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Lung cancer Flashcards

1
Q

What are the major histological types of cancer?

A

A) Small cell lung cancer (15%)

B) Non small cell lung cancer (85%)

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2
Q

Types of non-small cell lung cancer

A
  1. Squamous
  2. Adeno
  3. Large cell
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3
Q

Examination findings in patients with lung cancer

A
  • Fixed monophonic wheeze
  • Supraclavicular lymphadenopathy
  • Cervical lymphadenopathy
  • Clubbing (30%)
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4
Q

What is paraneoplastic syndrome?

A

Consequence of the presence of cancer, not directly related to the presence of a tumour e.g. production of hormones

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5
Q

What is Lambert Eaton syndrome?

A

Immune system attacks the neuromuscular junctions — the areas where nerves and muscles connect

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6
Q

Which cancer is most associated with Lambert Eaton syndrome?

A

Small cell lung cancer

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7
Q

Features of squamous cell lung cancer

A

Central

Parathyroid hormone-related protein - hypercalcaemia

Finger clubbing +++

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8
Q

What is hypertrophic pulmonary osteoarthropathy?

A

Most associated with adenocarcinoma, HPOA is a syndrome characterized by the triad of periostitis, digital clubbing and painful arthropathy of the large joints, especially involving the lower limbs

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9
Q

Features of adenocarcinoma of the lung

A

Peripheral so rarely causes obstruction

Associated with HPOA and hynaecomastia

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10
Q

You have a patient with lung cancer, they are a non-smoker. What are your thoughts re type?

A

Adenocarcinoma - most common lung cancer in non smokers

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11
Q

Features of large cell lung cancer

A

Peripheral

Anaplastic (cells with poor cellular differentiation, losing the morphological characteristics of mature cells)

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12
Q

Which type of lung cancer is associated with ectopic ADH and ACTH hormone?

A

Small cell lung cancer

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13
Q

Discuss investigations for lung cancer

A
  1. Chest x-ray: often the 1st investigation (reported as normal in 10% of those with lung cancer)
  2. CT: investigation of choice to investigate suspected cancer
  3. Bronchoscopy: for biopsy and histological diagnosis
  4. PET scan: typically done in non-small cell lung ca
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14
Q

Typical age of presentation of lung ca?

A

40-70

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15
Q

Which lung cancer is most associated with production of parathyroid hormone related protein?

A

Squamous cell carcinoma

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16
Q

Where are the majority of squamous cell lung cancers located?

A

Hilar/ central

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17
Q

Which lung cancer is associated with the longest survival?

18
Q

Which lung cancer is most associated with occupational exposure?

A

Adenocarcinomas

19
Q

What is adenocarcinoma?

A

Cancer arising from glandular cells

20
Q

Does adenocarcinoma of the lung tend to cause obstruction?

A

No because it is usually peripheral

21
Q

Which is the most aggressive form of non-small cell lung cancer?

A

Large cell

22
Q

Discuss small cell lung cancer

A

Most aggressive of all lung cancers

Starts in the neuroendocrine cells in the lungs

Considered to be a systemic disease

23
Q

Which type of lung cancers respond to chemo?

A

Small cell - although it is not curative, purely palliative

24
Q

Outline consequences of local invasion of lung cancer

A

Superior vena cava compressed: superior vena cava syndrome - SOB, facial swelling (esp. after lying down), arm oedema

Phrenic nerve compressed: hemidiaphragm paralysis, raised hemidiaphragm on affected side

Recurrent largyngeal nerve compressed: hoarse voice

Pancoast tumours: lung cancers located in apex of lung, can compress sympathetic chain and cause Horner’s syndrome (IPSILATERAL)

25
Where does lung ca commonly spread to?
Brain: headaches, nausea and vomiting Bones: pain and fractures Liver: abdo pain Adrenal glands: usually asymptomatic
26
Paraneoplastic syndrome associated with small cell lung ca
- SIADH - Lambert Eaton: cancer produces antibodies against pre-synaptic calcium channels, causes muscle weakness that improves as the individual uses the affected muscle (different to myasthenia gravis as in this the muscle gets weaker following use) - Antibodies that attack cerebellar neurons which causes ataxia and nystagmus
27
Paraneoplastic syndrome associated with large cell lung ca
B-hCG secretion causing gynaecomastia in males and galactorrhoea in females
28
What type of lung cancer causes 2/3 of Pancoast tumours?
Squamous
29
What is SIADH?
Syndrome of inapropriate anti diuretic hormone - most commonly associated with small cell lung cancer Symptoms: headache, nausea, muscle weakness, drowsiness and confusion **HYPONATREMIA** Pathology: more ADH therefore more fluid retained because ADH inserts AQP2 into DCT. Results in hypervolemia, reduced production of aldosterone and sodium is dumped in urine Causes other than small cell lung ca = stroke, brain trauma, drugs, infections and family hx
30
What is the only treatment of value for non-small cell lung cancer?
Surgery - only 15% of cases are operable when diagnosed \*only performed if patient has no mets and has good enough lung function reserve
31
What treatment is given if patients can't tolerate surgery for non small cell ca?
xRT
32
Palliative options for people with lung cancer?
Bronchial stenting to provide symtpomatic releif Daily prednisolone to increase appetite Opioids for pain
33
Mutations associated with adenocarcinoma of the lung
EGFR, ALK, RET, ROS1 - non smokers KRAS, BRAF - smokers
34
Mutations associated with small cell carcinoma
TP53 and RB1
35
What is the most common cause of cancer related death?
Lung cancer - in both men and women
36
Is lung cancer more common in men or women?
Men - 2:1 ratio M:F
37
What is the most common lung cancer cell type in the UK?
Squamous \*In the US this is adenocarcinoma and it is thought that adenocarcinoma will soon become most common in the UK
38
What common symptom warrants a chest x-ray when considering lung cancer?
3 week cough
39
Why do lung cancers cause wheeze?
Obstruction of an airway by a tumour
40
Which mode of imaging is used for characterising the extent of medistinal nodal involvement in lung cancer?
PET scan - most commonly these are combined with CT scans
41
Is MRI used for the indentification of primary lung tumours?
No - unless they are Pancoast tumours with nerve invasion

Respiratory (19 decks)

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