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Lung Cancer Flashcards

1
Q

Lung cancer associated with gynaecomastia

A

adenocarcinoma

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2
Q

Paraneoplastic associations of small cell lung cancer

A

Lambert Eaton Syndrome (immune system attacks the neuromuscular junctions)

SIADH (hyponatremia)

Cushings syndrome
ATCH-increased cortisol production

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3
Q

Paraneoplastic features of Squamous cell lung cancer

A

Hypercalcaemia due to parathyroid hormone

Hyperthyroidism

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4
Q

Local effects of lung cancer

A

Haemoptysis
Pain (invasion of chest wall)
Pneumonia (obstruction-inadequate lung drainage)

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5
Q

where does lung cancer commonly metastasise to

A 
bones
brain
skin
liver
adrenal
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6
Q

Systemic effects of lung cancer

A

Weight loss
Ectopic hormones (sq-PTH, SC-ATCH)
Fever

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7
Q

4 types of lung cancer

A

Small cell (worst)
Adenocarcinoma (most common)
Squamous
Large cell (lack of differentiation)

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8
Q

Investigations of lung cancer

A 
CXR
CT Scan
Bronchoscopy + Biopsy (confirm cell type, treatment)
(mediastinal-EBUS)
FBC- elevated platelets
Coagulation screen
Na+, K+, Ca2+
Spirometry, FEV1
PET scan (to look for metastases if going for surgery)
NOT sputum cytology
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9
Q

What type of lung cancer is keratinising

A

Squamous

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10
Q

What type of lung cancer is gland forming and mucin

A

Adenocarcinoma

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11
Q

appearance of small cell cancer

A

small lymphoid like cells

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12
Q

high grade malignant tumour with endocrine phenotype

A

small cell carcinoma

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13
Q

gold standard treatment of lung cancer

A

Surgery

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14
Q

which Lung cancer is chemosensitive

A

Small cell- but has rapid resistance

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15
Q

what is immunohistochemistry

A

antigen expression on tumour cells

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16
Q

what tumour expresses TTF1

A

Adenocarcinoma

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17
Q

What tumour expresses p63 and cytokeratins

A

Squamous carcinoma

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18
Q

Therapeutic targets for SCLC

A

Myc, p53, Rb, 3p

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19
Q

Therapeutic targets for NCLC

A

K-ras, EGFR, myc, p53, Rb, 3p

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20
Q

Mechanism of EGFR mutation

A

in lung cancer there is mutations in EFGR so EGF doesn’t have to bind to start signalling of the tyrosine kinase pathway-switched on all the time- excessive cell division

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21
Q

who is EGFR mutation most common in

A

Adenocarcinoma
Non-smoker
Asian

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22
Q

what do EGFR mutation LC respond to

A

Tyrosine kinase inhibitors eg erlotinib

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23
Q

why do lung cancers express PLD1

Which lung cancers express PDL1

A

PDL1 binds to PDL of CD8+ cells on T lymphocytes and inactive them
NSCLC

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24
Q

Process of bronchial lung cancer development

A

Squamous metaplasia, Dysplasia, carcinoma in situ, Invasive malignancy

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25
describe peripheral adenocarcinoma
atypical adenomatous hyperplasia along the alveolar walls | associated with smoking, KRAS and EGFR mutations
26
Prognostic indicators in lung cancer
Stage (TNM) Grade Histological sub type
27
What is carcinoid
low grade neuroendocrine tumour
28
what tumours are often seen in salivary glands
Bronchial gland neoplasms
29
routes through which cancer can spread
Blood, Lymph, serous cavities
30
S+S of primary lung tumour
Haemoptysis recurrent pneumonia Stridor SOB
31
S+S of local invasion of lung cancer
Hoarse voice- recurrent laryngeal nerve chest pain- invasion of chest wall Pleural effusion Dysphagia-Oesophagus arm pain/weakness/numbness, wasting of small muscle in the hand - Brachial Plexus (Pancoast tumour) head swelling, headache, engorged blood vessels-SVC SOB, AF, Pericardium effusion-Pericardium Horners syndrome- compression of sympathetic chain- weakness in eyes, side of face, pupil constriction
32
Causes of finger clubbing
``` Abscess Bronchiectasis Cystic fibrosis and Cancer Dont say COPD Empyema Fibrosis ```
33
Describe symptoms of cerebral metastases and treatment
slow, insidious onset, weakness visual disturbances, headaches (worse in morning, not photophobic) Fits Ring enhancing lesion Oral steroids to reduce swelling,
34
Paraneoplastic symptoms of lung cancer
``` weight loss finger clubbing hypertrophic pulmonary osteoarthropathy (periosteum lifts off, lower shin pain) thrombophlebitis hypercalcemia (squamous) hyponatremia (SIADH, SCLC) Weakness- Eaton Lambert syndrome (SCLC) ```
35
Symptoms of hypercalcemia
Stones- biliary and renal calculi Bones- bone pain Groans- abdominal pain, constipation, N+V Thrones- polyuria Psychiatric overtones- depression, anxiety, coma, reduced GCS
36
treatment of hypercalcemia
Rehydration if Ca >4 or doesn't correct with fluid, IV bisphosphonate treat cause eg squamous carcinoma
37
Symptoms of SIADH
``` usually small cell cancer N+V myoclonus lethargy, confusion seizures/coma ```
38
Treatment of SIADH
Fluid restriction <1.5L/day Demeclocycline treat underlying cause
39
signs of lung cancer on examination
``` dull on percussion bloated face finger clubbing lymphadenopathy tracheal deviation enlarged liver Mono wheeze ```
40
Radicle LC treatment
Surgery, Radicle radiotherapy
41
Why may someone have a PET scan
to check for metastases before surgery | shows where high metabolic activity is
42
methods of tissue diagnosis of lung cancer
bronchoscopy, EBUS, CT guided biopsy Lymph node or pleural aspiration thoracoscopy
43
DD of patient with abnormal CXR, haemoptysis and is a smoker
Lung cancer, secondary lung cancer, TB, PE, Bronchiectasis, lymphoma, vasculitis,
44
threshold for surgery of lung cancer near carina
if cancer is less than 2cm from carina can't do surgery because surgeon must be able to make a stump after pneumonectomy
45
surgery options for lung cancer
pneumonectomy lobectomy (also remove lymph glands) VATS thoracotomy
46
Staging of lung cancer
``` type of cancer tumour size local invasion nodes metastasis ECOG score (fitness) ```
47
side effects of chemotherapy
``` N+V Hair loss lethargy pulmonary fibrosis bone marrow suppression- anaemia, infection ```
48
SABR
Multiple Xray beams from different angles to one area | less collateral damage
49
what is a pleural effusion
fluid in pleural cavity
50
primary investigation of lung problem
CXR
51
where do lung pleura combine
hila, to form the pulmonary ligament which runs inferiorly and attaches the root of the lung to the diaphragm
52
causes of unilateral pleura effusion
Tumour (mesothelioma) Infection chylothorax Haemorrhage
53
Investigations of pleural effusion
``` CXR, pleural aspirate (if not cardiac failure) biochemistry (exudate or transudate) cytology culture contrast enhanced CT scan repeat pleural tap pleural biopsy ask about occupational, asbestos exposure ```
54
criteria for transudate vs exudate
transudate <30g/L exudate >30g/L if pleural sample LDH is two thirds greater than serum- likely to reflect exudate effusion
55
causes of transudate
transudate- increased hydrostatic pressure ``` congestive heart failure hypoalbuminemia Cirrhosis Atelectasis peritoneal dialysis ```
56
causes of exudate
exudate- inflammation, increased capillary permeability ``` pneumonia cancer TB Viral infection pulmonary infarct asbestos autoimmune ```
57
Causes of bilateral pleural effusion
Cardiac failure LVF PTE drugs
58
bloody pleural effusion
trauma malignancy infection infarction
59
turbid/milky
empyema, chylothorax
60
turbid/milky in pleural effusion
empyema, chylothorax
61
Foul smelling pleural effusion
anaerobic empyema
62
food particles in pleural effusion
oesophageal rupture
63
Normal pH of pleural fluid
7.6
64
pleural effusion <7.3
pleural inflammation (malignancy, RhA)
65
pleural effusion <7.2
requires drainage
66
what to do with pus in pleural space
drain, dont test pH
67
Lymphocytes in effusion
TB, malignancy
68
neutrophils in effusion
acute process
69
tests if worried about TB
PCR, AFB stain, liquid culture bottles
70
how often will pleural aspiration diagnose malignancy
60%, do no more than 2 biopsies
71
S+S of mesothelioma
breathlessness, chest pain, weight loss, fever sweating, cough takes 30-40 years after asbestos exposure to show S+S
72
Describe 3 types of asbestos
chrysotile- white, most common amosite- brown crocidolite - most dangerous
73
Treatment of mesothelioma
``` pleurodeses effusions talc slurry long term pleural catheter radiotherapy chemotherapy surgery palliative care ```
74
2 types of talc
talc slurry: talc in suspension | talc poudrage: insufflated talc
75
complications of talc
``` minor pleuritic pain and fever abscess talc pneumonitis/ARDS Pneumonia Respiratory failure ```
76
Predicting survival time in patients with malignant pleural effusion
LENT score LDH ECOG score Neutrophil to lymphocyte ratio Tumour type
77
Presentation of PX
``` acute onset of pleuritic chest pain SOB, Hypoxia Tachycardia Hyper-resonance reduced expansion quiet breath sounds on ausculation Hammans click ```
78
how to differentiation between small PX and bullous disease
CT scan
79
Management of pneumothorax
oxygen Aspiration 1st line chest drain may need suction
80
indications for surgical intervention in pneumothorax
``` 2nd ipsilateral PX 1st bilateral PX 1ST contralateral PX persistent PX at risk professions ```
81
who tends to pneumothorax
``` tall, thin men marfans syndrome cannabis smokers smokers secondary-existing lung disease primary-apical bullae ```
82
signs of TPX
tracheal deviation elevated JVP hypotension reduced area entry on opposite side
83
encased pus in pleural space
empyema
84
Risk factors of pleural infection
Diabetes Immunosuppression Gastro oesophageal reflux Drug misuse , IV drug abuse
85
Contents of empyema
Pus
86
Complicated effusion
``` G+ stain pH <7.2 Low glucose Septations Loculations ```
87
Treatment of large effusion
Chest drain Antibiotics Fibrinolytics/ DNA ase
88
what cells do small cell carcinoma arise from
APUD cells
89
what lung cancers are typically central and typically peripheral
central- small cell, squamous | peripheral- adenocarcinoma
90
lung cancer associated with gynaecomastia
adenocarcinoma
91
lung cancer associated with hyperthyroidism
squamous cell lung cancer
92
lung cancer associated with BHCG
LARGE CELL CARCINOMA

Respiration (6 decks)

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