Lung cancers Flashcards
What is the general prognosis of bronchial carcimoma?
Around 50 percent of patients will die within 6 months of diagnosis.
What is meant by paraneoplastic effects?
Biologically active molecules are released from the tumour cells which can mimic the effects of naturally occuring hormones
How can lung cancer present?
Primary tumour
Local invasion
Metastasis
Paraneoplastic
What can cause lung cancer?
smoking
atmospheric pollution
genetic predisposition ?
What are the carcinogens in tobacco?
Polycyclic hydrocarbons aromatic amines phenols nickel cyanides
What other chemicals can predispose bronchial carcinmona?
Asbestos
nickel
chromates
radiation
How is lung cancer classified?
Histologically
What are the classifications of lung cancer?
Small cell
Non-small cell
Other eg bronchial gland tumour
Give the non small cell tumours?
Adenocarcinoma
Squamous cell carcinoma
Large cell
neuroendocrine tumours
What is the most common lung cancer?
Adenocarcinoma
Which lung cancer is caused by smoking?
Squamous cell
Give some features of small cell carcinoma
Rapid growth Early metastisis Worst prognosis Not suitable fore surgery Chemosensitive
Give the features of squamous cell carcinoma?
Central in main or segmental bronchi
Obstructive symptoms
Can destroy cartilage rings
Bronchiectasis and obstructive pneumonitis
Give the features of an adenocarcinoma?
Peripheral
Radidly incades lymohatics, blood vessels, pleura etc
may be multiple tumours
Give the features of large cell cancer?
Tumour with no aciner or squamous differentiation
Necrosis and haemorrage frequent
Invades pleura and adjacent structures
What is the pathway for malignancy formation?
Squamous metaplasia- Dysplasia- Carcinoma in situ- malignancy
What is a broncioalveolar carcinoma?
Type of adenocarcinoma that invades along the alveolar walls
Does not usually infiltrate pleura
Good prognosis with surgery
What is a carcinoid tumour?
Neuroendocrine tumour with low grade malignancy
What is a bronchial gland neoplasm?
More commonly seen in salivary glands
Adenoid cyctic carcinoma
Microepidermoid carcinoma
How can pleural neoplasms arise?
Benign (rare)
Primary- mesothelioma
Secondary- invasion by lung carcinomas and metastatic cancers
Give a summary of the symptoms of bronchial carcinoma?
Cough Haemoptysis Weight loss Chest pain Recurrent infections Breathlessness Tiredness Hoarseness
How can lung cancer cause a hoarse throat?
PAralysis of the vocal cord due to damage to the recurrent laryngeal nerve
What can a pericadium invasion by a tumour cause?
Breathlessness
AF
Pericardial effusion
How can lung cancers affect the oesophagus?
Can cause dysphagia
What is a pancoast tumour?
One that invades the brachial plexus and results in muscle wasting in the arm and hand
How can lung cancers affect the pleural cavity?
Pleural effusion- breathlessness
What happens if the tumour obstructs the SVC?
Reduced veinous drainage from the head and arm
Puffy eyes and headache
Distention of veins in neck and abdomen
What are the symptoms of the tumour invading the chest wall?
Well localised chest pain
worse at night or on movement
What can happen if the tumour encases an artery?
Severe haemoptysis and death
Where are the common sites of metastasis?
Liver Adrenals Bone Brain Skin
What are the signs of a cerebral metastasis?
Weakness
Headache worse in the morning
Fits
What are the features of liver metastasis?
Obstructive jaundice
Abnormal alkaline phosphatase
What are the features of a bone metastasis?
Pain worse at night
Fractures
What are some non metastatic/paraneoplastic symptoms?
Clubbing HPOA Weight loss Thrombophebitis Hypercalcaemia Hyponataemia Weakness ie eaten lambert syndrome
What are some of the signs of bronchial carcinoma?
Clubbing Bloated face Hoarse voice Lymphadenopathy Tracheal deviation Dull percussion Stridor Enlarged liver
What investigations should be done?
FBC Coagulation screen Electrolytes and alkaline phosphatase FEV1 CT scan Spirometry CXR Bronchoscopy Biopsy Lymph and pleural aspiration
What test would you NOT do?
sputum cytology
What would be your differentials?
TB Vasculitis PE Lymophoma Bronchiectasis
What is gefitinib?
An EGFR inhibitor which interrupts signaling through the epidermal growth factor receptor (EGFR) in target cells. Therefore, it is only effective in cancers with mutated and overactive EGFR, such as adenocarcinomas.
What is EGFR?
epidermal growth factor receptor
What transcription factor is expressed by small cell carcinomas?
TTF 1
Thyroid transcription factor 1
What othe tumour expressed TTF1?
Adenocarcinoma
What mutation is associated with Adenocarcinoma?
k-ras and wild type EGFR (smoking)
What oncogenes are associated with SCLC?
myc
What oncogenes are associated with NSCLC?
myc, K-ras, EGFR
What tumour suppressor genes are associated with SCLC?
p53, Rb, 3p
What tumour suppressor genes are associated with NSCLC?
p 53, Iq, 3p, 9p, 11p, Rb
