week 4 Flashcards
what are tyrosine kinase inhibitors (TKIs)
these drugs target tumours carrying specific mutations in adenocarcinoma (a non-small-cell lung cancer)
how is radiotherapy to the brain given
radiotherapy to the brain is given prophylactically (“prophylactic” treatment is anything that is given to prevent something) as it is known that SCLC frequently spreads to the brain.
what has the protein content of 3g/dl
this describes the protein content of an exudative effusion, which is caused by inflammation.
what can liver failure cause
transudative pleural effusion
liver failure alters the protein composition of blood, and therefore alters the balance in oncotic pressure that maintains constant volume in the pleural cavity. This is therefore a process of fluid accumulation due to a change in filtration rather than inflammation, so causes a transudative effusion.
what is PTH a feature of
sqaumous cell lung cancer
what is stage IV
designates the development of distant metastases
what percentage of smokers will develop lung cancer
10%
what is radical treatment
any treatment given with the intent to cure the cancer
what leeds to voice hoarseness
recurrent laryngeal nerve damage
what will happen to the air filled cavity produced after a pneumonectomy
it will eventually fill with fluid
what type of lung cancer is faster growing
SCLC - it has a doubling time of 29 days
whereas NSCLC has a doubling time of 129 days
what type of pleural effusion does heart failure cause
left ventricular failure causes pulmonary vascular congestion, which forces more fluid into the pleural space. It is therefore a transudative process that causes the pleural effusion seen in heart failure.
what type of pleural effusion does rheumatoid arthritis cause
exudative, Rheumatoid arthritis is a multi-system inflammatory disease, and the fluid accumulates due to inflammatory changes.
what is prevelance of smoking cigarettes correlated to
economic deprivation, adults in the most deprived postcodes are three times more likely to smoke than adults in the least deprived postcodes.
what would happen to the position of the mediastinum in lung collapse
it would shift towards the abnormal side, collapse involves loss of volume, so it creates a pulling force on the mediastinum, causing it to deviate towards the side of the collapsed lung.
where do most pleural tumours arise from
most pleural tumours are metastatic deposits from cancer elsewhere – often lung or breast cancers.
what is the pressure of pleural fluid
pleural fluid has a slight negative pressure, with the lowest pressure being at the apex. This negative pressure helps keep the surfaces of the lung, pleura and thoracic cavity adherent and facilitates breathing.
what are Ectopic ACTH secretion and SIADH effects of
endocrine effects of small cell lung cancer.
ACTH = adrenocorticotropic hormone
SIADH = Syndrome of Inappropriate Antidiuretic Hormone secretion
what are paraneoplastic syndromes
hormonal or chemical changes that occur in the body due to lung cancer, often as a result of the secretion of hormones by the primary tumour itself, or through immune system stimulation.
where is a sqaumous cell carcinoma of the lung more likely to arise
squamous cell epithelium lines the larger central airways, and so this tumour type tends to arise centrally.
does smoking increase the risk of bladder cancer
smoking does not just increase risk of lung cancer. Bladder cancer risk is increased three-fold by smoking (and the relative risks of many other cancers are also increased).
what symptoms of lung cancer can radiotherpy be used to treat
bony pain (from metastases) and haemoptysis can be improved by palliative radiotherapy.
where is adenocarcinoma of the lung more likely to arise
bronchioalveolar epithelial stem cells transform and undergo atypical adenomatous hyperplasia, developing into adenocarcinoma in situ and then invasive adenocarcinoma of the lung. This epithelium is found in small airways, so this cancer is more likely to arise peripherally.
what does putting sterile talcom powder in the pleural cavity do
provokes an inflammatory reaction, which causes the visceral and parietal pleura to fuse, preventing recurrence of pleural effusion.
why are T4 lung tumours not surgically resectable
T4 tumours are locally advanced – i.e. invading into surrounding structures such as the aorta or the trachea, and so generally are not suitable for surgical resection.
what is horners syndrome a sign of
an apical lung tumour, and results from compression of the sympathetic trunk. Patients with Horner’s syndrome have a constricted pupil (miosis), a drooping eyelid (partial ptosis), and decreased sweating (anhidrosis) on the affected side.
how many carcinogens do cigarettes contain
over 60 known
regarding lights criteria how would u know if effusion is exudative
If the pleural fluid protein concentration is more than half the serum protein concentration
what is a pulmonary mass classed as in a chest xray
an opacity over 3cm
by what percent does giving chemo and radio concurrently increase survival rates
5%
what are side effects of radiotherapy
pulmonary fibrosis, oesophagitis, ulceration and burning to skin and pericarditis.
can PET/CT show the metabolic activity of a lesion
PET imaging involves injection of a radio-labelled glucose analogue. High uptake of glucose (i.e. a high metabolic activity) will therefore show up on the scan as a bright spot, and this may identify metastatic deposits (as cancers typically have high metabolic activity due to their rapid growth).
how long after asbestos exposure does it take foe mesothelioma to develop
20-40 years
what is adjuvant treatment and when is it given
Adjuvant treatment is chemotherapy or radiotherapy that is given after surgery to resect a lung cancer.
what imaging modality allows site of drainage in pleural effusion to be marked
ultrasound imaging allows the fluid to be visualised and quantified with the patient in a seated position, and a marking can be made on the skin to show a safe site for needle insertion and fluid drainage. This cannot be done from a CXR because it is a 2D image, and a CT scan is performed in a supine position, so fluid would move as soon as the patient sits up!
what type of lung cancer has a faster response to treatment
Small cell lung cancer tends to have a faster response to treatment than non-small-cell lung cancer. because these cancers grow quickly and are highly metabolically active, they are also vulnerable to treatment and respond quickly.
where does lung cancer commonly metastasize to
adrenal gland
what type of cancer is the highest mortality worldwide
lung cancer
can lung cancer which had spread to mediastinal lymph nodes be resected
no
does risk of heart attack decrease when u quit smoking
15 years after stopping smoking, heart attack risk returns to that of a never-smoker. An encouraging reason to stop smoking!
can a pneumothorax resolve without treatment
yes, small pneumothoraces in well patients can simply be monitored, as the air will eventually be absorbed by the pleura.
can lung cancer cause bronchiectasis
yes, small airway obstruction by a lung tumour can cause the abnormal dilatation of airways known as bronchiectasis.
can lung cancer cause bronchiectasis
yes, small airway obstruction by a lung tumour can cause the abnormal dilatation of airways known as bronchiectasis.
what must the estimated post operative FEV1 value be to be considered for resective surgery
at least 1L, less than this will likely cause severe breathlessness
who do primary pneumothoraces occur in
people with no pre-existing lung disease
can lung cancer be staged from a chest xray
people with no pre-existing lung disease
is it more likely for a patients cancer to be upstaged or downstaged
up to 15% of patients will have their cancer UPstaged. This is because PET/CT can detect small foci of high metabolic activity (likely metastases) that may have been missed on CT imaging.
what is lights criteria for exudative effusion
Pleural fluid protein/Serum protein >0.5
Pleural fluid LDH/Serum LDH >0.6
Pleural fluid LDH >2/3 the upper limit of the lab reference range for serum LDH
what can be used instead of surgery
Very high dose radiotherapy can be used instead of surgery in some patients with lung cancer, to remove tumours by ablation. it involves a short coarse of very high dose radiation
