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MBBS - Year 2 > Respiratory - Tobacco Smoking and Lung Cancer > Flashcards

Respiratory - Tobacco Smoking and Lung Cancer Flashcards

1
Q

When do most people start smoking

A

While still children and become addicted to nicotine

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2
Q

How much more likely are those whose parents smoke to start smoking than those w/ non-smoking parents

A

3x

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3
Q

Which group of people finds it harder to give up smoking

A

Children who start smoking at younger ages

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4
Q

Why has the prevalence of smoking decreased in the 21st century

A

Smoking is no longer associated w/ Hollywood glamour and its social acceptability has decreased

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5
Q

Habitus

A

The body of tacit knowledge that we each carry with us that either enables us to feel comfortable on certain social settings or out of place

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6
Q

Models explaining mechanisms of health inequality

A

Behavioural
Material
Psychosocial
Life-course

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7
Q

Behavioural model of health inequality

A

Involve class differences in behaviour that are damaging or health promoting which are subject to individual choice

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8
Q

Material model of health inequality

A

Involve hazards that are inherent in the present form of social organisation and to which some people have no choice but to be exposed

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9
Q

Which model of health inequality is most important in accounting for social class differences in health

A

Material model

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10
Q

Psychosocial model of health inequality

A

Feeling affect behaviours
Incl helath-related stigma
Feelings that arise because of inequality, subordination and lack of social support may directly affect biological processes

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11
Q

Life-course model of health inequality

A

Disadvantages in their various forms are likely to accumulate through childhood and adulthood and into old age

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12
Q

Lifestype drift

A

The idea that govts start w/ policies designed to address the social of health e.g. poverty but due to complexity of this work they end up, endorsing narrow lifestyle interventions or individuals

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13
Q

What will habitus influence

A

The social acceptability of certain health practices

Social and cultural context plays a role in whether we smoke, drink, what food we eat

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14
Q

The rise of surveillance medicine

A

The idea that med has become much more about monitoring healthy bodies that it used to be

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15
Q

How common is lung cancer on the UK

A

130 dx daily

3rd most common cancer in UK

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16
Q

Lung cancer risk factors

A 
Cigarette smoking 
Occupational exposure 
Genetics 
Low level radiation 
Smoking and low intake of beta carotene 
Lung disease hx
Fhx
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17
Q

Symptoms seen in lung cancer

A 
Persistent cough
Change in cough 
SOB 
Haemoptysis 
Ache/ pain in chest or shoulder 
Unexplained wt loss
Hoarse voice 
Swollen face
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18
Q

Signs seen in lung cancer

A 
Pyrexia 
Recurring infections e..g bronchitis snd pneumonia 
Clubbing 
Swollen lymph nodes in neck 
Pleural effusion 
Dysphasia
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19
Q

Where do lung cancer pts px initially

A

76% in primary care

24% in secondary care

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20
Q

Why do we need a timely dx in lung cancer

A

To detect disease at an asymotomatic stage
In really stages, treatment is most successful
Earlier dx can increase survival

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21
Q

Why don’t we screen for lung cancer

A

High no. pts needed to screen
Cost effectiveness uncertain
Risk of over dx and invasive tests for benign sounds

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22
Q

What is likely to be more cost effective then screening for lung cancer

A

Smoking cessation snd tobacco control

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23
Q

Profile of a pt that should be referred urgently for a CXR (suspected lung cancer)

A

Unexplained haemoptysis or persistent lung cancer symptoms (>3/52) or <3/52 in pts w/ known risk factors

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24
Q

Profile of a pt that should be referred urgently to a lung cancer specialist

A 
Persistent haemoptysis and are smokers or ex smoker 40+
CXR suggestive of lung cancer 
Finger clubbing 
Severe wt loss 
SVC obstruction - medical emergency 
Neck nodes - smokers
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25
Q

CXR suggestive of lung cancer

A

Lung nodules

Inca pleural effusion and slowly resolving consolidation

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26
Q

Why do we stage cancers

A

Treatment decision
Prognosis refinement
Communication between Drs
Stratification for clinical trials

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27
Q

Types of cancer staging

A

Clinical
Surgical
Pathological

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28
Q

What modalities are involved in clinical staging of lung cancer

A 
CXR 
CT scan +/- bx
MRI 
PET csan 
Bone scan
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29
Q

What is involved in surgical staging of lung cancer

A 
Bronchoscopy 
EBUS-TBNA - best dx accuracy 
Mediastinoscopy
Thoracoscopy (VATS)
Thoracotomy
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30
Q

Pathological staging of lung cancer

A

After complete resection and LN (lymph node) staging

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31
Q

VATS in lung cancer

A

Can identify +ve or -ve LN stations

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32
Q

Staging lung cancer in metastatic disease

A

When the disease is metastatic the biopsy is obtained from the easiest site
CT/ USA guided needle aspiration - thoracocentTesis, cervical lymph node, liver bx
EBUS - L adrenal metastasis

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33
Q

TMN system of staging

A

T - tumour (0, 1A - 1C, 2A - 2B, 3, 4)
N - regional lymph nodes (0 - 3)
M - distant metastasis (0, 1A, 1B, 1C)

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34
Q

Pathological stating in the TMN system - T

A

Clinical size - size of solid component

Pathological size - size of invasive component

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35
Q

Implications of T component - TMN staging

A

Every cm counts; careful follow-up
Worse prognosis of larger tumours
Better prognosis for endobronchial location and total atelectasis and pneumonitis

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36
Q

Implications of N component - TMN staging

A

Amount of +ve LN has prognostic impact
Treatment decision regarding surgery
Prognosis refinement

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37
Q

Staging cancers w/ metastatic lesions

A

Multiple primary tumours - 1 TMN for each tumour

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38
Q

Implication of M component

A

No. metastasis is more important than their location
o M1a: pleural effusion, nodules in the unilateral or contralateral lung
o M1b: baseline definition of oligometastases and oligoprogression

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39
Q

Types of cancer cells (in order from highest to lowest frequency)

A 
Adenocarcinoma 
Squamous cell carcinoma 
Small cell 
Large cell (undifferentiated)
Carcinoid
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40
Q

What are the two manor classes of lung cancer

A

Small cell

Non small cell

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41
Q

Traits of NSCLC

A

Most common lung cancer

Gross more slowly than SCLC

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42
Q

Traits of SCLC

A

Usually begin in bronchi and nearly always caused by smoking
Spread more quickly than that of NSCLC
Frequently metastasises to mediastinal lymph nodes or distant sites at px

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43
Q

Main types of NSCLC

A

Adenocarcinoma - 40%
Squamous - 25-30%
Large cell - 10-15%

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44
Q

Features of adenocarcinomas

A

Slow growing cancers that can take years to develop into invasive cancer
Tend to be located in the periphery of the lung
Most common type of lung cancer among women and in non-smokers

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45
Q

Features of squamous cell carcinoma

A

Commonly starts in the bronchi and may not spread as rapidly as other lung cancers
Treatment is typically more difficult than other types
Dx in its initial state is v important

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46
Q

Features of large cell carcinoma

A

Named for the large, round cells seen in this cancer

Grow quickly and spread so usually are diagnosed in later stages

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47
Q

Good prognostic factors in NSCLC

A

Early stage disease at dx
Good performance status (ECOG 0, 1, 2)
No significant wt loss (5% or less)
Female gender

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48
Q

Biomarkers in lung cancer

A

Pts w/ spp gene mutations or rearrangements had better prognosis - lived longer and improved therapeutic efficacy

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49
Q

Common biomarkers in lung cancer

A

EGFR
K-ras oncogene
EML4-ALK fusion oncogene
PDL1

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50
Q

Immunohistochemical staining in SCC

A

TTF-1 -ve
P63 +ve
Cytokeratin 5/6 +ve

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51
Q

Immunohistochemical staining in adenocarcinoma

A

TTF-1 +ve

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52
Q

What does SCLC typically present with

A

Large hilar mass - bulky mediastinal lymphadenopathy that causes cough and dyspnoea
Paraneoplastic syndromes

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53
Q

What type of lung cancer has earlier development of widespread metastases

A

SCLC

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54
Q

Paraneoplastic syndromes in SCLC

A 
SIADH
Ectopic ACTH production - cushingoid
Eaton-Lambert myasthenic syndrome 
Hypercalcaemia
Peripheral neuropathy 
Increases risk of DVT/ PE
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55
Q

SIADH

A

Secretion of Inappropriate ADH

Causes hyponatraemia

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56
Q

Eaton-Lambert myasthenic syndrome

A

Proximal muscle weakness that improves on repetition

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57
Q

Signs and symptoms in SCLC

A 
Smokers (almost exclusively)
Cough 
Haemoptysis 
Dyspnoea and chest pain 
Clubbing 
Pneumonia 
Wt loss and constitutional symptoms
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58
Q

Best ix for SCLC

A 
Labs - FBC, LFTs, LDH
CT chest/abdo/pelvis 
Brain imaging (CT or MRI) - esp if symptomatic
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59
Q

Why do we image the brain in SCLC ix

A

Up to 30% have brain metastases at px

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60
Q

Common SCLC metastasis

A

BALLS

Brain (30%)
Adrenal (20-40%)
Liver (25%)
Lung 
Skeletons (bones)
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61
Q

What kind of factors strongly influence whether or not someone smokes

A

Psychological
Micro social
Macro social

62
Q

Psychological factors affecting whether or not people smoke

A

Beliefs
Coping resources
Risk factors e.g. stress

63
Q

Micro social factors affecting whether or not people smoke

A

Background
School and area - peer group initiation
Culture, identity

64
Q

Macro social factors affecting whether or not people smoke

A

Advertising

Wider society

65
Q

In which groups do >75% people smoke

A

Homeless
Severe mental illness
Substance misuse
Criminal justice system

66
Q

Public health interventions for smoking

A

Solution must be wider than individual smoking cessation

Plain packaging 
Harm reduction - E-cigarette
Tax 
Advertising 
Smoke-free space
67
Q

Why do we need smoke free public spaces

A

Importance of passive smoking

Increased risk of IHD and lung cancer by 25%
Increased risk of stroke >40%
WW estimation of 600,000 lives lost to 2nd hand smoke

68
Q

NHS Stop Smoking services

A

Offers effective combined behavioural and pharmacological support to stop smoking

69
Q

Lung cancer avg 5 year survival

A

5-10% survival

70
Q

What % of lung cancer pts are dead within 12/12 of dx

A

80%

71
Q

Mean time from dx to death in lung cancer pts

A

6/12

72
Q

Bone pain in lung cancer

A

HPOA - hypertrophic pulmonary osteoarthropathy

73
Q

Types of large cell cancers

A

Adenocarcinoma
SCC
Undifferentiated large cell
Bronchoalveolar

74
Q

What do all lung cancer pts for radical therapy need

A

PET-CT

75
Q

How do we dx lung cancer

A 
Hx and examination 
CXR 
Bronschoscopy
CT chest 
Lung function tests 
Biopsy 
MDT discussion
76
Q

The role of surgery in lung cancer

A

Dx
Staging
Treatment

77
Q

What do you need to consider in treatment of NSCLC

A

Is the disease localised?

Is the ot well enough to have potentially, curative treatment?

78
Q

What should ideally be considered for treatment of NSCLC

A

Surgery - more likely to kill all tumour cells

If surgery is not feasible - radiotherapy

79
Q

What can be considered in localised NSCLC

A

Surgery or radiotherapy

80
Q

When is surgery not feasible for NSCLC

A

Tumour to closer to other structures of pt not well enough

81
Q

What influences selection for surgery in NSCLC

A 
Disease features (resectability)
Pt features (operability)
82
Q

Disease features affecting selection for lung cancer surgery

A

Histology (NSCLC)

Stage (I/ II/ IIA)

83
Q

Pt features affecting selection of surgery for lung cancer

A

PMH/ co-morbidities

Pulmonary function

84
Q

Contraindications to surgery for lung cancer

A 
Malignant pleural effusion 
SVC obstruction 
Horner’s syndrome 
Vocal cord paralysis 
Phrenic nerve paralysis
85
Q

Surgical resection procedures for lung cancer

A

Wedge excision
Segmentectomy
Lobectomy - chest wall excision
Pneumonectomy - intra/ extra pericardial, chest wall excision

86
Q

When is chemotherapy indicated in lung cancer

A

To improve results of RT

SCLC

87
Q

When are biological agents used in lung cancer

A

Advanced or metastatic disease

88
Q

What extra modalities can be used in lung cancer in infancy

A

Immunotherapy

Gene therapy

89
Q

How is RT given

A

Radically - curative intent, given daily over 4-6 weeks

Palliatively - relief of symptoms in shorter courses

90
Q

Purpose of palliative RT for lung cancer

A 
To relieve symptoms:
Haemoptysis 
Breathlessness due to obstruction 
Pain 
Short term fatigue
91
Q

Post-operative RT

A

Given only when tumour is known to extended to the surgical margins

92
Q

Endobronchial RT

A

Placing radioactive isotope in the bronchus
Placed via a bronchoscope
Effective palliative for symptom relief

93
Q

Overcoming tumour motion in NSCLC

A

Resp gating is a way of reducing the amount of normal lung irradiated
The RT is given in one Lhasa of breathing cycle

94
Q

Gating in RT

A

Linking the treatments witch to the breathing cycles

95
Q

Chemotherapy for lung cancer

A

Systemic treatment
Not curative except in lymphoma or leukaemia
Can reduce bulk of tumour by killing dividing cells
Difficult side effects

96
Q

Chemo drugs for lung cancer

A

Cisplatin and carboplatin

Gemcitabine and vinorelbine

97
Q

In which cancers can biological agents be very effective

A

NSCLC, eso if they have an EGFR mutation

Works well in non-smokers, Asians, females and BAC pts

98
Q

BAC

A

Bronchiolo-alveolar cell carcinoma

99
Q

How is the risk of post-operative dyspnoea after lung cancer surgery assessed

A

By spiro

Predicted post-op FEV1 or TLCO <40% predicted is considered moderate-high risk of dyspnoea

100
Q

General stages of operation in lung cancer surgery

A

Inspection to confirm no disease progression
Define anatomy
Divide vein, artery, bronchus (typically)
Lymphadenectomy

101
Q

When would adjuvant chemo be considered after lung cancer surgery

A

Unexpected higher staging
Confirmed nodal involvement
Large tumour size

102
Q

A/c side effects of radiotherapy

A

Oesophagitis
Pneumonitis
N & V
Bone marrow suppression

103
Q

Longer term side effects of radiotherapy

A

Pneumonitis and pulmonary fibrosis
Rib fractures
Cardiac fibrosis and dysfunction
Hypothyroidism

104
Q

Stigma (Monaghan & Williams)

A

Meaning imposed on an attribute via -ve images, stereotypes and attitudes that potentially discredits a member of a particular category

105
Q

‘Virtual social identity’

A

What a person ‘ought’ to be according to social norms

Linked to the idea of stereotype

106
Q

‘Actual social identity’

A

The attributes the person actually possesses

107
Q

‘Discredited’ - stigma

A

Stigmatised attribute is known by others

108
Q

‘Discreditable’ - stigma

A

Concealed attribute that could be a source of stigma

109
Q

Graham Scrambler’s theories of stigma

A

Felt stigma - fear of discrimination

Enacted stigma - enactments of discrimination

110
Q

Possible reasons why condns are stigmatised

A

Perception of infection/ contamination e.g, HIV
Perception that the condn devalues QoL e.g. wheelchair users
Perception that condn is ‘self inflicted’ e.g. obesity, lung cancer
Sense of social embarrassment e.g. speech impediment
Perception that someone living w/ a condn cannot live independently

111
Q

Why is haemoptysis seen in lung cancer

A

Bronchial tissue is friable

Sign of infection

112
Q

Why is SOB seen in lung cancer

A

Space occupying lesion affecting alveoli

Pleural effusion

113
Q

Why is chest pain seen in lung cancer

A

Invasion of pleura

Rib metastasis

114
Q

Why is hypercalcaemia seen in lung cancer

A

PTHrP or metastatic bone cancer

115
Q

What is HPOA

A

Triad of periostitis, digital clubbing and painful arthropathy of large joints

116
Q

Lung cancer referral pathway

A

Urgent referral in 2/52

117
Q

Which cancers cause thrombocytosis

A

LEGO

Lung
Oesophageal
Gastric
Ovarian

Clotting screen must be performed

118
Q

Pharmacological smoking cessation agents

A

Bupropion
Varenicline
NRT

119
Q

How is SVCO obstruction treated

A

Stent and radiotherapy

120
Q

Where does the oblique fissure begin

A

At level of T3 spinous process and lies anteriorly at 6th costal cartilage

121
Q

Course of horizontal fissure

A

Comes from meeting point with oblique and runs anteriorly to follow line of 4th rib

122
Q

Which lobe of the lung is above 4th rib

A

Upper

123
Q

Which lobe of the lung is found between 4th to 6th rib

A

Middle

124
Q

Which lobe of the lung is found below the 6th lung

A

Lower

125
Q

Surfaces of the lungs

A

Anterior (costal)
Posterior (costal)
Diaphragmatic

126
Q

Where is the lingula found

A

L lung

127
Q

Where does the primary bronchus enter the hilum

A

Posteriorly

Most posterior element in hilum

128
Q

Structure of L hilum

A

Pulmonary artery is most superior structure

Below and posterior is airway, then pulmonary veins

129
Q

Structure of R hilum

A

Pulmonary artery enters R lung anteriorly at same level as airway
Pulmonary veins enter inferiorly and anteriorly

130
Q

Pulmonary ligament

A

Found inferiorly

Fold of mediastinal pleura

131
Q

Specific features on L lung

A

Lingula

Cardiac notch

132
Q

Function of sympathetic chain

A

Carries sympathetic outflow from CNS

133
Q

Where is the sympathetic chain

A

T1 to L2 in thorax

134
Q

Where does the sympathetic chain run

A

On lateral aspect of vertebral bodies

135
Q

Where are ventral rami of the sympathetic chain found

A

IC spaces

136
Q

Where are the ganglions in the sympathetic chain found

A

At each vertebral level

137
Q

Largest ganglion in the sympathetic chain

A

Stellate ganglion - goes to head and neck, part of upper L8IQMY

138
Q

Rami communicantes

A

Connections between rami

139
Q

White rami of sympathetic chain

A

Delivers signal from spinal nerve into sympathetic chain

140
Q

Splanchnic nerves

A

Pre synaptic fibres (myelinated - go through diaphragm into abdominal cavity to innervate abdominal viscera

141
Q

Common places for space occupying lesions in lung

A

Hilum (adenocarcinoma)

Apex (small cell, Pancoast’s)

142
Q

Which lesions may compromise the azygous vein

A

Lesion in R main bronchus - hilum tumour

143
Q

What structures may be compressed by apical tumours

A

Sympathetic chain - Horner’s syndrome

Vagus nerve

144
Q

What might a hilar tumour affect on the L lung

A

Recurrent branch of vagus nerve

145
Q

Why can lung tumours cause a hoarse voice

A

Apical tumours may compress recurrent laryngeal nerve around R lung ——> unilateral vocal cord paralysis ——> hoarse voice

146
Q

Divisions of the Bronchial tree

A

Trachea - both lungs
Main bronchus - single lung
Secondary bronchus - lobe
Tertiary bronchus - bronchopulmonary segment

147
Q

Bronchopulmonary segment

A

Discrete portion of the lung that has its own individual bronchus, arterial supply and venous drainage
Contain alveoli - site of gaseous exchange

148
Q

What are bronchopulmonary segments separated by

A

Connective tissues

149
Q

What property allows the resection of bronchopulmonary segments without affecting each other

A

Having its own bronchus, arterial supply and venous drainage allows each segment to function semi-independently

150
Q

What is the main difference in the layout of structures in the L and R hilum

A

On the L, the artery is superior to the bronchus

On the R, the bronchus is superior to the artery

151
Q

If someone stops breathing after inhaling a foreign object, where is the item most likely to be

A

Trachea - obstructing whole airway

152
Q

Where is an inhaled foreign body most likely to be

A

R main bronchus or R lower 2’ bronchus

R main is wider, shorter & more vertically orientated. May continue to lower 2’ bronchus if small enough

MBBS - Year 2 (20 decks)

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