Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Week 8 - Respiratory > Pathology of Lung Cancer > Flashcards

Pathology of Lung Cancer Flashcards

1
Q

List the risk factors for lung cancer [7]

A
  1. Smoking (major)
  2. Ionising radiation - radon, uranium
  3. Air pollution
  4. Asbestos
  5. Other, e.g.
    • Fibrosing conditions of lung
    • Human papilloma virus (HPV)
    • Hereditary (polymorphisms in cytochrome p450)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the general symptoms of lung cancer? [8]

A
  1. Cough (that doesn’t go away or long-standing cough that gets worse)
  2. Haemoptysis
  3. Shortness of breath (can be due to lobar/lung collapse, particularly in patients with co-exisiting COPD)
  4. Chest and/or shoulder pain
  5. Unexplained weight loss/anorexia
  6. General malaise
  7. Recurrent infections
  8. Hoarse voice
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the clinical signs that may be associated with lung cancer? [7]

A
  1. Finger clubbing
  2. Signs of lobar collapse or a pleural effusion
    • Stony dull percussion
    • Reduced expansion
    • Reduced breath sounds
  3. From metastases - hepatomegaly, cervical lymphadenopathy, bony tenderness
  4. Cachexia (muscle wasting)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the common CXR changes that occur as a result of lung cancer? [5]

A
  1. Mass lesion
  2. Lobar or lung collapse
  3. Pleural effusion
  4. Mediastinal widening or hilar lymph nodes
  5. Slowly resolving consolidation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the signs & symptoms specific to a…

  1. central lung cancer? [5]
  2. peripheral lung cancer? [2]
A
  1. Central
    • Haemoptysis
    • Bronchial obstruction
      • Shortness of breath
      • Retention pneumonia
    • Cough
  2. Peripheral
    • May have few symptoms
    • Pain if pleura or chest wall is involved
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Where can lung cancer spread to locally and what can this result in? [6]

A
  1. Pleura
    • Haemorrhagic effusion
  2. Hilar lymph nodes
  3. Adjacent lung tissue
    • May involve large blood vessel leading to haemoptysis
  4. Pericardium
    • Pericardial effusion with subsequent involvement of pericardium
  5. Mediastinum
    • Superior vena caval obstruction
    • Recurrent laryngeal nerve compression as it hooks under arch of the aorta and travels up side of larynx
    • Phrenic nerve paralysis - hemidiaphragm paralysis
  6. Pancoast tumour
    • Involvement of brachial plexus giving sensory and motor symptoms
    • Horner’s syndrome/Oculosympathetic palsy (cervical sympathetic chain)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the signs [3] and symptoms [4] of superior vena caval obstruction?

A
  • Symptoms
    1. breathless,
    2. dysphagia,
    3. stridor,
    4. swollen oedematous face and right arm
      • plethoric face - headache worse on stooping
  • Signs
    1. venous congestion in the neck,
    2. dilated veins on chest wall and the arm
    3. raised JVP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How do you treat superior vena caval obstruction? [4]

A
  1. high dose steroids,
  2. vascular stents,
  3. anti-coagulation,
  4. radiotherapy or chemotherapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How can phrenic nerve paralysis be seen on CXR and why does it present in this manner? [2]

A
  1. The diaphragm is controlled by the phrenic nerve so if the phrenic nerve gets infiltrated by a tumour, it leads to diaphragmatic paralysis
  2. This can be seen on CXR as the right hemidiaphragm going up
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the symptoms that arise as a result of a Pancoast tumour? [3]

A
  1. Severe pain in the shoulder or the scapula
  2. Pain in the arm and weakness of the hand on the affected side
  3. Horner’s syndrome (due to invasion of cervical sympathetic chain)
    • Ptosis - drooping of upper eyelid
    • Enophthalmos - posterior displacement of the eyeball within the orbit
    • Miosis - constriction of the pupil
    • Anhidrosis - loss of sweating on one side
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Where and how can lung cancer spread distally? [5]

A
  1. Haematogenous
    • Common due to invasion of pulmonary veins
    • It can spread by this method to several organs such as:
      • Liver
      • Bone
      • Brain
      • Adrenals
  2. Lymphatic
    • To the cervical lymph nodes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the non-metastatic effects of lung cancer? [9]

A
  1. ACTH secretion
    • Adrenal hyperplasia → Raised blood cortisol → Cushing’s syndrome
  2. ADH secretion
    • Retention of water → Dilutional hyponatraemia (SIADH)
  3. Parathyroid hormone related peptide (PTHrP) secretion
    • Osteoclastic activity → Hypercalcaemia
  4. Encephalopathy
  5. Cerebellar degeneration
  6. Neuropathy
  7. Myopathy
  8. Eaton Lambert myasthenia-like syndrome
  9. Cancer associated retinopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Lung cancer can be histologically classified into 2 groups. Name these 2 groups [2]

A
  1. small cell lung cancer
  2. non-small cell lung cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Name the other types of lung cancer [5]

A
  1. Tumours of mesenchymal tissues
    • Inflammatory myofibroblastic tumour
  2. Salivary gland-type tumours
    • Adenoid cystic carcinoma
  3. Tumours of ectopic origin
    • Germ cell tumours
  4. Tumours of neuroendocrine cells
    • Carcinoid
  5. Tumours of the lymphatic system
    • Lymphoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What investigations must be done for diagnosis and assessing fitness for treatment of lung cancer? [6]

A
  1. Routine bloods
    • FBC,
    • U&Es,
    • LFTs,
    • serum calcium,
      • bone profile (check for possible metastases to bone resulting in hypercalcaemia)
    • CRP
  2. CT chest and upper abdomen looking for:
    • lymph nodes,
    • evidence of liver or adrenal metastases
  3. Fine needle biopsy
  4. Bronchoscopy
    • will detect more central lesions
  5. Full lung function tests
    • If considering surgery (need an FEV1 >1.5L)
  6. ECG & Echo
    • To investigate evidence of cardiac disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe the features of small cell carcinoma [8]

A
  1. Most aggressive form of lung cancer
    • Metastasizes early and widely
  2. Often initial good response to chemotherapy - but most patients relapse
  3. Appearance
    • small oval to spindle shaped epithelial cells
    • ill-defined cell borders
    • inconspicuous nucleoli
    • scant cytoplasm
    • high mitotic count
    • nuclear moulding (more prominent in cytology)
17
Q

Name the 3 sub-types of non-small cell carcinoma [3]

A
  1. adenocarcinoma
  2. squamous cell carcinoma
  3. large cell carcinoma
18
Q

Describe the features of squamous cell carcinoma [7]

A
  1. Tend to arise centrally from major bronchi
  2. Often within dysplastic epithelium following squamous metaplasia
  3. Slow growing and metastasize late therefore may be good candidate for surgery
  4. May undergo cavitation
  5. May block bronchi leading to retention pneumonia or collapse
  6. Appearance
    • A malignant epithelial tumour showing keratinization and/or intercellular bridges
    • In situ squamous cell carcinoma may seen in the adjacent airway mucosa
19
Q

Describe the features of adenocarcinoma [5]

A
  1. Common tumour in females
  2. Also seen in non-smokers (but also associated with smoking)
  3. Two thirds arise in the periphery sometimes in relation to scarring
  4. Appearance
    • Glandular, solid, papillary or lepidic
    • Mucin production
20
Q

Describe the features of large cell carcinoma [3]

A
  1. A diagnosis of exclusion
  2. Usually arises centrally
  3. An undifferentiated malignant epithelial tumour that lacks the cytological features of SCLC and glandular or squamous differentiation
21
Q

Describe the features of carcinoid tumour [4]

A
  1. Tumour of neuroendocrine cells
  2. Central or peripheral
  3. Classified as typical or atypical
  4. Can metastasise but much better prognosis than other conventional lung cancers (5yrs for typical 85-90%; atypical 5yrs 50-75%)
22
Q

Describe the features of mesothelioma [4]

A
  1. Primary pleural tumour (also occurs in peritoneum, pericardium and tunica vaginalis testis)
  2. Almost always due to asbestos exposure
  3. Very long lag period before disease develops
  4. Tumour had either an epithelial or sarcomatoid appearance or a mixture of both (biphasic)
23
Q

What are the signs [1] and symptoms [2] of spinal cord compression?

A
  • Symptoms
    1. leg weakness and numbness,
    2. reduced bladder and bowel control
  • Signs
    1. upper motor neurone signs in legs at sensory level
24
Q

How do you treat spinal cord compression? [3]

A
  1. high dose steroids,
  2. urgent oncology input (radiotherapy) and/or neurosurgical input

Week 8 - Respiratory (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions