Lung Cancer Flashcards
What are the red flag symptoms in a respiratory examination?
Haemoptysis, weight loss, persistent cough, breathlessness, pain, changes in fingers suggesting clubbing or pain in the limbs indicating Hypertrophic osteoarthropathy.
What do you understand by Skill mix?
This is the use of different grades of staff trying to use skilled personnel at the right level. For doctors this originally meant trying to avoid clerical duties but now includes training non medics to do work to keep costs down and provide a resilient workforce.
What do you think happens in your trust when something seems to have gone wrong?
Case report, duty of candor
There are a number of non metastatic manifestations of malignant disease how many can you give?
These are commonest with small cell lung cancer but clubbing and the closely related hypertrophic arthropathy occur with other types of cancer.
Eaton lambert (Lambert Eaton) syndrome and myasthenia gravis happen due to autoantibodies but behave differently in the muscle synapses. The former prevents Acetyl choline being released while the latter blocks ACh acting. Myasthenia is closely linked to the thymus and a tumour is seen in 15% of patients with the condition but half of patients with a thymoma have myasthenia.
SIADH has a long list of causes but one classic one is small cell cancer and this should be excluded with a scan if the sodium is very low.
Hypertrophic osteoarthropathy results in new bone forming in the periostium in the forearms and lower legs. the patient will have pain and also marked clubbing. Treatment of the primary cancer (or any other cause for severe clubbing) will result in resolution of the disease unlike metastases.
Cushings syndrome due to secretion of ACTH by the tumour or hyperparathyroidism also by hormone secretion.
Other rare causes include acanthosis, polymyositis, dermatomyosistis, cerebellar syndrome, thrombophlebitis, fits, confusion and neuopathy.
Describe the SPIKES framework used to break bad news
S = Setting P = Patients Perception I = Invitation to continue with the explanation K = Knowledge in small chunks. E = Empathy for the shock or other emotions S = Strategy what you and the patient are going to do
What is illuminated on a PET scan?
The scan shows up anything that’s using glucose and that includes your vocal cords and brown fat
What are the causes of bronchial carcinoma?
- Tobacco smoking
- Ionising radiation
- Asbestos
- Fibrosing alveolitis
- Industrial chemicals
- Arsenic
- Chloromethyl ethers
- Chromium
- Nickel
- Polyaromatic hydrocarbons
- Vinyl chloride
What are the types of bronchial carcinoma?
- Lung
- Primary (76% non-small cell = squamous, adenocarcinoma)
- Secondary (breast, kidney, bladder, testes) - Pleura
- Primary (mesothelioma)
- Secondary
Other cell types (sarcoma, lymphoma)
What is the clinical presentation of bronchial carcinoma?
?- Cough
- Hemoptysis
- Chest pain
- Breathlessness
- Stridor
- Hoarse voice
- Weight loss
- Facial swelling
- Finger clubbing
- Lymphadenopathy
- Chest asymmetry
- Focal chest signs (consolidation/fluid)
- Hepatomegaly
- Neuropathy
Weeks/months
What are the complications of a bronchial carcinoma?
- Pancoast syndrome (superior sulcus tumors along with ipsilateral shoulder and arm pain, paresthesias, paresis and atrophy of the thenar muscles of the hand and Horners syndrome (ptosis, miosis, and anhidrosis).)
- SVC Obstruction
- Facial/hand swelling worst in mornings
- Headache - Cutaneous metastasis
- Shoulder
- Hard palate
Name the non-metastatic manifestations of bronchial carcinoma
- Finger clubbing
- Hypertrophic pulmonary osteoarthropathy
Hormone syndromes:
- Hypercalcemia
- Inappropriate ADH
- Ectopic ACTH
Neuromyopathies:
- Eaton-Lambert syndrome
- Peripheral neuropathy
- Dementia
- Cerebellar syndrome
What is the treatment for small cell/non-small cell carcinoma?
Small cell = chemotherapy
Non-small cell:
- Surgery
- Radical radiotherapy (usually 20 daily treatments)
- Palliation (symptomatic, radiotherapy, chemotherapy)
What are the possible differentials for bronchial carcinoma?
- TB
- Pneumonia
- Lung metastases from other primary (ie. breast)
- Benign lung tumours
- Rarities (Wegener’s granulomatosis - inflammation of respiratory tract and kidneys)
What investigations are done in bronchial carcinoma?
- Chest xray/CT scan
- Bloods (FBC, LFTs, Calcium)
- Fibreoptic bronchoscopy (60%)
- Percutaneous needle biopsy
- Node biopsy
- Mediastinoscopy/mediastinotomy
- Thoracotomy
What is the macroscopic appearance of bronchial carcinoma seen at thoracoscopy?
Visceral + parietal pleural deposits of mesothelioma
In what situations would a non-small cel bronchial carcinoma not be operable?
- Distant metastasis
- Mediastinal spread (i.e. recurrent laryngeal nerve palsy, phrenic nerve palsy)
- Poor pulmonary function
- Frequent angina/heart failure
- Psychological failure
What is a FDG-PET scan?
A PET scan uses a small amount of a radioactive drug, or tracer, to show differences between healthy tissue and diseased tissue. The most commonly used tracer is called FDG (fluorodeoxyglucose), so the test is sometimes called an FDG-PET scan. Before the PET scan, a small amount of FDG is injected into the patient.
How are bronchial carcinomas staged?
Primary tumour (T0-T4)
Regional lymph nodes (N0-N3)
Distant metastasis (M0-M1b)
What is the importance of EGFR positive lung cancer cells?
EGFR is a protein found in abnormally high levels on the surface of many types of cancer cells, particularly non-small cell lung cancer cells.
EGFR mutation positive cells predict response to specific chemotherapy - GEFITINIB
What are multiple pleural plaques on X-ray an indicator of?
Asbestos exposure
As far as we can tell these plaques are benign and very slow growing. They are not the cancer called mesothelioma. As far as we know these plaques do not change into mesothelioma. They do however suggest significant past exposure to asbestos and that in itself increases your risk of mesothelioma.
What is asbestosis?
Asbestosis refers to a very specific chronic lung condition associated with lung fibrosis that follows chronic exposure to asbestos