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Respiratory Diseases > Lung cancers > Flashcards

Lung cancers Flashcards

1
Q

What is the general prognosis of bronchial carcimoma?

A

Around 50 percent of patients will die within 6 months of diagnosis.

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2
Q

What is meant by paraneoplastic effects?

A

Biologically active molecules are released from the tumour cells which can mimic the effects of naturally occuring hormones

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3
Q

How can lung cancer present?

A

Primary tumour
Local invasion
Metastasis
Paraneoplastic

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4
Q

What can cause lung cancer?

A

smoking
atmospheric pollution
genetic predisposition ?

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5
Q

What are the carcinogens in tobacco?

A 
Polycyclic hydrocarbons
aromatic amines
phenols
nickel
cyanides
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6
Q

What other chemicals can predispose bronchial carcinmona?

A

Asbestos
nickel
chromates
radiation

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7
Q

How is lung cancer classified?

A

Histologically

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8
Q

What are the classifications of lung cancer?

A

Small cell
Non-small cell
Other eg bronchial gland tumour

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9
Q

Give the non small cell tumours?

A

Adenocarcinoma
Squamous cell carcinoma
Large cell
neuroendocrine tumours

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10
Q

What is the most common lung cancer?

A

Adenocarcinoma

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11
Q

Which lung cancer is caused by smoking?

A

Squamous cell

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12
Q

Give some features of small cell carcinoma

A 
Rapid growth
Early metastisis
Worst prognosis
Not suitable fore surgery
Chemosensitive
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13
Q

Give the features of squamous cell carcinoma?

A

Central in main or segmental bronchi
Obstructive symptoms
Can destroy cartilage rings
Bronchiectasis and obstructive pneumonitis

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14
Q

Give the features of an adenocarcinoma?

A

Peripheral
Radidly incades lymohatics, blood vessels, pleura etc
may be multiple tumours

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15
Q

Give the features of large cell cancer?

A

Tumour with no aciner or squamous differentiation
Necrosis and haemorrage frequent
Invades pleura and adjacent structures

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16
Q

What is the pathway for malignancy formation?

A

Squamous metaplasia- Dysplasia- Carcinoma in situ- malignancy

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17
Q

What is a broncioalveolar carcinoma?

A

Type of adenocarcinoma that invades along the alveolar walls
Does not usually infiltrate pleura
Good prognosis with surgery

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18
Q

What is a carcinoid tumour?

A

Neuroendocrine tumour with low grade malignancy

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19
Q

What is a bronchial gland neoplasm?

A

More commonly seen in salivary glands
Adenoid cyctic carcinoma
Microepidermoid carcinoma

20
Q

How can pleural neoplasms arise?

A

Benign (rare)
Primary- mesothelioma
Secondary- invasion by lung carcinomas and metastatic cancers

21
Q

Give a summary of the symptoms of bronchial carcinoma?

A 
Cough
Haemoptysis
Weight loss
Chest pain
Recurrent infections
Breathlessness
Tiredness
Hoarseness
22
Q

How can lung cancer cause a hoarse throat?

A

PAralysis of the vocal cord due to damage to the recurrent laryngeal nerve

23
Q

What can a pericadium invasion by a tumour cause?

A

Breathlessness
AF
Pericardial effusion

24
Q

How can lung cancers affect the oesophagus?

A

Can cause dysphagia

25
Q

What is a pancoast tumour?

A

One that invades the brachial plexus and results in muscle wasting in the arm and hand

26
Q

How can lung cancers affect the pleural cavity?

A

Pleural effusion- breathlessness

27
Q

What happens if the tumour obstructs the SVC?

A

Reduced veinous drainage from the head and arm
Puffy eyes and headache
Distention of veins in neck and abdomen

28
Q

What are the symptoms of the tumour invading the chest wall?

A

Well localised chest pain

worse at night or on movement

29
Q

What can happen if the tumour encases an artery?

A

Severe haemoptysis and death

30
Q

Where are the common sites of metastasis?

A 
Liver
Adrenals
Bone
Brain
Skin
31
Q

What are the signs of a cerebral metastasis?

A

Weakness
Headache worse in the morning
Fits

32
Q

What are the features of liver metastasis?

A

Obstructive jaundice

Abnormal alkaline phosphatase

33
Q

What are the features of a bone metastasis?

A

Pain worse at night

Fractures

34
Q

What are some non metastatic/paraneoplastic symptoms?

A 
Clubbing
HPOA
Weight loss
Thrombophebitis
Hypercalcaemia
Hyponataemia
Weakness ie eaten lambert syndrome
35
Q

What are some of the signs of bronchial carcinoma?

A 
Clubbing
Bloated face
Hoarse voice
Lymphadenopathy
Tracheal deviation
Dull percussion
Stridor
Enlarged liver
36
Q

What investigations should be done?

A 
FBC
Coagulation screen
Electrolytes and alkaline phosphatase
FEV1
CT scan
Spirometry 
CXR
Bronchoscopy
Biopsy 
Lymph and pleural aspiration
37
Q

What test would you NOT do?

A

sputum cytology

38
Q

What would be your differentials?

A 
TB
Vasculitis
PE
Lymophoma
Bronchiectasis
39
Q

What is gefitinib?

A

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.

40
Q

What is EGFR?

A

epidermal growth factor receptor

41
Q

What transcription factor is expressed by small cell carcinomas?

A

TTF 1

Thyroid transcription factor 1

42
Q

What othe tumour expressed TTF1?

A

Adenocarcinoma

43
Q

What mutation is associated with Adenocarcinoma?

A

k-ras and wild type EGFR (smoking)

44
Q

What oncogenes are associated with SCLC?

A

myc

45
Q

What oncogenes are associated with NSCLC?

A

myc, K-ras, EGFR

46
Q

What tumour suppressor genes are associated with SCLC?

A

p53, Rb, 3p

47
Q

What tumour suppressor genes are associated with NSCLC?

A

p 53, Iq, 3p, 9p, 11p, Rb

Respiratory Diseases (13 decks)

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