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Respiratory AM > Neoplasia > Flashcards

Neoplasia Flashcards

1
Q

What % of deaths in the UK are caused by lung cancer?

A

6%

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2
Q

What are the causes of lung cancer?

A 
Tobacco
Asbestos
Environmental radon
Occupational exposure to carcinogens
Ai pollution and urban environment
Other radiation
Pulmonary fibrosis
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3
Q

What is the most common cause of lung cancer?

A

Smoking- >85%

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4
Q

What % of smokers get lung cancer?

A

10%

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5
Q

Who is more susceptible to the carcinogens in cigarettes?

A

Females

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6
Q

How can the risk of lung cancer from smoking be decreased?

A

Risk decreases with abstinence, but slowly

Resisting genomic changes mean risk doesn’t full disappear

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7
Q

What carcinogen causes squamous small cell lung carcinoma?

A

Polycyclic aromatic hydrocarbons

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8
Q

What carcinogen causes adenocarcinoma?

A

N-nitrosamines

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9
Q

What are the 2 main pathways of carcinogens in the lung?

A

In the periphery

In the central lung airways

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10
Q

What is the pathway od carcinogenesis in the periphery of lungs?

A

Bronchioalveolar epithelial stem forms
Adenocarcinoma
Caused by N nitrosamines

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11
Q

What is the pathogenesis of carcinogenesis in the central lung airways?

A

Bronchial epithelial stem cell forms
Squamous cell carcinoma
Caused by polycyclic aromatic hydrocarbons

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12
Q

What does the KRAS mutation cause in the lungs and what % of patients have this?

A

Adenocarcinoma

35%

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13
Q

What does the EGFR mutation cause in the lungs and what % of patients have this?

A

Adenocarcinoma

15%

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14
Q

What does the BRAF mutation cause in the lungs and what % of patients have this?

A

Adenocarcinoma

2%

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15
Q

What does the HER2 mutation cause in the lungs and what % of patients have this?

A

Adenocarcinoma

2%

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16
Q

What do ALK rearrangements cause in the lungs and what % of patients have this?

A

Adenocarcinoma

2%

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17
Q

What genetic mutations are smoking induced?

A

KRAS

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18
Q

What mutations can be targeted by a therapeutic?

A

EGFR

ALK

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19
Q

What are the cell types of cancer?

A

Squamous cell
Adenocarcinoma
Small cell carcinoma
Large cell carcinoma

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20
Q

What % of lung cancer cases are of each cell type?

A

Squamous- 40%
Adenocarcinoma- 41%
Small cell carcinoma- 15%
Large cell carcinoma- 4%

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21
Q

What are the histological types of lung cancer?

A

Small cell

Non small cell

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22
Q

What % of patients have each histological type of lung cancer?

A

Small cell- 15%

Non small cell- 85%

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23
Q

What is non small cell lung carcinoma?

A

A histological classification of tumour when tumours cannot be exactly identified

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24
Q

What are the local bronchial effects of lung cancer?

A

Collapse
Endogenous lipid pneumonia
Infection/Abscess
Bronchiectasis

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25
Q

What are the local pleural effects of lung cancer?

A

Inflammatory

Malignant

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26
Q

What are the local effects of lung cancer by direct invasion of nerves?

A

Phrenic= diaphragmatic paralysis
Left recurrent laryngeal nerve= hoarse, bovine cough
Brachial plexus= pan coast T1 damage
Cervical sympathetic nerve= Horner’s syndrome

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27
Q

Where can lung cancer directly invade?

A

Chest wall
Nerves
Medistinum

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28
Q

What are the local effects of lung cancer due to lymph node metastases?

A

Mass effect

Lymphangitis carcinomatosa

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29
Q

Where are the most common places for lung cancer to metastasise to?

A 
Liver
Adrenals
Bone
Brain
Skin
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30
Q

What are the non metastatic skeletal effects of lung cancer?

A

Clubbing

Hypertrophic pulmonary osteoarthropathy

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31
Q

What are the non metastatic endocrine effects of lung cancer?

A

Carcinoid syndrome
Gynecomastia
Paraneoplastic syndrome caused by hormone secretion- ACTH, siADH, PTH

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32
Q

What are the non metastatic neurological effects of lung cancer?

A

Polyneuropathy
Encephalopathy
Cerebellar degeneration
Myasthenia (Eaton Lambert)

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33
Q

What are the non metastatic cutaneous effects of lung cancer?

A

Acanthosis nigerians

Dermatomyositis

34
Q

What are the non metastatic haemolytic effects of lung cancer?

A

Granulocytosis
Eosiophilia
DIC

35
Q

What are the non metastatic CV effects of lung cancer?

A

Thrombophlebitis migrans

36
Q

What are the non metastatic renal effects of lung cancer?

A

Nephrotic syndrome

37
Q

What are the non metastatic effects of cancer due to?

A

Chemical/hormonal effect caused by the cancer other than the spread

38
Q

How are the non metastatic effects of cancer mediated?

A

Autoimmune mediated

Immune system “conned” by tumour into attacking its own tissues

39
Q

What are the most common clinical features of lung cancer?

A 
Chronic cough
Haemoptysis
Wheeze
Chest and bone pain
Frequent chest infections
40
Q

What are the less common features of lung cancer?

A 
Difficulty swallowing
Raspy hoarse voice
SOB
Unexplained weight loss
Nail clubbing
41
Q

What are the metastatic advanced disease symptoms of lung cancer?

A

Bone pain
Spinal cord compression
Cerebral metastases
Thrombosis

42
Q

What does spinal cord compression in lung cancer cause?

A

Limb weakness
Paraesthesia
Bladder/bowel dysfunction

43
Q

What do cerebral metastases in lung cancer cause?

A 
Headaches
Vomiting
Dizziness
Ataxia
Focal weakness
44
Q

What are the paraneoplastic effects of advanced lung cancer?

A 
Hyponatraemia
Anaemia
Hypocalcaemia
Dermatomyocytosis/polymyositis
Cerebellar ataxis 
Sensorimotor neuropathy
45
Q

What causes hypercalcaemia in lung cancer?

A

Parathyroid hormone related protein

Bone metastases

46
Q

What are the clinical signs of lung cancer?

A 
Chest signs
Clubbing
Lymphadenopathy
Horner's syndrome
Pancoast tumour
Hepatomegaly
Skin nodules
47
Q

What initial investigations are carried out to investigate for lung cancer?

A

CXR
CT
Clotting screen
Tissue diagnosis

48
Q

When is a CT scan carried out?

A

If CXR abnormal

49
Q

What are the methods of tissue diagnosis?

A 
Bronchoscopy
Image guided lung biopsy
Image guided liver biopsy
Fine needle aspiration neck node/ skin metastases
Excision of cerebral metastases
Bone biopsy
Mediastinoscopy
Surgical excision biopsy
Endobronchial ultrasound
50
Q

When is bronchoscopy used for tissue diagnosis?

A

Most common

Used for central tumours

51
Q

What does histology of tumours allow for?

A

Assessment of most appropriate treatment and prognosis

52
Q

What type of staging is used for lung cancer?

A

TNM

53
Q

What do the 3 areas of TNM staging assess?

A

Tumour size and proximity to chest wall
Lymph node involvement
Metastasis

54
Q

What are PET scans used for?

A

Detect distant micrometastases

55
Q

How do PET scans work to detect tumours?

A

Radionucleotide sugary contrast given to “light up” cancer cells

56
Q

What is stage T1?

A

Tumour <3cm in greatest dimension, surrounded by lung or visceral pleura, no involvement of main bronchus
T1a <1cm
T1b <2cm
T1c <3cm

57
Q

What is stage T2?

A

Tumour 3-5cm, involving visceral pleura and main bronchus but not carina
Associated with atelectasis or obstructive pneumonitis that extends to hilar region
T2a 3-4cm
T2b 4-5cm

58
Q

What is stage T3?

A 
Tumour 5-7cm or directly invades one of
-chest wall
-phernic nerve
-parietal pericardium
or has tumour nodules in same lobe as primary tumour
59
Q

What is stage T4?

A 
Tumour >7cm of invades one of 
-diaphragm
-mediatinum
-heart
-great vessels
-trachea
-recurrent laryngeal
-oesophagus
-vertebral body 
-carina
or has tumour nodes in a separate lobe
60
Q

What is stage N0?

A

No regional lymph node metastases

61
Q

What is stage N1?

A

Ipsilateral peribronchial, hilar, or intrapulmonary nodes including by direct extension

62
Q

What is stage N2?

A

Ipsilateral mediastinal or subcarinal

63
Q

What is stage N3?

A

Contralateral mediastinal, hilar, scalene or supraclavicular

64
Q

What is stage M0?

A

No distant metastases

65
Q

What is stage M1?

A

Distant metastases
M1a- separate tumour nodules in contralateral lobe, tumour with pleural or pericardial nodules or malignant pleural or pericardial effusion
M1b- single distant metastases
M1c- multiple distant metastases

66
Q

What is the prognosis for small cell carcinoma?

A

Bad

67
Q

What is the prognosis for adenocarcinoma?

A

Good

68
Q

What is performance status?

A

Assessment used to predict how patients will respond to treatment
0-2 likely have good prognosis

69
Q

What are the performance statuses?

A 
0=fully active
1= symptomatic but ambulatory
2= up and about >50%, unable to work
3= up and about <50%, limited self care
4= bed or chair bound
70
Q

What are the surgical treatment options?

A

Wedge resection
Lobectomy
Pneumonectomy

71
Q

What % of patients can get surgery?

A

18%

72
Q

What are the 3 types of radiotherapy?

A

Radical
Palliative
Sterotactic

73
Q

How can chemotherapy be used?

A

Alone
Combined
Adjuvant

74
Q

What are the 2 types of chemo?

A

Radical

Palliative

75
Q

What are the aims of best supportive care?

A

Reduce pain

Increase quality of life

76
Q

What is used in symptom control in best supportive care?

A

Chemo/radiotherapy
Opiates, bisphosphates, benzodiazepines
Treatment of hypercalcarmia, dehydration, hyponatraemia

77
Q

What are the treatment options for non small cell lung cancer?

A

Surgery
Chemo
Radiotherapy

78
Q

What is neoadjuvant and adjuvant therapy?

A

Pre and post operative therapy to increase chance of cure

79
Q

What is the treatment of choice for small cell lung carcinoma?

A

Chemo

80
Q

What are the ideal concurrent therapies for small cell lung carcinoma?

A

Chemo
Thoracic radiotherapy
Prophylactic cranial radiation

81
Q

What is the treatment for expensive small cell lung cancer?

A

4 cycles of chemo
Singl fraction radiotherapy if not fit for chemo
Radiotherapy and steroids for brain metastases

Respiratory AM (10 decks)

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