Brainscape's Knowledge GenomeTM

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


See full index

Medicine Respiratory > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

General features of cancer

A

Malignant growth, uncontrolled replication, local invasion, metastasis (lymphatic spread, blood stream, serous cavities), non-metastatic systemic effects

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

Symptoms of lung cancer

A

Cough >3 weeks, breathlessness, chest infection that doesn’t clear, haemoptysis, unexplained weight loss, chest or shoulder pains, unexplained tiredness or lack of energy, a hoarse voice, enlarged liver, dysphagia, bloated face, stridor

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

What causes haemoptysis in lung cancer?

A

Haemorrhage due to the tumour ulcerating through the surface

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

Local invasion of lung cancer

A

Recurrent pharyngeal nerve, pericardium, oesophagus, brachial plexus, pleural cavity, SVC

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

Symptoms arising from local invasion of lung cancer to pericardium

A

Breathlessness, atrial fibrillation, pericardial effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What causes muscle weakness in lung cancer?

A

Brachial plexus invasion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which symptom can occur when the lung cancer invades the pleural space?

A

Breathlessness due to pleural effusion

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

Which symptoms can occur when the lung cancer invades the superior vena cava?

A

Distended veins on abdomen and thorax, distended external jugular vein, puffy eyelids and headache

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

Common sites for metastases for lung cancer

A

Brain, liver, bone, adrenal, skin, lung

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

Symptoms of cerebral metastases

A

Insidious onset: weakness, visual disturbances, headaches (worse in morning and not photophobic)
Fits

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

Common presentations of bone metastases

A

Localised pain that is worse at night or a pathological fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What type of imaging can show bone metastases?

A

Isotope bone scan

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

Paraneoplastic symptoms in lung cancer

A

Finger clubbing, hypertrophic pulmonary osteoarthropathy, weight loss, thrombophlebitis, hypercalcaemia, hyponatraemia, weakness (Eaton Lambert syndrome)

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

What should you think of when you hear hypercalcaemia (Rhyme)

A

Stones (renal/biliary calculi)
Bones (bone pain)
Groans (abdominal pain, constipation, nausea and vomiting)
Thrones (polyuria)
Psychiatric overtones (depression, anxiety, reduced GCS, coma)
Cardiac arrhythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Treatment for hypercalcaemia

A

Initial treatment is rehydration
If calcium very high on admission >4 or does not correct with fluid then also use IV biphosphonate
Treat underlying cancer

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

Which cancer is usually associated with hypercalcaemia?

A

Squamous cell

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

Syndrome of inappropriate antidiuretic hormone:

  • Which cancer is it related to?
  • What does it result in?
  • Symptoms
A
  • Usually small cell lung cancer
  • Low sodium concentration
  • Nausea, vomiting, myoclonus, lethargy/confusion, seizures/coma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Treatment of syndrome of inappropriate antidiuretic hormone

A

Treat the underlying cause, fluid restriction (1.5L/day), sometimes need demeclocycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Signs of lung cancer

A

Finger clubbing, bloated face, lymphadenopathy, tracheal deviation, dull percussion, enlarged liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Investigations for lung cancer

A
  • FBC
  • Coagulation screen
  • Na, K, Ca, Alk phos
  • Spirometry, FEV1
  • CXR
  • CT scan of thorax
  • PET scan
  • Bronchoscopy
  • Endobronchial ultrasound
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

PET scan in lung cancer:

  • What does it assess?
  • What does it analyse?
A
  • Function rather than structure

- Analysis of tissue uptake of radio-labelled glucose - tissues with high metabolic activity light up

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

Investigations to make a tissue diagnosis in lung cancer

A
  • Bronchoscopy
  • CT guided biopsy
  • Lymph node aspirate
  • Aspiration of pleural fluid
  • Endobronchial ultrasound
  • Thoracoscopy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Bronchoscopy:

  • Under what type of anaesthetic?
  • Where is the bronchoscope passed?
  • What types of tumours are bronchoscopies useless in identifying
A
  • Local anaesthetic with intravenous sedation
  • Through the nose
  • Possible tumours out in the periphery of the lungs
24
Q

Endobronchial ultrasound:

  • What is used to do this?
  • What does it do?
A
  • A bronchoscope with ultrasound tip

- Enables visualisation of hilar and mediastinal lymph structures and targets and samples lymph nodes

25
Q

Medical thoracoscopy:

  • Under what type of anaesthetic?
  • Where is the semi-rigid scope inserted?
  • What does it do?
A
  • Local anaesthetic and under sedation
  • Between the rib spaces
  • The lung is deflated to allow visualisation of the pleural space and biopsies can be taken from the pleura
26
Q

Differential diagnoses for the following clinical picture:

Haemoptysis, smoker, abnormal chest x-ray

A

Lung cancer, tuberculosis, vasculitis, pulmonary embolism, secondary cancer, lymphoma, bronchiectasis

27
Q

Harmful carcinogens in tobacco smoke

A

Polycyclic hydrocarbons, aromatic amines, phenols, nickel, cyanates

28
Q

Risk factors for lung cancer

A
  • Smoking - main risk factor
  • Asbestos exposure
  • Nickel
  • Chromates
  • Radiation
  • Atmospheric pollution
  • Genetics play a very small part
29
Q

4 common smoking associated types of lung cancer

A

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

30
Q

Why is classification of lung cancer important?

A

To determine prognosis, treatment, pathogenesis and epidemiology

31
Q

Which type of lung cancer has the worst prognosis?

A

Small cell lung cancer

32
Q

What is the only way to differentiate between different non-small cell lung cancers?

A

Immunohistochemistry:

  • Adenocarcinoma expresses TTF1
  • Squamous cell carcinoma expresses nuclear cell antigen p63 and high molecular weight cytokeratins
33
Q

New targeted treatments for lung cancer:

  • What are they based on?
  • Give an example
A
  • Pathologically identified abnormal DNA or other markers in tumour
  • Specific point mutations render the EGFR gene active in the absence of ligand binding and this mutation is most commonly seen in adenocarcinoma (non-smokers and asian population). These tumours respond to tyrosine kinase inhibitors
34
Q

PD-L1:

  • What does it do?
  • How can it be treated?
A
  • Binds to programmed death receptor on T lymphocytes inactivating the cytotoxic immune response
  • Targeted therapy can often inhibit this effect and enhance immune killing of the tumour
35
Q

Bronchial tumours development

A

Squamous metaplasia → dysplasia → carcinoma in situ → invasive malignancy

36
Q

Prognostic indicators in lung cancer

A

Tumour stage, tumour histological subtype

37
Q

Giving the patient the diagnosis of lung cancer

A
  • Prepare the ground - ask what they think the diagnosis could be
  • Bring a relative
  • Make sure they understand
  • Prepare for the obvious questions
  • Tell their GP
  • Arrange a follow-up
38
Q

Treatment for small cell lung cancer

A

Rapidly spreads and has early metastases so rules out surgery. Has a good initial response to chemotherapy nit has rapidly emerging resistance.
=> cytotoxic chemotherapy often backed up by radiotherapy

39
Q

Treatment of non-small cell lung cancer

A

Surgery or radical radiotherapy are curative options. Palliative chemotherapy can also be given

40
Q

Treatment choices in lung cancer

A

Surgery, radiotherapy, chemotherapy, palliative care

41
Q

Things to consider when surgery is a treatment option for lung cancer

A

Can we cut it out? Is the disease localised? Will the patient survive the operation? What will the residual lung function be?

42
Q

Staging for surgery

A
  • Bronchoscopy (vocal cord palsy, proximity to carina, cell type
  • EBUS (lymph nodes)
  • CT of brain (metastases)
  • CT of thorax (tumour size, lymph nodes, metastases, local invasion)
  • PET scan (metastases)
43
Q

After lung removal, how much disease free bronchus must you have to close off the hole?

A

2cm

44
Q

Surgical options for lung cancer

A

Pneumonectomy or lobectomy done through thoracotomy or video assisted thoracic surgery

45
Q

Thoracotomy:

  • What is it?
  • How long does it take to recover?
A
  • Major surgery involving a long incision around the length of the 6th rib to gain access to the lung
  • Weeks
46
Q

Staging for chemotherapy

A
  • Bronchoscopy or other tissue sampling (small cell vs non-small cell)
  • CT scan (tumour size, local invasion, nodes, metastases)
  • Performance on the ECOG score
47
Q

What is the combination of drugs given in chemotherapy dependent on?

A

The cell type

48
Q

Cytotoxic chemotherapy:

  • Curative or Palliative?
  • Which type of cancer has a better response?
  • How is it given?
  • What does it target?
A
  • Rarely curative but longer survival
  • Better response in small cell cancer
  • IV infusions every 3-4 weeks in outpatient clinic
  • Targets rapidly dividing cells and can cross the blood-brain barrier
49
Q

Side effects of cytotoxic chemotherapy

A
  • Nausea and vomiting
  • Tiredness
  • Hair loss
  • Bone marrow suppression (opportunistic infection and anaemia)
  • Pulmonary fibrosis
  • Neutropenic sepsis
50
Q

Radiotherapy:

  • What does it involve?
  • Curative or palliative?
A
  • Involves radiation (usually X-rays in an external beam)

- Can be radical, with curative intent, or palliative which is useful for metastases)

51
Q

Downsides to radiotherapy

A
  • Maximum cumulative dose
  • Collateral damage (spinal cord, oesophagus, adjacent lung tissue)
  • Only goes where you point the beam
52
Q

Common side effect of radiotherapy

A

Temporary oesophagitis

53
Q

Positives of stereotactic ablative radiotherapy

A

Many more beams and each beam is less powerful so there is less collateral damage. The total dose delivered to the tumour is higher and so more effective

54
Q

Examples of endobronchial therapy

A

Stent insertion for stridor, photodynamic therapy, other laser therapy

55
Q

What is treatment of lung cancer determined by?

A

The cell type, the extent of the disease, co-morbidity and patient’s wishes

56
Q

Co-morbidities in lung cancer

A

Smoking related diseases (COPD, ischaemic heart disease)

Medicine Respiratory (12 decks)

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