Respiratory - Lung Cancer Flashcards

1
Q

What is the most common cause of lung cancer?

A

Smoking

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2
Q

What are the two broad types of lung cancer?

A

Small-cell lung cancer (20%)
Non-small-cell lung cancer (80%)

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3
Q

How are non-small-cell lung cancers divided?

A

Adenocarcinomas (40%)
Squamous cell carcinoma (20%)
Large-cell carcinoma (10%)
Other (10%)

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4
Q

What do small-cell lung cancers contain?

A

Neurosecretory granules that release neuroendocrine hormones

Can cause paraneoplastic syndromes

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5
Q

What is mesothelioma?

A

Malignancy affecting mesothelial cells of the pleura

Linked to asbestos

Up to 45 years latent period

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6
Q

How does lung cancer present?

A

Finger clubbing
Haemoptysis
Cough
SOB
Recurrent pneumonia
Weight loss
Supraclavicular lymphadenopathy

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7
Q

What are some extrapulmonary manifestations of lung cancer?

A

Recurrent laryngeal nerve palsy (tumour presses on nerve)
Phrenic nerve palsy
SVC obstruction
Horner’s syndrome (pancoast tumour pressing on sympathetic ganglion)
SIADH
Cushing’s syndrome
Hypercalcaemia
Limbic encephalitis
Lambert-Eaton myasthenic syndrome

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8
Q

What causes limbic encephalitis in lung cancer?

A

Small-cell lung causes immune system to make antibodies against brain tissue

Causes memory impairment, hallucinations, confusion and seizures

Anti-Hu antibodies

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9
Q

What causes Lambert-Eaton myasthenic syndrome in lung cancer?

A

Antibodies against small-cell lung cancer cells

Antibodies target voltage-gated calcium channels on presynaptic terminals in motor neurones

Causes weakness in proximal muscles
Intraocular muscles causing diplopia
Pharyngeal muscles

Autonomic dysfunction

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10
Q

How should patients with suspected lung cancer be managed?

A

CXR within 2 weeks to patients with:
- Clubbing
- Lymphadenopathy
- Recurrent chest infections
- Thrombocytosis
- Chest signs of lung cancer

Or
Two or more unexplained symptoms in patients that have never smoked

One or more unexplained symptoms in patients that haven’t smoked or had asbestos exposure

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11
Q

What investigations are used for lung cancer?

A

CXR first line
Staging CT
PET-CT

Bronchoscopy
Histology

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12
Q

How is lung cancer treated?

A

MDT meeting
Surgery is first-line in non-small-cell lung cancer

Radiotherapy can be curative if diagnosed early

Adjuvant chemotherapy

Small-cell is treated with chemotherapy and radiotherapy

Endo brachial treatment with stents or debulking to relieve obstruction

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13
Q

What signs of lung cancer would there be on a CXR?

A
  • Hilar enlargement
  • Peripheral opacity
  • Pleural effusion
  • Collapse
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14
Q

What are the different options for removing a lung tumour?

A

Segmentectomy or wedge resection (portion of one lobe)
Lobectomy (entire lobe removal)
Pneumonectomy (entire lung)

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15
Q

What are the different types of surgery for removing lung cancer?

A
  • Thoracotomy ,open surgery and separation of rib to access thoracic cavity
  • Video-assisted thoracoscopic surgery (VATS)
  • Robotic surgery
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16
Q

What are the main thoracotomy incisions?

A

Anterolateral thoracotomy
Axillary thoracotomy
Posterolateral thoracotomy