Lung cancers Flashcards
Cancer in the pleura?
mesothelioma
cancer of lung parenchyma?
Bronchial
what are the 2 types of bronchial lung parenchyma cancers?
small cell
Non small cell
what are the 4 types of non small cell cancers?
squamous
adenocarcinoma
carcinoid
large cell
what are 1^ metastasis sites?
Bone, liver, adrenals (usually aSx), brain, lymph nodes
What is mesothelioma?
Malignancy of lung pleura
Mesothelioma
Cause?
When do Sx present?
Who is affected?
ABESTOS
typically don’t present till decades after exposure - latent period
males 40-70
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
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
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
What would be seen on a chest x ray/CT?
pleural thickening +/- effusion
which is better, CT or Xray and why?
High resolution, more detailed than chest x ray
Tx for mesothelioma
Very aggressive tumour; usually palliative
If found early, cam try surgery + chemo/radio (but generally resistant)
Is mesothelioma likely to metastasise distantly?
Unlikely to distantly metastasise as affects pleura, pleura in body isn’t found everywhere
What is a bronchial carcinoma?
primary malignancy of lung parenchyma
small cell
non small cell
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)
