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Medicine: Respiratory > Carcinoma of the Bronchus > Flashcards

Carcinoma of the Bronchus Flashcards

1
Q

What is the second most common cancer in the UK?

A

Carcinoma of the bronchus

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2
Q

What is the most important clinical differentiation in carcinoma of the bronchus?

A

Small cell (SCLC)(25%) and non-small cell (NSCLC)(75%)

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3
Q

Which non-small cell lung cancer is this describing?

Primary lung malignancy, smoking link, from larger airways. Well-defined ‘metaplasia, dysplasia, carcinoma’ sequence.

A

Squamous cell carcinoma

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4
Q

Which non-small cell lung cancer is this describing?
Commonest in non-smokers, peripheral small airways. Precursor lesion is called atypical adenomatous hyperplasia and is asymptomatic.

A

Adenocarcinoma

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5
Q

What is this describing?
Cancer, not graded (too aggressive). Arises in central location in lungs. Commonly distant metastases at presentation. Strongest smoking link.

A

Small cell lung cancer

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6
Q

What are the risk factors for carcinoma of the bronchus? (lifestyle, environmental, genetic)

A
  1. Lifestyle - cigarette smoking (90%), passive smoking
  2. Environmental - industrial hazards (asbestos, arsenic, chromium, radiation), air pollution, radon gas in Cornwall.
  3. Genetic factors - EGFR mutations in non-smokers, KRAS mutations in smokers
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7
Q

What is this a presentation of?

Male, persistent cough with weight loss or haemoptysis in a smoker over 50. Some dyspnoea and chest pain.

A

Carcinoma of the bronchus

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8
Q

What is this a presentation of?

Lung cancer, SOB, facial swelling, head fullness, arm swelling, chest pain, dysphagia and stridor.

A

SVC obstruction (cerebral oedema, low cardiac output)

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9
Q

What is this describing?
Cancer in the apex of the lung which manifests as shoulder pain radiating in ulnar distribution down the arm of Horner’s syndrome.

A

Pancoast’s tumour

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10
Q

What are the metastatic effects of lung cancer?

A
  1. Lymphadenopathy
  2. Bone pain and hypercalcaemia, anaemia
  3. Neurological signs
  4. Hepatomegaly
  5. Proximal myopathy, peripheral neuropathy
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11
Q

What is the important paraneoplastic syndrome in squamous cell lung cancer?

A

Hypercalcaemia (PTHrP)

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12
Q

What are the important paraneoplastic syndromes in small cell lung cancer?

A
  1. SIADH - cerebral oedema: clumsiness, tiredness, confusion.
  2. Cushing’s (ectopic ACTH)
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13
Q

What are the complications of lung cancer?

A
  1. Hoarse voice (recurrent laryngeal invasion)
  2. Raised hemidiaphragm (phrenic nerve palsy)
  3. Horner’s syndrome (ptosis, miosis, facial anhidrosis)
  4. Lambert-Eaton syndrome (proximal limb weakness)
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14
Q

How is a suspected lung cancer investigated?

A
  1. CXR - nodules, hilar enlargement, consolidation, collapse, effusion.
  2. Sputum cytology
  3. CT CAP - smokers with worrying CXR signs, stage and guide bronchoscopy.
  4. Bronchoscope for central lesions
  5. FNA - peripheral lesions and lymph nodes only
  6. MRI/CT brain - brain mets
  7. Bone scan - bone mets
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15
Q

How is lung cancer staged?

A

TNM:
T with CT
N and M with PET-CT 1st line

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16
Q

What is the management for limited small cell lung cancer?

A

Chemotherapy and radiotherapy concurrently.

17
Q

What is the management for extensive small cell lung cancer?

A

Chemotherapy (relapses), radiotherapy to palliate (refer to palliative care), surgical intervention not of much use as people present late.

18
Q

What is the management for non-small cell lung cancer?

A
  1. Excision for small, peripheral tumours with no metastatic spread.
  2. Initially - lobectomy with curative intent
  3. Pre-op chemotherapy, post-op radiotherapy and chemo in higher stage patients.
  4. Stand-alone chemo and radiotherapy in more advanced patients.
19
Q

What is the prognosis for small cell lung cancer?

A
  1. Limited - 12-24% 5-year survival

2. Extensive - 1-5% 5-year survival

20
Q

What is the prognosis for non-small cell lung cancer?

A

Depends on staging, from 67% 5-year survival to 1%

21
Q

What is this describing?
A malignant tumour of the pleura associated with asbestos exposure. Latent period between exposure and development of condition may be up to 45 years.

A

Mesothelioma

22
Q

What is this a presentation of?

Male, >60 years old, breathlessness, chest pain, pleural effusion, asbestos exposure.

A

Mesothelioma

23
Q

How is mesothelioma managed?

A
  1. CXR/CT
  2. Diagnosis on cystological examination of pleural fluid or on histology of a pleural biopsy.
  3. Manage using chemotherapy
24
Q

What is asbestosis?

A

Diffuse fibrosis of the lung parenchyma caused by high levels of asbestos exposure.

Medicine: Respiratory (29 decks)

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