

EML4-ALK

43
Q

how do some lung cancers activate the cytoxic immune response

A

PD-L1 binds to PD receptor on T cells

inhibited by targeted therapy

44
Q

what is a primary malignant neoplasm

A

mesothelioma

45
Q

true/false - pleural neoplasia is commonly malignant

A

true

46
Q

what is a carcinoid

A

neuroendocrine neoplasm with low grade malignancy

47
Q

where is a bronchial gland neoplasm often found

A

salivary glands

48
Q

where would a pripheral adenocarcinoma be found and how common is it

A

becoming more common

neoplastic cells along alveolar walls

49
Q

what is squamous metaplasia

A

ciliated columnar epithelium changing to squamous

50
Q

true/false - a higher TNM stage means better prognosis

A

false - higher means worse prognosis

51
Q

how long before half of lung cancer patients are dead

A

6 months

52
Q

which type of lung cancer is best suited for chemo

A

small cell, it is rapidly progressive so rarely suited for surgery
Chemo will recede cancer but will not go away

53
Q

what can be used to treat non small cell lung cancer

A

palliative chemotherapy

surgery and radical radiotherapy

54
Q

what factors will be considered prior to surgery

A 
will patient make it?
can tumour be cut out?
residual function?
staging/metastases?
proximity to carina?
55
Q

what surgeries could be performed?

A

lobectomy
pneumonectomy - less common
thoracotomy or by VATS

56
Q

most common type of chemotherapy for lung cancer?

A

palliative

57
Q

what must be collected in order to correctly select a type of chemotherapy

A

tissue sample - usually from biopsy

58
Q

how curative is cytotoxic chemotherapy

A

not very, better response in small cell cancer

59
Q

chemotherapy target cells that divide rapidly/slowly

A

rapidly

60
Q

radical radiotherapy has what intent

A

to cure

61
Q

palliative radiotherapy aims to?

A

shrink tumours and reduce effect of symptomatic metastases

62
Q

does radiotherapy have a limit

A

yes, damage can be caused by too much radiation

63
Q

where can collateral damage from radiotherapy occur?

A

oesophagus - dysphagia
spinal cord - paralysis
fibrosis of lung tissue

64
Q

what is SABR

A

small doses of radiation combining to one large dose

65
Q

what is endobronchial therapy

A

photodynamic therapy, laser therapy and stent insertions

66
Q

how is a treatment plan determined

A

cell type, extent of cancer and patient wishes

67
Q

co-morbidities of lung cancers

A

smoking related disease - COPD

ischaemic heart disease

MB1: Respiratory (15 decks)

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