tumours Flashcards
what is main cause of lung cancer
smoking
other causes of lung cancer
- radon exposure
- asbestos
- ionising radiation
- arsenic
- chromium
- nickel
- pulmonary fibrosis
- HIV
- genetics
what are the 2 types
- small cell
- non-small cell
examples of non-small cell
- adenocarcinoma
- squamous cell
- large cell
what is a mutation
in the epidermal growth factor (EGFR)
what do squamous cell carcinoma arise from
epithelial cells associated with production of keratin
what is most common type in non-smokers
adenocarcinoma
where do small cell arise from
neuroendocrine cells (APUD cells)
what do small cell often secrete
polypeptide hormones
where are small cell most common
centrally
symptoms
- cough
- chest pain
- haemoptysis
- chest infection
- malaise
- breathlessness
- wheeze
- recurrent infection
- invasion of phrenic nerve
what is most common symptom
cough
why do patients get breathless
tumour occludes large airways can cause lung collapse
what is a co-existing disease
COPD
why does patient get hoarse voice
compression of left recurrent laryngeal
where can it metastases
- liver
- bone
- adrenal gland
- brain
- malignant pleural effusion
extra pulmonary manifestations
- anaemia
- finger clubbing
- hypertrophic pulmonary osteoarthropathy
- weight loss
- anorexia
- gynaecomastia
lots more
aims of investigations
- stage
- differentiate
- assess fitness to undergo treatment
what investigations are done
- chest x-ray
- CT
- ultrasound
- biopsy
what does CT indicate
extent of disease
what is used for staging
TNM
what does T stand for in TNM
tumour size
what does N stand for in TNM
nodal involvement
what does M stand for in TNM
metastases
TX means
- primary tumour cannot be assessed
- or tumour present in sputum but cannot be found
T0 means
no evidence of primary tumour
Tis means
carcinoma in situ
T1 means
tumour <3cm
T2 means
tumour >3cm but less than 7cm
- involves main bronchus
- invades visceral pleura
T3 means
tumour >7cm
- directly invades chest wall, diaphragm, phrenic nerve, pleura
T4 means
tumour of any size that invades any of the following: mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, oesophagus, carina
NX means
regional lymph nodes cannot assessed
N0 means
no regional lymph node metastases
N1 means
metastasis in ipsilateral peribronchial hilar lymph nodes
N2 means
metastasis in ipsilateral mediastinal and/or subcranial lymph nodes
N3 means
metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene nodes
M0 means
no distant metastasis
M1 means
distant metastasis
when are lymph nodes classed as being enlarged
> 1cm
what is test for assessing extent of lymph node involvement
PET
is MRI useful
no
when is MRI useful
pancoast tumour
what is bronchoscopy used for
biopsy
when is tumour inoperable
if carcinoma involved first 2cm of either main bronchus
what is most common complication of biopsy
pneumothorax
are most patients curable or incurable
incurable
when is surgery done
non small cell
what is treatment of choice when surgery not available
radiation therapy
what is given at end of chemotherapy
radiotherapy
to consolidate treatment in small cell lung cancer
what is used in palliation
laser therapy
who are all involved in treatment
MDT
how do metastases of lung present
as round shadows
where do secondary lung tumours come from
- kidney
- prostrate
- breast
- bone
- GI tract
differential diagnosis
- primary bronchial carcinoma
- tuberculoma
- benign tumour of lung
- hydatid cyst
BENIGN TUMOURS
BENIGN TUMOURS
what is most common benign tumour
pulmonary hamartoma
how is pulmonary hamartoma detected on CXR
well-defined round lesion 1-2cm
what do bronchial carcinoids produce
adrenocorticotrophic hormone (ACTH)
what does small cell release
ACTH
what does ACTH cause
cushing syndrome
what does squamous cell carcinoma release
PTH
what does PTH cause
hypercalaemia
what are the signs of cushing syndrome
- central obesity
- ‘buffalo hump’
- striae
- proximal muscle weakness
what is most common in non-smokers
adenocarcinoma
metastases from primary lung cancer
BLAB
- brain
- liver
- adrenal
- bone
where is pancoast tumour
apex of lung
where do pancoast tumour invade
the brachial plexus
what is pancoast tumour associated with when it compresses the sympathetic chain
Horner syndrome
features of Horner syndrome
- miosis
- ptosis
- anhidrosis
what can pancoast tumour compress
sympathetic chain
what do squamous cell carcinoma produce
keratin
