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Finals - CardioResp > Lung cancers > Flashcards

Lung cancers Flashcards

1
Q

How many lobes are in the R vs L lobe of the lung?

Which fissures divide these?

A

Right: 3 lobes divided by the oblique and horizontal fissure

Left: 2 lobes divided by the oblique fissure

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2
Q

How can can the histological types of lung cancer can be broadly divided?

Which is more common?

A

Small cell lung cancer (20%)
Non-small cell lung cancer (80%)

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3
Q

List the 4 types of non-small cell lung cancer

Incl how common each is among total lung cancers

A

Adenocarcinoma (40%)
Squamous cell carcinoma (20%)
Large-cell carcinoma (10%)
Other types (10%)

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4
Q

Which type of lung cancers are responsible for paraneoplastic syndromes?

A

Small cell lung cancer

Contain neurosecretory granules that can release neuroendocrine hormones

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5
Q

List 4 histological features of Squamous cell Carcinomas

(CAKE under a bridge)

A
  1. Central
  2. Angulate cells
  3. Keratin pearls and Keratinisation
  4. Eosinophiliic cytoplasm
  5. Intercellular bridges (prickles)
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6
Q

List 4 histological features of an Adenocarcinoma

A
  1. Peripheral
  2. Columnar/cuboidal cells
  3. Glands (acini) -
  4. Papillary structures
  5. May line alveoli
  6. Some produce mucin
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7
Q

List 4 histological features of Small cell carcinoma

A
  1. “oat cell carcinoma”
  2. Very cellular
  3. Small nuclei
  4. Little cytoplasm
  5. Nuclear moulding
  6. Necrosis and lots of mitoses
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8
Q

What is a Mesothelioma?

A

Malignancy affecting the mesothelial cells of the pleura

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9
Q

Mesotheliomas are highly linked with what?

A

History of Asbestos inhalation

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10
Q

List 4 symptoms of lung cancer

A
  1. Haemoptysis
  2. Finger clubbing
  3. SOB
  4. Cough
  5. Weight loss
  6. Recurrent pneumonia
  7. Lymphadenopathy
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11
Q

Which lymph node is most commonly the first to be found on examination?

A

supraclavicular

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12
Q

What extra-pulmonary manifestation of lung cancer is associated with horse voice?

A

Recurrent laryngeal nerve palsy

Due to tumour pressing on the RLN as it passes through the mediastinum

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13
Q

If a tumour affects the phrenic nerve how may the patient present and why?

A

SOB due to diaphragm weakness

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14
Q

Superior vena cava obstruction is a complication of lung cancer, how does it present?

A

Facial swelling, difficulty breathing and distended veins in the neck and upper chest

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15
Q

What sign associated with SVC obstruction can be elicited on examination?

A

“Pemberton’s sign” - medical emergency

When raising the hands over the head causes facial congestion and cyanosis

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16
Q

What tumour is associated with Horners syndrome?

A

Pancoast tumour pressing on the sympathetic ganglion

17
Q

What is the triad of Horner’s syndrome?

A

Ptosis, anhidrosis and miosis

18
Q

Which lung cancer may present with hyponatraemia and why?

A

Small cell lung cancer

Secrete ectopic ADH causing SIADH

19
Q

Which lung cancer may present with Cushings Syndrome and why?

A

Small cell lung cancer which secrete ectopic ACTH

20
Q

Which lung cancer may present with Hypercalcaemia?

A

Squamous cell carcinoma which secretes ectopic PTH

21
Q

What is Limbic encephalitis?

A

Paraneoplastic syndrome associated with small cell lung cancer

Causes immune system to make antibodies against tissues in the brain, specifically the limbic system, causing inflammation

22
Q

List 4 symptoms of Limbic encephalitis?

A
  1. Short term memory impairment
  2. Hallucinations
  3. Confusion
  4. Seizures
23
Q

What antibody is associated with Limbic encephalitis?

A

Anti-Hu antibodies

24
Q

What is Lambert-Eaton myasthenic syndrome?

A

Antibodies produced against small cell lung cancer

These antibodies also target VOCC on presynaptic motor neurones

25
Q

List 4 symptoms of Lambert-Eaton myasthenic syndrome

A
  1. Proximal muscle weakness
  2. Diplopia (intraoccular muscles)
  3. Ptosis (levator muscles)
  4. Slurred speech and dysphagia (pharyngeal muscles).

Patients may also experience dry mouth, blurred vision, impotence and dizziness due to autonomic dysfunction

26
Q

What is the NICE Referral Criteria for suspected lung cancer?

A

Offer a chest x-ray, carried out within 2 weeks, to patients >40 with:

  • Clubbing
  • Lymphadenopathy
  • Recurrent or persistent chest infections
  • Raised platelet count (thrombocytosis)
  • Chest signs of lung cancer
27
Q

List 2 other two instances when we should consider a chest x-ray

A

Patients over 40 years old who have:

  • ≥ 2 unexplained symptoms and never smoked
  • ≥ 1 unexplained symptoms in patients that have smoked
28
Q

Investigations for suspected lung cancer?

Highlight the first line

A
  1. Chest x-ray
  2. Staging CT scan
  3. PET-CT
  4. Bronchoscopy with endobronchial ultrasound (EBUS)
  5. Biospy
29
Q

List 4 x-ray findings suggestive of lung cancer

A
  1. Hilar enlargement
  2. Peripheral opacity
  3. Pleural effusion - usually unilateral
  4. Collapse
30
Q

What are the 2 ways a biopsy is obtained for suspected lung cancer?

A

Bronchoscopy or percutaneous biopsy

31
Q

Management of non-small cell lung cancer?

A
  1. Surgery offered first-line if disease is isolated (curative)
  2. Radiotherapy (curative) if diagnosed early
  3. Adjuvant chemotherapy
  4. Palliative chemotherapy
32
Q

Management of small cell lung cancer?

A
  1. Chemotherapy and radiotherapy
  2. Endobronchial treatment (stents , debulking) for palliative treatment
33
Q

Is prognosis better for small cell or non-small cell cancer?

A

Non-small cell lung cancer

34
Q

List the 3 types of surgery for lung cancer

A
  1. Thoracotomy
  2. Video-assisted thoracoscopic surgery (VATS) – minimally invasive “keyhole” surgery
  3. Robotic surgery

Finals - CardioResp (18 decks)

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