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Respiration > Lung Cancer > Flashcards

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
Q

describe peripheral adenocarcinoma

A

atypical adenomatous hyperplasia along the alveolar walls

associated with smoking, KRAS and EGFR mutations

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26
Q

Prognostic indicators in lung cancer

A

Stage (TNM)
Grade
Histological sub type

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27
Q

What is carcinoid

A

low grade neuroendocrine tumour

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28
Q

what tumours are often seen in salivary glands

A

Bronchial gland neoplasms

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29
Q

routes through which cancer can spread

A

Blood, Lymph, serous cavities

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30
Q

S+S of primary lung tumour

A

Haemoptysis
recurrent pneumonia
Stridor
SOB

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31
Q

S+S of local invasion of lung cancer

A

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

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32
Q

Causes of finger clubbing

A 
Abscess
Bronchiectasis
Cystic fibrosis and Cancer
Dont say COPD
Empyema
Fibrosis
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33
Q

Describe symptoms of cerebral metastases and treatment

A

slow, insidious onset, weakness
visual disturbances, headaches (worse in morning, not photophobic)
Fits

Ring enhancing lesion

Oral steroids to reduce swelling,

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34
Q

Paraneoplastic symptoms of lung cancer

A 
weight loss
finger clubbing
hypertrophic pulmonary osteoarthropathy (periosteum lifts off, lower shin pain)
thrombophlebitis 
hypercalcemia (squamous)
hyponatremia (SIADH, SCLC) 
Weakness- Eaton Lambert syndrome (SCLC)
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35
Q

Symptoms of hypercalcemia

A

Stones- biliary and renal calculi
Bones- bone pain
Groans- abdominal pain, constipation, N+V
Thrones- polyuria
Psychiatric overtones- depression, anxiety, coma, reduced GCS

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36
Q

treatment of hypercalcemia

A

Rehydration
if Ca >4 or doesn’t correct with fluid, IV bisphosphonate
treat cause eg squamous carcinoma

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37
Q

Symptoms of SIADH

A 
usually small cell cancer
N+V
myoclonus 
lethargy, confusion
seizures/coma
38
Q

Treatment of SIADH

A

Fluid restriction <1.5L/day
Demeclocycline
treat underlying cause

39
Q

signs of lung cancer on examination

A 
dull on percussion
bloated face
finger clubbing
lymphadenopathy
tracheal deviation
enlarged liver
Mono wheeze
40
Q

Radicle LC treatment

A

Surgery, Radicle radiotherapy

41
Q

Why may someone have a PET scan

A

to check for metastases before surgery

shows where high metabolic activity is

42
Q

methods of tissue diagnosis of lung cancer

A

bronchoscopy, EBUS, CT guided biopsy
Lymph node or pleural aspiration
thoracoscopy

43
Q

DD of patient with abnormal CXR, haemoptysis and is a smoker

A

Lung cancer, secondary lung cancer, TB, PE, Bronchiectasis, lymphoma, vasculitis,

44
Q

threshold for surgery of lung cancer near carina

A

if cancer is less than 2cm from carina can’t do surgery because surgeon must be able to make a stump after pneumonectomy

45
Q

surgery options for lung cancer

A

pneumonectomy
lobectomy (also remove lymph glands)
VATS
thoracotomy

46
Q

Staging of lung cancer

A 
type of cancer
tumour size
local invasion
nodes 
metastasis
ECOG score (fitness)
47
Q

side effects of chemotherapy

A 
N+V
Hair loss
lethargy
pulmonary fibrosis
bone marrow suppression- anaemia, infection
48
Q

SABR

A

Multiple Xray beams from different angles to one area

less collateral damage

49
Q

what is a pleural effusion

A

fluid in pleural cavity

50
Q

primary investigation of lung problem

A

CXR

51
Q

where do lung pleura combine

A

hila, to form the pulmonary ligament which runs inferiorly and attaches the root of the lung to the diaphragm

52
Q

causes of unilateral pleura effusion

A

Tumour (mesothelioma)
Infection
chylothorax
Haemorrhage

53
Q

Investigations of pleural effusion

A 
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
Q

criteria for transudate vs exudate

A

transudate <30g/L
exudate >30g/L

if pleural sample LDH is two thirds greater than serum- likely to reflect exudate effusion

55
Q

causes of transudate

A

transudate- increased hydrostatic pressure

congestive heart failure
hypoalbuminemia 
Cirrhosis
Atelectasis 
peritoneal dialysis
56
Q

causes of exudate

A

exudate- inflammation, increased capillary permeability

pneumonia
cancer
TB
Viral infection
pulmonary infarct
asbestos
autoimmune
57
Q

Causes of bilateral pleural effusion

A

Cardiac failure
LVF
PTE
drugs

58
Q

bloody pleural effusion

A

trauma malignancy infection infarction

59
Q

turbid/milky

A

empyema, chylothorax

60
Q

turbid/milky in pleural effusion

A

empyema, chylothorax

61
Q

Foul smelling pleural effusion

A

anaerobic empyema

62
Q

food particles in pleural effusion

A

oesophageal rupture

63
Q

Normal pH of pleural fluid

A

7.6

64
Q

pleural effusion <7.3

A

pleural inflammation (malignancy, RhA)

65
Q

pleural effusion <7.2

A

requires drainage

66
Q

what to do with pus in pleural space

A

drain, dont test pH

67
Q

Lymphocytes in effusion

A

TB, malignancy

68
Q

neutrophils in effusion

A

acute process

69
Q

tests if worried about TB

A

PCR, AFB stain, liquid culture bottles

70
Q

how often will pleural aspiration diagnose malignancy

A

60%, do no more than 2 biopsies

71
Q

S+S of mesothelioma

A

breathlessness, chest pain, weight loss, fever sweating, cough
takes 30-40 years after asbestos exposure to show S+S

72
Q

Describe 3 types of asbestos

A

chrysotile- white, most common
amosite- brown
crocidolite - most dangerous

73
Q

Treatment of mesothelioma

A 
pleurodeses effusions 
talc slurry
long term pleural catheter
radiotherapy
chemotherapy
surgery
palliative care
74
Q

2 types of talc

A

talc slurry: talc in suspension

talc poudrage: insufflated talc

75
Q

complications of talc

A 
minor pleuritic pain and fever
abscess
talc pneumonitis/ARDS
Pneumonia
Respiratory failure
76
Q

Predicting survival time in patients with malignant pleural effusion

A

LENT score

LDH
ECOG score
Neutrophil to lymphocyte ratio
Tumour type

77
Q

Presentation of PX

A 
acute onset of pleuritic chest pain
SOB, Hypoxia
Tachycardia
Hyper-resonance
reduced expansion
quiet breath sounds on ausculation
Hammans click
78
Q

how to differentiation between small PX and bullous disease

A

CT scan

79
Q

Management of pneumothorax

A

oxygen
Aspiration 1st line
chest drain
may need suction

80
Q

indications for surgical intervention in pneumothorax

A 
2nd ipsilateral PX
1st bilateral PX
1ST contralateral PX
persistent PX
at risk professions
81
Q

who tends to pneumothorax

A 
tall, thin men
marfans syndrome
cannabis smokers
smokers
secondary-existing lung disease
primary-apical bullae
82
Q

signs of TPX

A

tracheal deviation
elevated JVP
hypotension
reduced area entry on opposite side

83
Q

encased pus in pleural space

A

empyema

84
Q

Risk factors of pleural infection

A

Diabetes
Immunosuppression
Gastro oesophageal reflux
Drug misuse , IV drug abuse

85
Q

Contents of empyema

A

Pus

86
Q

Complicated effusion

A 
G+ stain
pH <7.2
Low glucose 
Septations
Loculations
87
Q

Treatment of large effusion

A

Chest drain
Antibiotics
Fibrinolytics/ DNA ase

88
Q

what cells do small cell carcinoma arise from

A

APUD cells

89
Q

what lung cancers are typically central and typically peripheral

A

central- small cell, squamous

peripheral- adenocarcinoma

90
Q

lung cancer associated with gynaecomastia

A

adenocarcinoma

91
Q

lung cancer associated with hyperthyroidism

A

squamous cell lung cancer

92
Q

lung cancer associated with BHCG

A

LARGE CELL CARCINOMA

Respiration (6 decks)

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