Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

RESPIRATORY > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

What different ways can lung cancers present?

A

Primary tumour
Local invasion symptoms
Metastases
Paraneoplastic syndrome (e.g. hormones)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What symptoms should prompt you to think of making a lung cancer referral?

A
  • Cough >3 weeks
  • Breathless for no reason
  • Chest infection that doesn’t clear up
  • Coughing up blood
  • Unexplained weight loss
  • Chest/shoulder pain
  • Unexplained tiredness
  • Hoarse voice
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When you look at any chest X-ray, the smaller of the two lungs is usually the diseased one. TRUE/FALSE?

A

TRUE

  • enlarging tumour obstructs proximal divisions of the bronchial tree
  • air beyond obstruction is absorbed
  • lung tissue shrinks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Describe the appearance of the lung mucosa when a tumour lies underneath it

A

red (prone to haemoptysis) and ulcerated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Why do lung cancers often cause stridor (inspiratory noise) rather than an expiratory wheeze?

A
  • tumour causes bronchi narrowing and pools of secretions
    => difficulty breathing in
  • asthma and COPD have expiratory wheeze as the air can enter the lungs but has difficulty getting out
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What structures can be locally invaded by a lung cancer?

A 
Recurrent laryngeal nerve
Pericardium
Oesophagus
Brachial plexus
Pleural cavity
Superior vena cava
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What symptom does the patient experience if a lung cancer invades the recurrent laryngeal nerve?

A

Hoarse voice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What symptoms can the patient experience if a lung cancer invades the pericardium?

A

AF

pericardial effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What symptom would indicate that a lung tumour has spread to the oesophagus?

A

Dysphagia to solids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

A pancoast tumour can invade what structure and cause what symptoms?

A

Invades brachial plexus

=> causes neuropathy in hand/arm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Why do lung cancers cause pleural effusions?

A
  • tumour invades the pleural space
  • generates large volume of pleural fluid (can be litres!!)
  • presenting symptom = breathlessness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What symptoms are caused by local invasion and obstruction of the SVC?

A
  • obstructs drainage of blood from the arms and head

- superficial veins on abdomen distend to avoid SVC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Bone pain due to lung cancer invasion is often worse at what time of the day?

A

Night

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Where do lung cancers commonly metastasise to?

A 
Adrenal
Skin
Liver
Brain
Bone
Other Lung
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What sign in the hands may point towards a lung cancer diagnosis?

A

Finger clubbing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What hormones can be secreted from lung tumours and what effects do these cause?

A

PTH Mimic => causes Hypercalcaemia (Bones, groans, moans, stones etc)

ADH released => SIADH => hyponatraemia and confusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What acute neuropathy is caused by a primary lung tumour and resolves upon tumour resection?

A

Lambert Eaton syndrome

causes weakness similar to mysathenia gravis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is Hypertrophic pulmonary osteoarthropathy?

A
  • association of lung cancers
  • causes bone pain/tenderness near joints
  • periosteum of bone lifts away from bone surface
  • it is NOT a sign of metastasis to the bone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How is hypercalcaemia due to a lung tumour treated?

A
  • Bisphosphonates may need to be used to prevent bone disease
  • initial Tx = rehydration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What type of lung cancer is more likely to release a mimic of PTH and cause hypercalcaemia?

A

Squamous Cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What type of lung cancer usually secretes ADH?

A

Small cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How is SIADH due to lung cancer treated?

A

Fluid restriction – 1.5L/day

23
Q

What other differential diagnoses exist for patients who smoke, have experienced haemoptysis and have an abnormal CXR?

A 
Tuberculosis
Vasculitis
Pulmonary embolism
Secondary cancer
Lymphoma
Bronchiectasis
24
Q

What chemicals are found in tobacco smoke that are responsible for lung cancer?

A 
polycyclic hydrocarbons
aromatic amines
phenols
nickel
cyanates
25
Q

Other than the lung, smokers are also known to suffer from what types of cancer?

A
  • Laryngeal
  • Cervical
  • Bladder
  • Oral
  • Oesophageal
  • Colon cancer
26
Q

Why do patients with lung cancer struggle to clear pneumonia and lung infections?

A

Tumour causes obstruction

=> area of pneumonia is often stuck distal to this site and cant be cleared/ reached by antibiotics

27
Q

Why do larger airways have cartilage rings for support?

A
  • to help conduct the movement of air in and out of the lungs
  • smaller airways (e.g. terminal bronchioles) take place in gas exchange instead
28
Q

What type of epithelium covers the respiratory system in order to produce mucous and secretions?

A

Pseudostratified Ciliated Columnar Epithelium with Goblet cells (these secrete mucous)

  • this is also known as Respiratory Epithelium
29
Q

If the bronchioles of the lung contain no cartilage, how are they held open?

A

elastic “tug” of surrounding alveoli

30
Q

What parts of the respiratory tract make up the functional unit of the lung?

A

“Respiratory acinus”

AKA respiratory bronchioles + alveolar ducts + alveoli

31
Q

What lung tumours are mostly associated with smoking?

A

adenocarcinoma (35%)
squamous carcinoma (30%)
small cell carcinoma (25%)
large cell carcinoma (10%)

32
Q

Adenocarcinomas are the most common type of lung tumour and therefore a large percentage of these can also occur in non-smokers. TRUE/FALSE?

A

TRUE

- whereas virtually ALL small cell cancers are caused by smoking

33
Q

How can a histological sample of a lung cancer be obtained?

A

Bronchoscopy
- biopsy tumour if seen during this (wont see it if at lung periphery)

Biopsy/ needle aspiration of mets
- mediastinal/supraclavicular lymph nodes

Endobronchial ultrasound guided specimens (EBUS)

34
Q

What feature on histology would indicate a squamous carcinoma?

A

Keratinising lesion
=> producing keratin layers similar to that of skin
=> dark pink on H+E stain

35
Q

What histological feature indicates an adenocarcinoma of the lung?

A

Formation of glands

- can be stained for mucin (turns blue)

36
Q

What histological feature indicates a small cell carcinoma?

A

Lots of small cells packed tightly into space

  • high nuclear:cytoplasm ratio
  • i.e. very dark purple
37
Q

How are small cell and non-small cell lung cancers treated differently?

A

Small cell - chemosensitive

Non-small cell - surgery is treatment of choice (radical radiotherapy may also be an option)

38
Q

Chemotherapy and radiotherapy can also be used in Non-small cell lung cancer. TRUE/FALSE?

A

TRUE

beware many lung cancers get Pemetrexed chemo but this is CONTRAINDICATED in squamous Ca.)

39
Q

EGFR mutations are commonly present in what type of lung cancer? And what can be used to treat this?

A

Adenocarcinoma

Tyrosine Kinase Inhibitors used to target EGFR signalling pathway

40
Q

Tumours can express PD-L1 and avoid cytotoxic killing by the immune system. How do they do this?

A

PD-L1 binds to PD (programmed death) receptor on T lymphocytes
=> inactivating the cytotoxic immune response

41
Q

What type of tumours usually occur in the bronchi and larger airways?

A

Squamous cell carcinomas

  • epithelium undergoes metaplasia (often related to smoking)
  • becomes dysplastic and forms carcinoma in situ before becoming invasive
42
Q

Adenocarcinomas are normally found at the periphery of the lung. Why is this?

A

Spread of neoplastic cells along alveolar walls (bronchioloalveolar carcinoma)
- this means these are often difficult to reach on bronchoscopy

43
Q

What is meant by a carcinoid tumour in the lungs?

A

neuroendocrine tumour of low grade malignancy

44
Q

What needs to be considered before commencing surgery on a primary lung cancer?

A
  • can it be excised?
  • is disease localised?
  • will patient survive?
  • what will their lung function be afterwards?
45
Q

Before surgery, clinicians stage the tumour and have a thorough look for metastases. How do they do this?

A

Bronchoscopy (to check for:)

  • Vocal cord palsy
  • Proximity to carina
  • Cell type

Mediastinoscopy/EBUS
- Lymph nodes

CT Head (mets)
CT Thorax 
PET Scan (mets)
46
Q

Surgery cannot be attempted if the tumour is within how many cm of the carina?

A

2cm

47
Q

What types of surgery can be used to operate on a lung cancer?

A
  • Pneumonectomy or lobectomy

This can be done via:
Thoracotomy - large incision (length of 6th rib), takes weeks to recover

Minimal access VATS

  • video assisted throacic surgery, keyhole technique
  • multiple smaller scars and quicker recovery time
48
Q

What happens to the hemi-diaphragm after a loss of lung volume on the affected side (usually after surgery)

A

Hemi diaphragm shifts up to compensate for loss of volume

49
Q

What side effects can occur due to cytotoxic chemotherapy?

A
  • N+V
  • Tiredness
  • Bone marrow suppression (rapidly dividing cells targeted by chemo)
  • Infection (due to neutropenia)
  • Anaemia
  • Hair loss
  • Pulmonary fibrosis
50
Q

What is the difference between radical and palliative radiotherapy?

A

Radical has curative intent

Palliative = for symptom relief e.g. bone mets pain

51
Q

What are the disadvantages of radiotherapy?

A
  • There is a maximum cumulative dose
  • Can cause collateral damage (Spinal cord, Oesophagus, Adjacent lung tissue)
  • may cause lung fibrosis in patients who already have poor lung function (i.e. COPD)
  • causes temporary oesophagitis
52
Q

What is Stereotactic ablative radiotherapy?

A
  • more beams (but each is less powerful)
    => Less collateral damage
  • Total dose delivered to tumour is higher
    => more effective

HOWEVER - 4D scanning required

53
Q

What palliative endobronchial therapies are available for patients symptom control?

A

Stent insertion for stridor
Photodynamic therapy
Other laser therapy

RESPIRATORY (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions