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2a > Lung tumours > Flashcards

Lung tumours Flashcards

1
Q

What is lung cancer?

A

Carcinoma (malignant tumour) of the bronchus or pleura. [PTS]

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2
Q

What are the main types of lung cancer in order of prevalence?

A

Non-small cell (80%) -squamous 35%, adenocarcinoma 30%, large-cell 15%
Small-cell (20%) [KC]

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3
Q

Give 3 risk factors for lung cancer.

A 
Smoking
Asbestos
Chromium
Arsenic
[pts]
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4
Q

Give 3 features of lung squamous cell carcinoma.

A

May cavitate with central necrosis
Cause obstructing lesions of bronchus with post-obstructive infection
Local spread common, metastases relatively late. [kc]

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5
Q

Give 3 features of lung adenocarcinoma.

A

Originate from mucus-secreting glandular cells, causes excess mucus secretion
Most common type in non-smokers.
May cause peripheral lesions on X ray/CT
Metastases common to bones, brain, pleura, lymph nodes and adrenal glands.

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6
Q

Give 3 features of small-cell lung carcinoma.

A

Tumour arising from neuroendocrine (APUD) cells.
Often secrete polypeptide hormones
Arise centrally and metastasise early.

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7
Q

Which lung cancer is more likely in a non-smoker?

A

Adenocarcinoma

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8
Q

Give 3 local effects of lung cancer.

A

Cough (40%) - 3-week cough -> CXR!
Chest pain (20%) - sharp pleuritic pain as chest wall and pleura well innervated.
Haemoptysis (7%) - tumour bleeds into airway
Breathlessness - occlusion, SOBOE, may also have COPD
Wheeze - monophonic, partial obstruction
Hoarse voice - left recurrent laryngeal nerve compression. [kc]

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9
Q

What would be the effect of metastases to the adrenal gland?

A

Asymptomatic - no adrenal insufficiency [kc]

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10
Q

Give a clinical feature of metastatic spread to the liver.

A

Liver - anorexia, weight loss, nausea, RUQ pain [kc]

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11
Q

Give a clinical feature of metastatic spread to bone.

A

Bony pain, fractures, risk of spinal cord compression

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12
Q

Give a clinical feature of metastatic spread to the lymph nodes.

A

Lymphadenopathy?

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13
Q

Give a clinical feature of metastatic spread to the brain.

A

Space occupying lesion -> raised ICP -> headache.

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14
Q

Give 3 paraneoplastic syndromes seen in non-small cell lung cancer.

A

Clubbing
Anorexia
Hypertrophic pulmonary osteoarthropathy (clubbing, periostitis)

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15
Q

Give 3 differential diagnoses of cough other than lung cancer.

A 
COPD
Asthma (diurnal variation)
Sarcoidosis
Heart failure
Upper airway cough syndrome/ post-nasal drip
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16
Q

Give 3 investigations you would do to diagnose lung cancer.

A 
Staging, tissue diagnosis, assess fitness for treatment. [ck]
CXR
Chest CT
Biopsy - surgical
Bronchoscopy
 [pts]
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17
Q

Give the T stages for lung cancer.

A

TNM staging.
T1a,b,c: <1,<2,<3cm. contained within the lung;
T2a,b: <4,<5cm/ spread to bronchus or pleura but not chest wall.
T3: 5-7cm/ >1 tumour in same lobe/ spread to chest wall, phrenic nerve or pericardium.
T4: >7cm/ >1 lobe affected/ spread outside chest wall. [cancer research uk]

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18
Q

Give the N stages for lung cancer.

A 
N1=  in lung or hilar LNS
N2 = in mediastinal or subcarinal LNs
N3 = contralateral hilar, mediastinal or supraclavicular LNs.
19
Q

Describe the M stages for lung cancer.

A

M1a - both lungs/ pleura/ pericardium (effusion)
M1b - single met outside the chest
M1c - multiple mets outside the chest.

20
Q

What determines management for lung cancer?

A

Tumour resectability and patient fitness for operation as well as patient preference.

21
Q

How is operability assessed?

A

WHO performance status: how restricted they are and how much time they spend in chair/bed.
ECG, lung function, exercise capacity
[lecture 8/12/17]

22
Q

Describe the management of stage 1 or 2 NSCLC.

A

Surgical excision
Radical deep X ray therapy
[lecture, pts]

23
Q

Describe the management of stage 3 or 4 NSCLC.

A

Palliative chemotherapy
Chemo + radio therapy
Supportive and palliative care
[lecture, pts]

24
Q

Give 3 local complications of lung cancer.

A 
Recurrent laryngeal nerve palsy
Horner's syndrome 
SVC obstruction
Pericarditis
AF
[ohcm]
25
Q

What is horner’s syndrome?

A

Disruption of the sympathetic pathway that runs from the hypothalamus to the eye, causing miosis (pupil constriction), ptosis (eyelid dropping), and anhidrosis (no sweating) on the affected side.

26
Q

How can SCLC be classified?

A

Limited disease: Disease limited to one hemithorax including supraclavicular lymph nodes.
Extensive disease: spreading further than this.

27
Q

How is limited SCLC treated?

A

Chemotherapy

Thoracic and cranial deep x-ray therapy

28
Q

How is extensive SCLC treated?

A

Chemotherapy

Supportive care.

29
Q

Give 5 cancers which are likely to metastase to the lung.

A 
Breast 
Colorectal
Prostate
Kidney
Thyroid
Melanoma
Lymphoma.
30
Q

What are the 4 types of malignant pleural tumours?

A

Mesothelioma
Primary lymphoma
Pleural thymoma
Pleural sarcoma [lecture]

31
Q

Give 1 type of benign pleural tumour.

A

Fibrous tumour [lecture]

32
Q

What is mesothelioma?

A

Malignancy of the cells that line the body cavities, including the pleura. Associated with asbestos. [pts]

33
Q

When does peak incidence of mesothelioma occur?

A

about 40 years after asbestos exposure. [pts]

34
Q

Describe the pathophysiology of mesothelioma.

A
  1. Mesotheliomal cells engulf asbestos fibres
  2. The fibres disrupt the mitotic spindle, causing mutations, commonly loss of chromosome 22.
  3. Sustained cellular damage by fibres also contributes.
    [pts]
    Mesothelial cells line thoracic and abdo cavities. Mostly affects lungs and pleura but can affect abdo organs if swallowed and other linings. [osmosis]
    Also cause inflammation
35
Q

Describe the presentation of mesothelioma.

A

Pleuritic pain
Dyspnoea
Bloody sputum if invades into blood vessel.
Pneumothorax
Systemic - fatigue, fever, sweats, weight loss

36
Q

What investigations would you do for ?mesothelioma?

A

Thoracentesis (pleural aspiration, reduces effusion]
CXR
CT scan
Pleural biopsy, may be guided by CT [lecture]

37
Q

How can mesothelioma be differentiated from other lung cancers?

A

Mesothelial plaques express calretinin, which is important for regulating intracellular calcium levels.
Biopy - immunostained with an antibody that reacts with calretinin to give ‘fried egg-shaped’ cells.

38
Q

How does mesothelioma cause pneumothorax?

A

Mesothelioma destroys lung tissue between bronchial tree and the pleural space, leaving air in the pleural space. [osmosis]

39
Q

Give 3 findings on X ray (and/or CT?) for mesothelioma.

A

Nodular pleural thickening
Pleural effusion
Pneumothorax [osmosis]

40
Q

Why is mesothelioma prognosis poor?

A

Cancer extremely resilient, spread to multiple organs before detected. [osmosis]

41
Q

Describe the management of mesothelioma.

A

Symptom control
Palliative chemotherapy and/or radiotherapy
Radical/debulking surgery [lecture]

42
Q

Is mesothelioma a transudative or exudative cause of pleural effusion?

A

Exudative.
Exudates are caused by inflammation (cancers, infection).
Transudates are caused by disturbances of pressure (HF, cirrhosis).

43
Q

Give 2 complications of mesothelioma.

A

Reduced lung function

Metastases

2a (75 decks)

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