Primary Lung cancers Flashcards
What is a cancer of the pleura called?
Mesothelioma
What are the different types of cancer of the lung parenchyma?
Small cell lung cancer and non-small cell lung cancer
Name some types of non-small cell lung parenchyma cancer
Squamous
Adenocarcinoma
Carcinoid
Large cell
What are common sites of metastasis for lung cancer to spread to?
Bone
Liver
Adrenals
Brain
Lymph nodes
What causes a mesothelioma?
Asbestos
(typically doesn’t present until decades after exposure
Who is most at risk of mesotheliomas?
males aged 40-70
What are symptoms of mesothelioma?
Weight loss
Tired all the time
Night pain
SOB
Persistent cough
pleuritic chest pain
Hoarse voice
Bone pain if metastasised
Why may a patient with mesothelioma present with a hoarse voice?
Tumour may press on nearby structures including the recurrent laryngeal nerve
How do you diagnose mesothelioma?
1st line = Chest x-ray and/or CT showing pleural thickening
Cancer antigen 125 raised in many tumours (sensitive but not specific)
Biopsy
Is a CT or a chest x-ray higher resolution and more detailed?
CT
How is mesothelioma cancer treated?
Very aggressive, so normally palliative care
If found early, surgery and chemo/radiotherapy howevere generally resistant
Is a mesothelioma likely to metastasise distally?
No, pleura isn’t found everywhere in the body
What is a primary malignancy of lung parenchyma called?
bronchial carcinoma
What percentage of bronchial carcinomas are small cell?
15%
What are risk factors for bronchial carcinomas?
Smoking
Asbestos
Coal
Ionising radiation
Lung disease already present
Who gets small cell bronchial carcinoma?
Exclusively smokers
What does small cell lung cancer cause?
Paraneoplastic syndromes
Ectopic ACTH causes Cushing’s
Ectopic ADH causes SIADH
Lambert Eaton Syndrome (disorder of NMJ)
Does small cell lung cancer grow quickly or slowly and metastasis or not?
Grows quickly, early metastases
What percentage of bronchial carcinomas are non-small cell?
85%
(consists of adenocarcinoma, squamous, carcinoid tumour and large cell)
What group of people make up the majority of squamous cell lung carcinoma?
Smokers
Describe what the squamous cell lung carcinoma affects
Arises from lung epithelium
Affects central lung
lesions with central necrosis
may secrete PTHrP (related protein) causing hypercalcaemia
When do squamous cell lung carcinoma mets appear?
Late
Mostly spread locally
What condition is heavily associated with non-small cell lung carcinoma, particularly squamous cell carcinoma?
Hypertrophic pulmonary osteoarthropathy
Hypertrophic pulmonary osteoarthropathy (associated with non-small cell lung carcinomas) consists of what 3 things?
Clubbing
Arthritis
Periostosis (swelling of tissue around joints and subperiosteal new bone formation)
What is the periosteum?
The membrane of nerves and blood vessels that wraps around most bones, key role in growing and repairing bones particularly after a fracture
What is an adenocarcinoma?
A malignant tumour of glandular structures in epithelial tissue
What are common causes of a lung adenocarcinoma?
Asbestos and smoking
Where does a lung adenocarcinoma form?
Affects the peripheral lung and arises from mucous secreting glandular epithelium
Where does a lung adenocarcinoma commonly metastasise to?
Bone
Brain
Adrenals
Lymph nodes
Liver
What does adenocarcinoma in situ mean?
Stage 0, tumour has not yet spread
What causes a carcinoid tumour?
Associated with genetics, MEN1 mutation and Neurofibromatosis 1 (a multisystem disorder)
Where do carcinoid tumour commonly arise?
in the GIT and sometimes the lungs
Carcinoid tumours and n______ tumours that secrete s_____
neuroendocrine
serotonin
When do symptoms of carcinoid tumour appear?
When it metastasises to the liver
What are general symptoms of a bronchial carcinoma?
Chest pain
Cough
Haemoptysis (coughing up blood)
Weight loss
Night sweats
Feeling tired all the time
Hoarse voice
Pemberton sign
Horner’s syndrome
What is Pemberton’s sign?
Lift arms up so forearms touch the sides of face. Positive sign shows facial congestion and cyanosis and respiratory distress after 1 minute
How do you diagnose a bronchial carcinoma?
1st line = imaging with Chest X-ray or CT
Bronchoscopy and biopsy
MRI for staging TNM
How do you treat small cell carcinoma of lungs?
If early consider chem/radiotherapy but often resistant
If metastasised, then palliative
How do you treat non-small cell carcinoma?
If early, surgical excision
If metastasised, chemo/radiotherapy
What chemotherapy may be used for non-small cell adenomas?
mAb therapy cetuximab against epidermal growth factor
What is a Pancoast tumour?
Tumour in lung apex that metastasis to neck’s sympathetic plexus causing Horner’s syndrome
What is the triad of symptoms for Horner’s syndrome?
Ptosis
Myosis (excessive pupil constriction)
Anhidrosis
True or false: primary lung tumours are much more common than secondary lung tumours
False
The lungs oxygenate all the blood so all the blood comes to the lungs therefore there is a higher risk of metasises
Which cancers commonly metastasise to the lung?
Breast
Kidney
Bowel
Bladder
