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Lung tumors Flashcards

1
Q

What are primary lung tumours usually?

A
  • Epithelial (>95%)
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2
Q

What are metastatic lung tumours?

A
  • Colon
  • Breast
  • Renal cell carcinoma
  • Prostrate
  • Melanoma
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3
Q

What are benign lung tumours?

A
  • Hamartoma (most common)
  • papilloma
  • adenoma
  • chondroma
  • haemangioma
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4
Q

What is the most common malignant lung tumour?

A

Non small cell carcinoma
- adenocarinoma
- squamous cell carcinoma
- large cell carcinoma
- NSCLC, NOS

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5
Q

What malignant tumours of the lung are less common?

A

Neuroendocrine carcinoma
- small cell carcinoma
- large cell neuroendocrine carcinoma
- carcinoid tumour

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6
Q

What are risk factors for lung tumours?

A
  • Cigarette smoking (85% carcinoma occurs in smokers)
  • Air pollution
  • Industrial exposure (asbestos)
  • Radon gas
  • COPD, fibrotic lung diseases
  • Genetics
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7
Q

What is bronchogenic carcinoma?

A
  • any type or subtype of lung cancer
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8
Q

What does lung carcinoma presentation depend on?

A
  • Site and Stage
  • Asymptomatic: CXR
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9
Q

What are local effects of lung tumours?

A
  • mass surrounding main bronchus
  • mucosa ulcerated, roughened
  • cough
  • haemoptysis
  • pleural effusion/pneumothorax
  • Reccurent pneumonia (carcinoma narrows lumen of bronchus)
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10
Q

Where do lung tumours spread locally?

A
  • Hilar + mediastinal lymph nodes
  • Superior mediastinum obstruction

mediastinal spread worse

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11
Q

What is Pancoast tumour?

A
  • apical lung tumour
  • Horner syndrome: invasion of sympathetic chain
  • Miosis
  • Ptosis
  • Anhidrosis
  • Shoulder + arm pain
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12
Q

What are distant metastases of lung tumours?

A
  • Lymph nodes (axilla, cervical)
  • Bone
  • Liver
  • Brain
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13
Q

What are non-metastatic systemic signs of lung tumours?

A
  • Cachexia (driven by metabolic changes caused by humour)
  • Clubbing
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14
Q

What is paraneoplastic syndrome?

A
  • cross reacting of antibodies
  • interferes with normal metabolic pathways
  • mostly seen in small cell lung carcinoma

immune system also attacks normal cells

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15
Q

What are some examples of paraneoplastic syndromes?

A
  • neuropathy, myopathy
  • Cushing Syndrome → ACTH
  • Hypercalcaemia
  • Hyponatraemia

look at slide 17 for more

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16
Q

What investigations are done for lung cancer?

A
  • Radiology (CXR , CT, PET)
  • Bloods (FBC, Ca, LFT, U&E)
  • Bronchoscopy
  • Tissue sampling
17
Q

What IHC test is positive for adenocarcinoma?

glandular

A
  • TTF-1
  • Napsin A
18
Q

What distinct features are found in squamous cell carcinoma?

A

IHC: CK5/6 and p63
- keratin produced, intercellular bridges
- Necrosis + cavitation

19
Q

What are some common molecular targets in lung carcinoma?

A
  • EGFR
  • ALK
  • ROS-1
  • RET
  • B-RAF
20
Q

What drugs target EGFR?

A
  • First and third generation EGFR TKI
21
Q

What drugs target ALK?

A

CNS disease:
- Second generation ALK TKI
- Crizotinib

Non-CNS disease:
- Crizotinib first, then ALK TKI (opposite)

22
Q

What drugs target ROS?

A
  • Crizotinib
23
Q

What drugs target RET?

A
  • Cabozantinib
24
Q

What drugs target BRAF?

A
  • BRAF inhibitors
25
Q

What are immune checkpoint inhibitors?

A
  • PD-1/PD-L1
  • Blocking PD allows T-cells to kill tumour cells
  • Works well with lung cancers because of more mutations - smoking
26
Q

What is ECOG status?

for NSCLC

A
  • used alongside TNM staging
  • ECOG 0-4 is evaluated
  • Patients with lung carcinoma have multiple co-morbidities
27
Q

What tests are positive for small cell carcinoma?

type of neuroendocrine

A
  • Giemsa stain
  • TTF1
  • CD56
  • Chromogranin
28
Q

What is the management for SCLC?

A
  • Chemotherapy: platinum + etoposide
  • Radiotherapy

very chemo sensitive

29
Q

What staging is used for SCLC?

A
  • Limited vs Extensive
  • Limited: cancer only reached one area of lung (radiotherapy)
  • Extensive: metastasis to other lung, pleural cavity, lymph, bones
30
Q

What are carcinoid tumours and what tests are positive?

A
  • Neuroendocrine tumours
  • CD56
  • Synaptophysin
  • Chromogranin

resp (20 decks)

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