Week 4 Flashcards
1
Q
In Europe alone, on person is dying of lung cancer every x minutes
A
2
2
Q
Pulmonary fibrosis is a risk factor for lung cancer
A
Yes
3
Q
Is there a safe smoking threshold?
A
No
4
Q
Passive smoking increases risk to what degree?
A
50-100% increased risk
Causes at least 25% of so called non-smoking lung cancers
5
Q
There is genomic damage with smoking
A
Yes
6
Q
Why does tobacco smoke cause smoking?
A
Host activation of pro-carcinogens
Inherited polymorphisms predispose:
Metabolism of pro-carcinogens
Nicotine addiction
Epithelial effects
7
Q
What are the two main pathways of carcinogenesis in the lung?
A
Lung periphery
Central lung airways
8
Q
Pathway of carcinogenesis in the lung periphery? (= what?)
A
Bronchioloalveolar epithelial stem cells transform
= adenocarcinoma
9
Q
Pathway of carcinogenesis in the central lung airways?
A
Bronchial epithelial stem cells transform
Squamous cell carcinoma
10
Q
When bronchial epithelial stem cells transform, what carcinoma forms?
A
Squamous cell
11
Q
When bronchioloalveolar epithelial stem cells transform, what cancer forms?
A
Adenocarcinoma
12
Q
How common are tumours of bronchial glands?
A
Very rare
13
Q
What are the 4 main types of carcinoma of the lung?
A
Squamous cell
Adenocarcinoma
Small cell carcinoma
Large cell carcinoma
14
Q
What are the three types of NSCLCs???
A
Adenocarcinoma
Squamous cell carcinoma
Large cell carcinoma
15
Q
Primary lung cancer presents when
A
Late in natural history
Grows clinically silent for many years
16
Q
Lung cancer does what to the bronchials
A
Causes obstruction due to collapse
17
Q
A local effect of lung cancer is bronchiectasis
A
Yah
18
Q
A local effect of lung cancer is infection/ abscess
A
19
Q
Local effect of lung cancer on the pleura?
A
It’s inflammatory and malignant
20
Q
Local effect of lung cancer on the phrenic nerve?
A
Diaphragmatic paralysis
21
Q
Local effect of lung cancer on l recurrent laryngeal?
A
Hoarse, bovine cough
22
Q
Local effect of lung cancer on brachial plexus?
A
Pancoast T1 damage
23
Q
Local effect of lung cancer on cervical sympathetic nerves
A
Hornets syndrome
24
Q
Which type of lung cancer has endocrine effects
A
Small cell
25
Has squamous lung cancer got endocrine effects?
PTH
26
Prognostic markers might be used to select patients for what type of therapy?
Adjuvant
27
Median survival of small cell carcinoma?
4%
Median survival = 9 months
28
Bronchioloalveolar epithelial stem cell transforms to what cancer?
Adenocarcinoma
29
Bronchial epithelial stem cells transform to what type of cancer?
Squamous cell carcinoma
30
Immunotherapy in NSCLC is rarely used
False
It’s actually transformed practice
31
Squamous cell has little or no effective molecular targeted therapy
True
Has none
32
Is there an immune response to tumours?
Some are immunogenic, some are not
33
How would a tumour evade the immune response?
Inhibitory immune checkpoints are one important mechanism
34
Where would adenocarcinoma be located?
Peripherally
35
Where would squamous cell carcinoma be located?
Located centrally (in the bronchi)
36
Where would large cell carcinoma be located?
Peripherally and centrally
37
Where is small cell carcinoma located?
Centrally
38
All the lung cancer metastasise early except which one?
Squamous cell, which is more common in smokers
39
What does squamous cell carcinoma secrete, causing hypercalcaemia?
PTHrP
40
Clinical features of lung cancer include unexplained cough for at least how long?
Unexplained cough for at least 3 weeks
41
Why bone pain in lung cancer?
Due to metastases- commonly the spine, pelvis and long bones
42
Why fatigue in lung cancer?
Due to anaemia of chronic disease
43
Patients presenting with red flag symptoms must be referred on a x week wait. How long
2
Must have CXR within 2 weeks
44
TB is a differential diagnoses of lung cancer, because of an unexplained cough, and weight loss. What are the features differentiating TB from lung cancer? (3)
1) drenching night sweats
2) positive sputum culture and microscopy
3) CXR showing hilar lymphadenopathy
45
Sarcoidosis is a lung cancer differential diagnoses due to cough and unexplained weight loss. What’s the differential symptoms? (2)
Skin signs eg erythema nodosum and lupus pernio
Tissue biopsy: non caseating Granulomas
46
What might a FBC of lung cancer show?
Anaemia
47
What might happen to serum calcium in squamous cell carcinoma?
Elevated
With secretion of PTH-related protein (PTHrP)
48
What’s SIADH associated with? (Syndrome of inappropriate antidiuretic hormone secretion)
Small cell carcinoma
49
What might a CXR of lung cancer show?
Single/ multiple opacities
Pleural effusion
Lung collapse
50
What’s used to confirm CXR findings?
CT
51
Why use bronchoscopy?
It involves the insertion of a small camera into the airways to directly visualise the tumour.
Then you can take a biopsy.
Biopsy is essential in order to make the diagnosis
52
What imaging enables staging of cancer?
Positron emission tomography CT
(PET CT)
53
Stage I lung cancer?
One small tumour (<4cm) - localised to one lung
54
Stage II lung cancer?
Larger tumour (>4cm) - may have spread to nearby lymph nodes
55
Stage III lung cancer?
Tumour that has spread to contra lateral lymph nodes, or grown into nearby structures (e.g. trachea)
56
Stage IV lung cancer?
Tumour that has spread to lymph nodes outside the chest, or other organs (e.g. liver)
57
Stage I-III non-small cell lung cancer management? (3) (incl. if too frail)
1) surgery eg lobectomy/pneumectomy, or wedge resection in patients with reduced lung function
2) pre-operative & post-operative chemotherapy and radiotherapy (or not if stage 1)
If too frail/ unsuitable for surgery?
=
Stereotactic ablative radiotherapy (SABR)
58
Stage IV NSCLC management? (Often palliative) (3)
1) targeted therapy- drugs to target mutations which drive pathogenesis
2) immunotherapy- these drugs target immune checkpoints
3) chemotherapy
59
Body’s purpose of an immune checkpoint?
Prevent the patients immune cells from killing tumour cells
60
The immune checkpoint is targeted by what?
Pembrolizumab
61
Which type of lung cancer is associated with high risk of brain metastases?
SCLC
62
What treatment for SCLC due too high risk of brain metastases?
Prophylactic cranial irradiation
63
What’s hornets syndrome due to?
A pancoast tumour
64
What’s a pancoast tumour?
A tumour in the lung apex infiltrating the brachial plexus
65
Horners syndrome features enophthalmos, what is that?
Posterior displacement of the eyeball into the orbit
66
Tumour that obstructs superior vena cava?
Prevents venous drainage from the head and neck, leading to facial swelling and distended neck/chest veins
67
SIADH is what type of syndrome?
Paraneoplastic syndrome
68
3 treatment related complications of radiotherapy?
Mucositis, pneumonitis, oesophagitis
69
What’s staging of the ECOG (eastern cooperative group) performance status measurement 0-5
0= asymptomatic; well
1= symptomatic, able to do light work
2= has to rest but for <50% of the day
3= has to rest for >50% of the day
4= bedbound
5= dead
70
Staging lung cancer using TNM: what does TNM stand for
T = tumour size, but also kinda location
N= nodal involvement
M= distant metastases
71
What’s the principle reason for undertaking thoracic surgery?
Lung cancsr
72
How many people with lung cancer are operable?
Only about 10%
73
Patients with lung cancer are at risk from what 2 things that might make them inoperable?
Ischaemic heart disease and COPD
74
Tumour, if attached to what, cannot be resected?
Vital structures such as heart or spine
75
The larger the tumour, the lower the T number
Falss
76
T1 tumour is less than 3cm, T2 is less than 5cm, T3 is larger than 5cm, and T4 is if it’s attached to vital structures e.g. trachea, superior vena cava, aorta, spine etc so can’t be resected easily….. true or false
True
77
What lymph nodes might be easily involved in lung cancer? (2)
Hilar lymph nodes
Mediastinum lymph nodes
78
TNM staging of lung cancer:
Which has a better prognosis, N1 or N3? What does N3 mean?
N3 = involved in other side of mediastinum to the primary tumour, or involved in neck in a different anatomical zone
N3 is worse
79
Lymph node involvement in lung cancer is sometimes responsible for what 2 nerve palsy’s
Recurrent laryngeal nerve palsy
Phrenic nerve palsy
Invasion of tumour cells
80
Phrenic nerve is on both sides, true or false
True
81
Recurrent laryngeal nerve is on both sides, and is a branch of the phrenic nerve
No
Just left
Off vagus nerve
82
The region between the aortic arch and the left pulmonary artery is called what?
Aorto-pulmonary window
83
The ligamentum arteriosum connects which two vessels?
Aortic arch and left pulmonary artery
84
What does the recurrent laryngeal nerve ‘hook’ around?
Medial side of the ligamentum arteriosum, then rises up neck to innervate the left vocal cord
85
Phrenic nerve enters chest in relationship with which artery?
Left subclavian, on the left side
86
Vagus nerve enters the chest in relation to which artery?
Left common carotid artery
87
Is the phrenic nerve anterior or posterior to the Hilum of the lung?
Anterior
88
Is the vagus nerve anterior or posterior to the Hilum of the lung?
Posterior
89
Where does the vagus nerve give off its recurrent laryngeal nerve branch?
Just underneath the ligamentum arteriosum
90
Lymph nodes develop carcinomas in the gap under the aortic arch?
= May cause recurrent laryngeal nerve palsy
91
Common sites of metastasis for lung cancer: (3)
Bones
Liver
Adrenals
92
Common symptom of metastasis in the bones or brain?
Pain
93
Personality change in lung cancer why?
Cerebral metastasis
94
What imaging to see nerve palsy?
Maybe x-ray
95
Patients with supraclavicular lymph nodes may indicate the presence of inoperable disease
Yes
96
Resect tumours that have metastasised?
You could… but then would that actually be a permanent cure?
97
A malignant pleural effusion might indicate?
That surgery wouldn’t get rid of lung cance r
98
Pleural effusion
Collection of fluid between the thin layers of pleura
99
4 things we look for in CXR when staging lung cancer?
Pleural effusion
Chest wall invasion
Phrenic nerve palsy
Collapsed lobe or lung
100
If phrenic nerve palsy, could lung cancer be operable?
No, inoperable
101
What have we got to do after seeing a collapsed lobe or lung in CXR for lung cancer?
Use PET scanning to see how much of the collapsed lung is tumour, and how much is just collapsed normal lung tissue
102
What blood tests for staging of lung cancer and why?
Look for features of anaemia for bone marrow involvement
103
Why look for abnormal LFTs when staging lung cancer?
To work out if seeing if spread to liver
Look for metastasis and abnormal bone profile
104
Are mediastinal nodes N1 or N2?
N2
105
Can we resect the chest wall?
Not really
106
Can the diaphragm be resected in lung cancer?
Only as long as the central portion only is invaded
Difficult to resect diaphragmatic recesses
107
Why ECHO in staging lung cancer?
Will demonstrate presence or absence of significant pericardial effusion
Could be malignant
108
Tumour at main bronchus… we need to do it’s not where?
Not at the carina
109
Walk me through what’s involved in a Mediastinoscopy
1) telescope is placed to a small incision above the sternum
2) pass down adjacent to the trachea
3) will probably find lymph nodes, so can take biopsies
110
If metastatic spread to the lymph nodes = what
No surgeyr
111
We have clinical assessment for fitness for surgery….. why would we want to know about previous CABG or angioplasty? (Coronary artery bypass graft)
Because stenosis may have developed
112
Would they consider importance of recent URTI for operating with lung cancer?
Yes
113
Would they consider importance of athsma for operating with lung cancer?
Yes
114
Why look out for pulmonary hypertension when operating on the lungs?
Because if the patient has got the pulmonary arteries (they’re very frail) then they can be easily damaged during surgical dissection
Well known cause of death
115
Where could you pick up presence of pulmonary hypertension on a scan?
ECHO
116
Patients with cirrhosis of the liver: suitable for lung cancer surgery?
No
What if the liver has a tough time removing poisons from blood stream following post operative infection?
If liver can’t…. Then circulation = vasodilation and increased capillary permeability = circulatory shock (heart works well, but no good blood pressure)
117
We tend to reject patients with cirrhosis and lung cancer
Yes
Rather have radiotherapy treatment
118
We do spirometry for our lung cancer patients
Yes
119
We do routine lung function testing on our lung cancer patients ?
Eg
Spirometry and diffusion studies
Maybe a special radionuclide test to work out how much air is going to each lobe of the lung , to work out post-op lung function with an FEV
120
Post op FEV1 should be what
At least 1 litre of more
Remember total lung capacity = 5 litres, which is residual volume + vital capacity
121
Vital capacity
Total amount of air exhaled after maximal inhalation
122
Lung cancer patients will get a CT scan. If the coronary arteries are very calcified, then what’s done
A coronary angiogram
123
Is resection of parietal structures feasible?
Yes
124
You don’t know for certain it’s lung cancer. Can you just go ahead and do a lobectomy, without any worries?
Yes, because it’s a lower risk operation
125
Not sure if they’ve got finger clubbing… what question do you ask?
Have you noticed recently it has become more difficult to cut their nails?
126
Myocardial infarction is a reason for post operative death (lung cancer)
Yes
127
ARDS is a for post operative death following surgery for lung cancer
Ues
128
What’s a wedge resection?
Using staple guns to chop out the tumour tissue from the lung itself- that’s a wedge resection
129
What’s a common reason for ARDS leading to post operative death?
Patient had interstitial lung disease in association with their lung cancer
Stress of operation could activate it
130
Is it common to get chest infections after a surgery
Yea
E.g. bronchopneumonia
131
Why are pulmonary embolism or pneumothorax affecting remaining lung so bad? Post-op
Cuz after only one lung
132
Would empyema be an example of a non-fatal complication of lung cancer surgery?
Yah
But also very serious.
Like
Imagine a whole chest cavity full of pus
133
Would atrial fibrillation be a non fatal complication of surgery for lung cancer?
Yes
134
What’s a broncho-pleural fistula?
An abnormal connection between bronchi and the pleural cavity
As evidenced by continued leak post-pneumothorax
135
How might a bronchopleural fistula develop?
1) patient has had a pneumonectomy so there is a large space
2) large space develops a negative pressure and chest wall collapses
3) space with fluid where lung used to be. Fluid never obliterates
4) negative pressure develops and air can be sucked in through the staple lines and surgical sutures and the bronchus
136
Bronchopleural fistula is difficult to eradicate once established. What’s the main symptom?
A chronic chest strain
Repeated chest infections
137
With repeated chest infections with Bronchopleural fistula?
Material in the empyema space inevitably leaks into the trachea,
138
Why insufficient ventilation with bronchopleural fistula?
When hole between the pleural cavity and the airway is large, tidal volume they breathe in goes into this dead space where the right or left lung should have been
Can be quite breathless
139
True or false: collapse of a lung actually makes tumour size easier to assess
No
Obviously not
Make tumour size more difficult to assess
140
Name 3 cels in pleural fluid
Macrophages
Lymphocytes
Mesothelial cells
141
How is pleural fluid produced?
The process of filtration..
It’s the parietal pleura that’s produces most of the draw coloured fluid
142
Pleural fluid has protein in it
Yes
143
Lymphocytes in the pleural fluid comes from where
Filtered out from blood
144
Mesothelial cells in the pleural fluid come from where
Shed from pleural surface
145
What’s the pressure gradient in the pleural cavity?
It’s negative
Most negative at the apex as opposed to the base
146
Why does pleural effusion usually occur? (2)
Excessive production
Reduced absorption
Or combo of the two
147
What are the two kinds of pleural effusion?
Transudate
Exudate
148
Why does transudate happen?
It’s purely a process of filtration
149
Transudate has high or low protein content? Is inflammatory or non-inflammatory?
Low protein
Non-inflammatory
150
Exudate has high or low protein
High protein
Is inflammatory
151
What’s the general protein cut off/ rule of thumb for exudate vs transudate?
Exudate = protein content of 3 grams per decilitre or more
152
What’s the actual criteria to differentiate between transudates or exudates?
Lights criteria
153
How much fluid must be present in pleural effusion before it’s detected
At least 300ml
154
Signs of pleural effusion (3)
Decreased chest wall movement
Dullness to percussion
Diminished breath sounds
Potentially tracheal deviation away from effusion
155
Protein content of normal pleural fluid is what
1-2g /dL
156
Exudate are caused by changed to factors that influence what
Formation and absorption of pleural fluid
157
Transudates are associated with these conditions:
Malignancy
Infection (eg empyema due to bacterial pneumonia)
Trauma
Pulmonary infarction
Pulmonary embolism
No
That’s for exudate
158
Transudates are concerned with these conditions:
Congestive heart failure
Liver cirrhosis
Severe hypoalbuminemia
Nephrotic syndrome
159
Transudative = pleural effusions caused by factors that alter what 3 things
Hydrostatic pressure
Pleural permeability
Oncotic pressure
160
The fluid is considered an exudate if any of the following are
present:
The ratio of pleural fluid to serum protein is greater than x
The ratio of pleural fluid to serum LDH is greater than y
The pleural fluid LDH value is greater than z of the
upper limit of the normal serum value
0.5
0.6
Upper two thirds
161
Purulent fluid indicated what
Empyema
162
The presence of food particles in a pleural effusion suggests what
Oesophageal rupture
163
LDH for normal pleural effusion is what?
Less than 50% plasma concentration
164
Normal pleural fluid glucose levels is similar to that of blood. What would low levels indicate? (2 important ones, 3 maybes)
A low pleural fluid glucose level (<3.4mmol/l) may be found in empyema, rheumatoid disease.
TB, malignancy, oesophageal rupture
165
Pleural fluid pH of less than 7.3 is associated with the same pathologies that cause low pleural fluid glucose levels- true or false
True
Eg
Rheumatoid disease
Empyema
TB, malignancy, oesophageal rupture
166
Pleural fluid lymphocytosis suggests what
TB, sarcoidosis, malignancy
167
Neutrophil dominant effusions are associated with what
Empyema and pulmonary embolism
168
Blood in the pleural space may result from pulmonary embolism
True
169
Pleural fluid eosinophilia (PFE) is usually caused by the presence of what in the pleural space
Air or blood
170
Organ failures eg cardiac, liver and renal account for the majority of transudates or exudates?
Transudates
171
Transudates are rarely bilateral effusions
False
Often bilateral effusions
172
Pulmonary causes of transudates are common
False
They’re rare
173
Pulmonary causes of exudates are common
True
174
3 common causes of exudates please
Malignancy
Effusions and empyema
TB
So like the most commonly encountered exudates are para pneumonic or effusions associated with pneumonia
175
Rheumatoid arthritis can cause pleural effusions
True
176
Investigation of pleural effusion, which three scans and why
US: more sensitive than CXR, mark site for aspiration, assess pleura, bedside
CXR: accessible, easy to interpret
CT thorax: complex effusions, visualising the pleura, vascular and mediastinal structures
177
Easiest way to work out what’s causing the effusion?
Get a sample of the fluid
178
Pleural fluid analysis? How
Aspiration
Inspect: pH (bedside ABG machine), biochemistry, microbiology, cytology
179
If pleural fluid is less than 7.2 what does that indicate?
Need for chest drain
Because high likelihood that acidic pleural effusion, will eventually form pus, and therefore infection becomes difficult to control
180
Pus pr blood in pleural fluid = what
Need for chest drain
181
Transudate management?
Treat the underlying cause, may not need CT imaging
182
Exudate management summed up?
Unless cause identified, will need further investigation for e.g. further imaging, and pleural biopsy
183
Why would a spontaneous pneumonthorax occur?
Weak surface areas that rupture spontaneously, and then leak air into the pleural cavity
184
Spontaneous pneumothorax: Weak surface areas that rupture spontaneously, and then leak air into the pleural cavity
What happens next?
Leak of air accumulates
Compresses the underlying lung
185
What happens to the trachea in a pneumothorax?
There is a tracheal shift
186
When is a pneumothorax called a secondary spontaneous pneumothorax?
If it occurs in someone with a pre-existing condition
187
Name 4 lung diseases which usually result in pneumothorax?
Interstitial lung disease
COPD
Asthma
Cystic Fibrosis
188
Tension pneumothorax is usually less serious
No
Life-threatening emergency
189
What’s a tension pneumothorax?
When air within the pleural cavity following pneumothorax builds up to the point that it causes pressure and pushes the central structures of the chest and squares opposite lung
190
What happens to blood pressure in a tension pneumothorax?
Blood pressure drops
191
Oxygen levels in a tension pneumothorax?
Drops due to compression of the opposite lung
192
What’s emergency response to tension pneumothorax?
Emergency release of that air under pressure
Eg popping a needle in or putting a chest drain on
193
Normal presentation of spontaneous pneumothorax? (6) (symptoms vs what)
Sudden
Chest pain
Sob
Underlying lung disease
Tall thin young men
History of biopsy/ line insertion/ mechanical ventilation
194
Why do patients with pneumothorax dismiss it?
Because they thought it was just sob or chest pain following exercise
But then they realised it was quite sudden and quite persistent
195
Breath sounds for pneumothorax?
Percussion sounds like what?
None
Hyper resonant
196
Two scans to diagnose a pneumothorax?
CXR
US
CT thorax maybe eg when complex, if underlying severe lung disease like COPD, or in CF
197
Easy to miss a pneumothorax on a CXR where?
The apice
198
3 management for pneumothorax?
Aspiration if patient well and over 2cm (drawing breath)
Chest drain insertion
Surgery (if recurrent events, unresolving)
199
Recurrence rate of pneumothorax
25-50%
200
Don’t lift for how long after pneumothorax has healed?
And fly
At least a week
201
If pneumothorax occurs a second time on the same side, what’s usually advised?
Surgical repair cuz high incidence of recurrence
202
Safe spot for aspiration?
Just avoid inadvertent damage to underlying organs like the heart, spleen and liver
203
Benign pleural rumours are quite common!
FALSE
Usually pleural malignancy is common , and presents as pleural effusioons
204
Pleural rumours are usually secondary
Yes
205
Why do pleural tumours cause/ present as pleural effusions?
Block lymphatics. Prevent drainage of pleural fluid, and result in an accumulation of pleural fluid
206
An example of a primary malignant tumour of the pleura language what?
Malignant mesothelioma
(Asbestos)
207
Malignant mesothelioma is usually caused by what
Asbestos dust and fibres, cause inflammation, provokes tumour formation
208
Mesothelioma of the pleura presents as what
Chest pain
SoB
Weight loss of unknown cause
209
CT is good at looking at the pleura why?
Looking at pleural surface in greater detail, can tell whether pleural lining is thickened
210
To diagnose mesothelioma of the pleura, what do you need?
Tissue (fluid not enough)
Need a biopsy
E.g. to see thickened pleura, pleural nodules or masses, pleural plaques, an effusion, soft tissue infiltration
211
Why would you spray the lining of the king with sterile talcum powder (pleurodesis)?
Stop the fluid from re-accumulating
212
Surgery in the treatment of mesothelioma?
Decortication (peel off thickened layers of pleura to relieve SoB)
Pleurodesis (spray sterile talcum powder)
213
Regarding lights criteria: if the pleural fluid protein concentration is more than half the serum protein concentration, the effusion is exudative
True
Remember:
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
214
Flavoured cigarettes are illegal
True
215
Lung cancer can lead to bronchiectasis. How?
Small airway obstruction by a lung tumour can cause the abnormal dilatation of airways known as bronchiectasis
216
Rheumatoid arthritis causes an exudative pleural effusion
True
217
After PET/CT scan, up to 15% of patients will have the stage of their cancer upgraded, found at later stage than originally thought
Yes
218
A person who has to rest less than 50% of their day due to their cancer symptoms and is unable to work has a performance status of 2
True
219
Performance status 0 = what?
Fully actice
220
Performance status 1?
Restricted in physically strenuous activity, but can do light house work, office work etc
221
Performance status 2?
Can do self care, but can’t work. Up and about more than 50% of waking hours
222
Performance status of 3?
Capable of limited self care, confined to bed or chair more than 50% waking hours
223
4 performance status?
completely disabled
224
Performance status 5?
Dead
225
What are tyrosine kinase inhibitors (TKIs)
They target tumours carrying specific mutations in adenocarcinoma (a non-small cell lung cancer)
226
Lung cancer can be staged from a CXR
False
It is “staged” due to its spread, therefore cross sectional whole body imaging is required
E.g ct scan
227
CT scan is often used for staging cancer
Yah
But like
The staging has to be related to its spread, therefore cross sectional whole body imaging is required
228
Adenocarcinoma of the lung is more likely to arise centrally
False
229
Adenocarcinoma develops how
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 normally found in small airways, so this cancer is more likely to arise peripherally
230
Adenocarcinoma is more likely to arise peripherally
True dat
231
Generally fluid from an exudative effusion contains 3G/dL of protein or more
Yah
Caused by inflammation
232
A pneumothorax which occurs without prior injury in a patient with a pre-existing lung condition is called a primary spontaneous pneumothorax
NO BRO
That’s secondary spontaneous pneumothorax
233
Which gland does lung cancer normally metastasise to?
Adrenal Glands
234
Lung cancer commonly metastasises to the thyroid gland
Flase
235
Doubling time of two different cell cancer types pleeeeeeeze
129 days for non small
29 days for small cell
236
Lowest pressure of the pleural fluid where in the lung
At the APEX
237
Patients with mesothelioma are entitled to compensation
TRUE
238
Regarding CXR’s: a pulmonary mass is classed as an opacity over what
3cm
239
Anything smaller than 3cm is classed as what , a mass?
NO BRO
It’s a nodule
240
Paraneoplastic syndromes occur due to direct metastatic invasion of endocrine glands by lung cancer
False
241
Paraneoplastic syndromes are hormonal or chemical changes- where do the hormones and chemicals come from
Primary tumour
Or
Through immune system stimulation.
242
TNM stands for
Tumour
Nodes
Metastasis
243
Phrenic nerve damage will cause what
Paralysis of the affected hemidiaphragm
244
Giving chemotherapy and radiotherapy concurrently increases the survival compared to radiotherapy by how much?
Increase in survival by 5%
245
What’s neoadjuvant treatment?
It’s used in other cancer types (not lung currently) and refers to treatment given before planned curative surgery
246
Squamous cell epithelium lines what part of the airway
Larger central ones
247
Patients with small cell lung cancer are only given radiotherapy to the brain if there are cranial metastases
False
It’s given prophylactically
As it’s known that SCLC frequently spreads to the brain
248
What kind of radiotherapy can be used to remove lung tumours by ablation
SABR
Stereotactic ablative radiotherapy
249
Small cell lung cancer tends to have a faster response to treatment
Yah
250
Ultrasound is the only imaging modularity that allows a site for drainage of a pleural effusion to be marked
Yes
