Lung cancers Flashcards by Manaal Arif

Cancer in the pleura?

mesothelioma

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cancer of lung parenchyma?

Bronchial

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what are the 2 types of bronchial lung parenchyma cancers?

small cell
Non small cell

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what are the 4 types of non small cell cancers?

squamous
adenocarcinoma
carcinoid
large cell

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what are 1^ metastasis sites?

Bone, liver, adrenals (usually aSx), brain, lymph nodes

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What is mesothelioma?

Malignancy of lung pleura

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Mesothelioma
Cause?
When do Sx present?
Who is affected?

ABESTOS
typically don’t present till decades after exposure - latent period
males 40-70

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Sx of mesothelioma

Cancer Sx (weight loss, night pain, TATT)

Lung Sx - SOB, Persistent Cough, pleuritic chest pain

Tumour may also press on nearby structures eg. recurrent laryngeal nerve = hoarse voice

Also signs of metastasis

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Sx of mesothelioma

Cancer Sx (weight loss, night pain, TATT)

Lung Sx - SOB, Persistent Cough, pleuritic chest pain

Tumour may also press on nearby structures eg. recurrent laryngeal nerve = hoarse voice

Also signs of metastasis

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Dx of mesothelioma?
first line? diagnostic?

1st line: chest x ray + CT
CA - 125 (cancer antigen 125) high
(non specifically raised in tumours, sensitive but not specific)
Diagnostic = Biopsy

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What would be seen on a chest x ray/CT?

pleural thickening +/- effusion

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which is better, CT or Xray and why?

High resolution, more detailed than chest x ray

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Tx for mesothelioma

Very aggressive tumour; usually palliative
If found early, cam try surgery + chemo/radio (but generally resistant)

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Is mesothelioma likely to metastasise distantly?

Unlikely to distantly metastasise as affects pleura, pleura in body isn’t found everywhere

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What is a bronchial carcinoma?

primary malignancy of lung parenchyma
small cell
non small cell

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RF of bronchial carcinoma?

SMOKING
ASBESTOS
coal
ionising radiation
lung disease already present

How many bronchial carcinomas are small cell?

Who do they affect?

15%
exclusively smokers

what does small cell carcinoma cause?
examples?

paraneoplastic syndromes
ectopic ACTH = Cushings
ectopic ADH = SIADH
Lambert Eaton syndrome (autoimmune disorder of njm - neuro)

small cell carcinoma
rate of growth?
metastasis?
where are the lung lesions?

Fast growing
early metastasis
central lung lesions

What is BALT lymphoma?

non Hodgkins lymphoma in bronchi (bronchial associated tissue lymphoma)

non small cell carcinoma affects what %?
squamous affects how many?

85%

25%

Squamous - non small cell
squamous affects who mostly?
Lesions where in the lung?
what may it secrete?
Arises from?
metastasis?
spread?

Mostly smokers affected

Central lung, lesions with central necrosis

May secrete PTHrP –> hypercalcemia

Arise from lung epithelium

late metastasis

locally spread mostly

What is hypertrophic pulmonary osteoarthropathy associated with?

NSCLC
A paraneoplastic syndrome, usually squamous cell carcinoma:
Clubbing, arthritis, periostitis

Adenocarcinoma

What % affected?
Caused by?
which part of lung affected?
Arise from?
Mets common to?

Commonly abestos (+ smokes, less so than squamous)

Affects peripheral lung

Arise from Mucus secreting glandular epithelium

Mets common to bone, brain, adrenals, lymph nodes, liver

Adenocarcinoma is the biggest cause of? Triad of Sx?

2^ hypertrophic osteoarthritis Clubbing Arthritis big bone swelling

What is a adenocarcinoma in situ?

stage 0 Not yet spread

Carcinoid tumour Associated with which genes? What is it? Arise from?

Genetics; MEN1 mutation + neurofibromatosis 1 Neuroendocrine tumour (secretes serotonin) arise in GIT (mostly) + sometimes lung Sx only appear when liver mets present

General Sx of bronchial carcinoma?

Chest pain Cough and haemoptysis (cough up blood) Cancer Sx Signs of mets (eg. hoarse voice, Pemberton sign (Mediastinal mass) + Horners syndrome (pan coast))

Dx of bronchial carcinoma?

1st line = Chest x ray/CT Diagnostic (is this cancer) = bronchoscopy + biopsy MRI - staging - TNM

Tx for Bronchial carcinoma? small cell and non small cell

Small cell - More aggressive if early = consider chemo/radio (often unsuccessful) Metastasised = palliative Non small cell - less aggressive Early = surgical excision Metastasised = Chemo +/- radio eg. mAb therapy cetuximab (vs epidermal growth factor)

Are 1^ or 2^ more likely or common and why?

2^ tumours much more likely as lungs oxygenate 100% blood therefore all blood comes to lungs therefore higher mets risk esp, breast, kidney, bowel, bladder cancers

What is a Pancoast tumour? What Sx does it cause?

Tumour in lung apex metastasises to neck's sympathetic plexus Causing HORNERS SYNDROME , ptosis (eyelid drooping), myosis (excessive pupil constriction), anhidrosis (lack of sweat)