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Gen Med (Resp) > Lung Malignancies > Flashcards

Lung Malignancies Flashcards

1
Q

What imaging investigation is used before curative surgery or radiotherapy to ensure there are no occult metastases?

A

PET-CT scan

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2
Q

What imaging investigation is indicated in patients with long cancer who have bony pain or increased calcium/ALP?

A

Isotope bone scan

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3
Q

Which broad category of lung cancer is most likely to potentially be cured?

A

Non-small cell lung cancers

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4
Q

What treatment options are most likely to be used in the management of non-small cell lung cancer?

A

Surgery and radiotherapy

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5
Q

What treatment options are most likely to be used in the management of small cell lung cancer?

A

Chemotherapy

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6
Q

What are the two main curative treatment options for patients with early stage non-small cell lung cancer?

A

Surgical resection, high-dose radical radiotherapy

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7
Q

Other than smoking, what are some risk factors for the development of a primary lung cancer?

A

Passive smoking, asbestos exposure, radiotherapy to the lungs, family history

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8
Q

Mutations in which proto-oncogene are responsible for 10-30% of lung adenocarcinomas?

A

K-ras

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9
Q

Epidermal growth factor (EGFR) mutations can arise in which broad category of lung cancer?

A

Non-small cell lung cancers

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10
Q

What are the most common respiratory symptoms of lung cancer?

A

Cough and haemoptysis

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11
Q

What are the most common systemic symptoms of lung cancer?

A

Weight loss and fatigue

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12
Q

What are some less common symptoms of lung cancer which may occur secondary to a bronchial obstruction?

A

Shortness of breath and wheeze

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13
Q

Why may a primary lung cancer eventually cause chest pain?

A

Chest wall or mediastinal invasion

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14
Q

Name some abnormal features which may occur as a result of a Pancoast tumour?

A

Ipsilateral Horner’s syndrome and pain/weakness/paraesthesia of the hand and arm

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15
Q

Tumours in which location are more likely to cause haemoptysis- central or peripheral?

A

Central

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16
Q

SVC obstruction caused by a lung tumour may cause what symptoms?

A

Face/arm/neck swelling, dizziness, headaches, fixed and dilated neck veins

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17
Q

Recurrent laryngeal nerve palsy caused by a lung tumour will cause what symptom?

A

Hoarseness

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18
Q

Phrenic nerve palsy caused by a lung tumour will cause what symptom?

A

Worsening dyspnoea

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19
Q

What is the most common paraneoplastic syndrome experienced by patients with primary lung cancer?

A

Fever

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20
Q

What are some FBC abnormalities which may be seen in patients with lung cancer?

A

Anaemia of chronic disease and thrombocytosis

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21
Q

What paraneoplastic syndrome is commonly associated with squamous cell lung cancer?

A

PTH related peptide production, resulting in hypercalcaemia

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22
Q

Small cell lung cancers can result in the ectopic production of which hormones?

A

ADH and ACTH

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23
Q

Lambert-Eaton syndrome, causing limb weakness and autonomic dysfunction, is caused by what? Which type of lung cancer can this be associated with?

A

Anti-calcium channel antibodies, associated with small cell lung cancer

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24
Q

Primary lung cancers are most likely to metastasise to which lymph nodes?

A

Mediastinal, cervical, axillary

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25
Q

What are some organs that primary lung cancers are likely to metastasise to?

A

Brain, bone, liver and adrenals

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26
Q

What is the standard investigation for any smoker aged > 50 with symptoms that could possibly be caused by lung cancer?

A

CXR

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27
Q

What are two blood tests that may be elevated in someone with bony metastases?

A

ALP and calcium

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28
Q

When are pulmonary function tests indicated in the investigation of individuals with lung cancer?

A

In all patients being considered for curative treatment

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29
Q

Other than a CXR, what further imaging is required in all patients with suspected lung cancer?

A

CT chest and abdo

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30
Q

Which imaging investigation(s) is/are indicated if a patient with suspected lung cancer has any neurological symptoms or signs?

A

Brain CT and/or MRI

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31
Q

What are the two curative surgical treatment options in the management of non-small cell lung cancers?

A

Lobectomy or pneumonectomy

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32
Q

Which patients are suitable for curative surgical treatment of non-small cell lung cancer?

A

Those with localised disease and no mediastinal invasion, and adequate lung function and performance status

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33
Q

In the management of non-small cell lung cancers, which patients receive curative radiotherapy?

A

Those who are not amenable to curative surgery

34
Q

What is the use for low dose radiotherapy in the management of lung cancer?

A

Palliation of symptoms (in both small cell and non-small cell cancers)

35
Q

EGFR inhibitors can be a useful treatment in the management of which type of lung cancer?

A

Adenocarcinomas with EGFR mutations

36
Q

Small cell lung cancers respond rapidly to chemotherapy, but most patients relapse within how long?

A

A few months

37
Q

How may a carcinoid tumour of the lung present?

A

Cough, lobar collapse, recurrent infections distal to bronchial obstruction

38
Q

In carcinoid tumours of the lung, serotonin release can cause carcinoid syndrome. What symptoms does this cause?

A

Diarrhoea and skin flushing

39
Q

What is the best treatment for carcinoid tumours of the lung?

A

Surgical excision

40
Q

What medication may be useful in decreasing the symptoms associated with carcinoid syndrome?

A

Somatostatin analogues e.g. octreotide

41
Q

What is the primary carcinogen responsible for causing mesothelioma?

A

Asbestos

42
Q

What is the peak age of onset of mesothelioma?

A

50-70

43
Q

What is the most common genetic abnormality associated with mesothelioma?

A

Chromosome 22 monosomy

44
Q

What is the typical presentation of mesothelioma?

A

Pleural effusion, progressive breathlessness and chest pain, associated with systemic symptoms

45
Q

What is the first line investigation for someone with a suspected mesothelioma? What might this show?

A

CXR- may show pleural thickening and/or pleural effusions

46
Q

On average, how long is the delay between asbestos exposure and presenting with mesothelioma?

A

20-30 years

47
Q

Which type of primary lung cancer may be described histologically as showing ‘keratin pearls’?

A

Squamous cell carcinoma

48
Q

Which type of primary lung cancer grows the most rapidly, and has usually metastasised by the time of presentation?

A

Small cell lung cancer

49
Q

A CXR of which type of lung cancer is most likely to show patches of slow-growing consolidation, rather than a focal, well-defined mass?

A

Adenocarcinoma

50
Q

Which type of lung cancer is most likely to occur in a non-smoker?

A

Adenocarcinoma

51
Q

Which type of lung cancer is most often associated with hypercalcaemia?

A

Squamous cell carcinoma

52
Q

Primary lung cancers arise from where?

A

Respiratory epithelium

53
Q

What risk factor is responsible for causing 9/10 cases of primary lung cancer?

A

Cigarette smoking

54
Q

At what age does the incidence of lung cancer peak?

A

80-84

55
Q

Describe the two main categories of lung cancer, and give the sub-categories also?

A

Small cell lung cancer + non-small cell lung cancer (adenocarcinomas, squamous cell carcinoma, large cell carcinoma)

56
Q

Which broad category of lung cancer is most common?

A

Non-small cell lung cancer

57
Q

Which specific category of lung cancer is most common?

A

Adenocarcinoma

58
Q

Which types of lung cancer are most likely to be located in the central airways?

A

Small cell and squamous cell carcinomas

59
Q

Which types of lung cancer are most likely to be located in the peripheral lung?

A

Adenocarcinomas and large cell carcinomas

60
Q

One of which two investigations must be performed to make a definitive diagnosis of lung cancer?

A

Biopsy for histopathology or sputum sample for cytology

61
Q

What is the first line investigation when lung cancer is suspected?

A

CXR

62
Q

Why is a tissue biopsy favoured over sputum cytology when making a definitive diagnosis of lung cancer?

A

Sputum cytology often gives false negatives

63
Q

How is a biopsy taken for proximal lung cancers?

A

Bronchoscopy with endobronchial biopsies

64
Q

How is a biopsy taken for peripheral tumours or lymph nodes?

A

Image guided needle biopsy

65
Q

How is a biopsy taken for pleural effusions?

A

Thoracentesis (needle aspiration)

66
Q

How is a biopsy taken for tumours/lymph nodes which cannot be samples in other ways as a last resort?

A

Surgical biopsy

67
Q

The rapid response to chemotherapy seen with small cell lung cancers can increase the risk of what complication? What does this cause and how is it treated?

A

Tumour lysis syndrome- this causes electrolyte disturbances and renal failure, it should be treated with IV fluids and allopurinol

68
Q

Name two management options for patients with brain metastases as a result of lung cancer?

A

Dexamethasone, whole brain irradiation

69
Q

What treatment option is used to improve pain control in lung cancer patients with bony metastases?

A

Radiotherapy

70
Q

After a diagnosis of small cell lung cancer, what is the mean survival time?

A

6 weeks

71
Q

A unilateral pleural effusion in a middle-aged male patient must always raise the suspicion of what diagnosis?

A

Mesothelioma

72
Q

If a patient has already had chemotherapy, what is an important differential for metastases to the lung?

A

Lung infections (as a result of immunosuppression)

73
Q

Where are carcinoid tumours of the lung usually found?

A

In a major bronchus

74
Q

Describe the typical growth pattern of carcinoid tumours of the lung?

A

Slow growing and locally invasive, often recur ofter excision, rarely metastasise

75
Q

Name some hormones that may be produced by carcinoid tumours of the lung?

A

ACTH, serotonin, bradykinin

76
Q

What is a pleural aspirate of a pleural effusion caused by a mesothelioma likely to show?

A

High protein (exudate), normal LDH, white and red blood cells

77
Q

What investigation is required to diagnose a mesothelioma?

A

Radiologically guided or thoracoscopic biopsy (of the affected pleura)

78
Q

Surgery is the only treatment option for mesothelioma that is potentially curative. Who would this treatment be indicated in?

A

Those with early stage disease and a good performance status

79
Q

What is the purpose of radiotherapy in the management of mesothelioma?

A

Palliation of chest pain

80
Q

What is the median survival time after a diagnosis of mesothelioma?

A

11 months

Gen Med (Resp) (4 decks)

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