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Respiratory > Cancer > Flashcards

Cancer Flashcards

1
Q

What are paraneoplastic factors?

A

Systemic effects from biologically active molecules released from the tumour cells which mimic the effect of naturally released hormones

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2
Q

What can lung cancer present as?

A

Primary tumour, local invasion, metastases, paraneoplastic factors

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3
Q

What are symptoms of lung cancer?

A

Cough for > 3 weeks, breathlessness for no reason, hoarseness, weight loss, haemoptysis, not clearing/recurrent chest infections, chest/shoulder pain, tiredness

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4
Q

What is bronchial mucosa lined with?

A

Ciliated epithelium

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5
Q

What does lung cancer cause in terms of histology?

A

Reddened mucosa

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6
Q

What often happens to a lung as the cancer progresses?

A

It will shrink- when looking at a CXR, the smaller lung is usually the affected one

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7
Q

What is stridor?

A

Difficulty breathing in and an inspiratory wheeze

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8
Q

What are examples of other structures the tumour could reach to cause symptoms?

A

Recurrent laryngeal nerve, pericardium, oesophagus, branchial plexus, pleura, SVC

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9
Q

What does invasion in the pericardium cause?

A

Breathlessness, AF, pericardial effusion

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10
Q

What does invasion in the oesophagus cause?

A

Dysphagia

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11
Q

What is a Pancoast tumour?

A

A tumour at the apex of the lungs

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12
Q

What is a common site of invasion in a Pancoast tumour?

A

Brachial plexus

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13
Q

What does invasion of the brachial plexus present as?

A

Weakness in the hand due to T1 root infiltration

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14
Q

When does a pleural effusion occur in lung cancer and what is the symptom of this?

A

When the tumour invades the pleural space- presents with breathlessness

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15
Q

What does an extended jugular vein and puffy eyelids/headache suggest?

A

Invasion of the SVC abstructing drainage from head/arms

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16
Q

What does bone erosion present as?

A

Pain which is worse at night

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17
Q

What can a tumour invading into the pulmonary artery and main bronchus result in?

A

Sudden death with massive haemoptysis

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18
Q

What are common sites for metastases for lung cancer?

A

Bone, skin, liver, adrenal glands, other sites of lung, brain

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19
Q

What are signs of cerebral metastases?

A

Gradual onset weakness, visual disturbance, headaches which are worse in the morning and fits

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20
Q

What is a short term therapy for the symptoms of cerebral metastases?

A

High dose corticosteroids

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21
Q

What can liver metastases present as?

A

Pain, and sometimes jaundice

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22
Q

What will bone metastases show on a CXR?

A

Lytic lesion on x-ray (section out of bone)

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23
Q

What will bone metastases present as?

A

Localised pain worse at night, pathological fracture

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24
Q

What must happen if new finger clubbing is found?

A

CXR

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25
Q

What are paraneoplastic factors of lung cancer?

A

Finger clubbing, hypertrophic pulmonary osteoarthropathy, weight loss, thrombophlebitis, hypercalcaemia, hyponatraemia, weakness

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26
Q

What do paraneoplastic factors result fro?

A

Effects of biochemically active products from the primary tumour- not indicative of metastatic disease

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27
Q

What is the cause of hypercalcaemia?

A

Tumour producing a substance which mimics the parathyroid hormone

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28
Q

What are symptoms of a tumour mimicking parathyroid hormone?

A

Headaches, thirst, confusion, constipation

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29
Q

What does hyponatraemia result from and what is the main symptom of this?

A

Substance mimics ADH- main symptom is confusion

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30
Q

What are symptoms of HPO?

A

Pain/tenderness in long bones near joints

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31
Q

What does thrombophlebitis present as?

A

Painful cord like structure

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32
Q

What is coughing up clear sputum every day generally caused by?

A

Chronic bronchitis

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33
Q

What will a cough caused by lung cancer often feel like?

A

Like they need to cough something up but it never comes

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34
Q

What are causes of breathlessness in terms of lung cancer?

A

Pleural effusion, PE, pericardial invasion

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35
Q

What does localised chest wall pain usually suggest?

A

Tumour invading the chest wall

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36
Q

What investigations do you do for lung cancer?

A

FBC, coagulation screen, spirometry, Us and Es, CXR. CT of thorax, PET scan bronchoscopy, endobronchial US

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37
Q

What test do you not do in suspected lung cancer?

A

Sputum cytology

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38
Q

What are differentials of lung cancer?

A

Lung cancer, TB, vasculitis, PE, secondary cancer, lymphoma, bronchiectasis

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39
Q

What are ways to make a diagnosis from tissue?

A

Bronchoscopy, CT guided biopsy, lymph node aspirate, aspiration of pleural fluid, endobronchial ultrasound, thoracoscopy

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40
Q

What are risk factors for lung cancer?

A

Smoking, asbestos, nickel, chromate, atmospheric pollution, genetics, radiation

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41
Q

What are the local effects of lung cancer and what do these cause?

A

Airway obstruction (pneumonia), invasion of the chest wall (pain) and ulceration (haemoptysis)

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42
Q

What are systemic effects of lung cancer?

A

Weight loss and ‘ectopic’ hormone production

43
Q

What hormone do squamous carcinomas release?

A

Parathyroid hormone

44
Q

What hormone does small cell cancer release?

A

Adrenocorticotropic hormone (stimulates cortisol release from adrenal glands)

45
Q

What are the 4 smoking types of lung cancer from most to lease common?

A

Adenocarcinoma, squamous cell carcinoma, small cell carcinoma, non-small cell carcinoma

46
Q

What are non-smoking associated tumours?

A

Neuroendocrine tumours or bronchial gland tumours

47
Q

If the tumour is seen and accessible, how is it diagnosed?

A

Bronchoscopy and biopsy

48
Q

If the tumour cannot be accessed, how is it diagnosed?

A

Needle aspiration or biopsy of metastases

49
Q

What is the prognosis of lung cancers (worst to best)?

A

Small cell carcinoma, non-small cell carcinoma, squamous/adenocarcinoma

50
Q

How is small cell cancer treated?

A

It responds well to chemotherapy but grows back very quickly so it is ineffective. Treatment is mainly palliative

51
Q

What is the primary treatment for all other lung cancers apart from small cell?

A

Surgery if there has been no metastases

52
Q

What type of lung cancer expresses thyroid transcription factor 1?

A

Adenocarcinoma

53
Q

What type of lung cancer expresses nuclear antigen p63 and high molecular weight cytokeratins?

A

Small cell carcinomas

54
Q

What type of cancer are mutations almost exclusively seen in?

A

Adenocarcinomas

55
Q

What do adenocarcinomas involving mutations respond to?

A

Tyrosine kinase inhibitors

56
Q

What are the different types of primary bronchial epithelium?

A

Mucous, ciliated, neuroendocrine, reserve

57
Q

What are the different type of primary bronchiolar/alveolar epithelium?

A

Clara cells (exocrine), alveolar type 1 and 2 cells

58
Q

What is the pathological transformation of bronchial tumours?

A

Squamous metaplasia, dysplasia, carcinoma in situ, invasive malignancy

59
Q

What is the pathological transformation of peripheral adenocarcinomas?

A

Atypical adenomatous hyperplasia, spread of neoplastic cells along the alveolar walls (bronchioalveolar carcinoma), invasive adenocarcinoma

60
Q

What are carcinoid lung neoplasms?

A

Neuroendocrine neoplasms of low grade malignancies

61
Q

What are bronchial gland neoplasms?

A

Adenoid cystic carcinomas, mucoepidermoid carcinomas

62
Q

What is the only type of primary tumour of the pleura?

A

Mesothelioma

63
Q

After telling a patient a lung cancer diagnosis, what should you do?

A

Make sure they have understood, discuss a treatment plan and inform their GP

64
Q

What often goes along with chemotherapy for SCC?

A

Radiation

65
Q

What are treatment options for NSCC?

A

Surgery or radical radiotherapy

66
Q

What are the factors to consider when thinking about surgery for lung cancer?

A

Can it be cut out? Is it localised? Will the patient tolerate surgery? What will residual lung function be?

67
Q

What is a big risk of surgery for lung cancer?

A

The cancer may return later in life

68
Q

When will a tumour be impossible to remove?

A

Within 2cm of the carina

69
Q

What are surgery options for lung cancer?

A

Pneumonectomy or lobectomy via thoracotomy or keyhole surgery

70
Q

What is the disadvantage of a thoracotomy?

A

Long recovery time

71
Q

Why is performance status measured before chemotherapy?

A

A patient has to be fairly fir to undergo it

72
Q

What is the purpose of chemotherapy in lung cancer?

A

Rarely curative but gives longer survival

73
Q

What do side effects of chemotherapy include?

A

Nausea and vomiting, tiredness, bone marrow suppression, hair loss, pulmonary fibrosis

74
Q

Where does radiation often cause collateral damage to?

A

Spinal cord, oesophagus, surrounding lung tissue

75
Q

What does visceral pleura cover and form?

A

Covers the lungs and forms the inter-lobular fissures

76
Q

Where are the inferior borders of the pleura compared to the lungs?

A

Lower

77
Q

Where is there no pleura?

A

At the hilum

78
Q

What cancers metastasise to the pleura?

A

Virtually all

79
Q

What type of pleural effusions should always raise alarms?

A

Large unilateral ones

80
Q

What tests do you do to diagnose a pleural malignancy?

A

CXR, pleural aspirate, biochemistry, cytology, culture

81
Q

What will a CXR show if there is fluid in the pleura?

A

Trachea will be deviated- to make sure you can make the patient lie on their side to see if the fluid will move

82
Q

What can small bilateral pleural effusions be due to?

A

Heart failure or PE

83
Q

What does a straw coloured effusion suggest?

A

Cardiac failure

84
Q

What does a bloody pleural effusion suggest?

A

Trauma, malignancy, infection, infarction

85
Q

What does a milky/foul smelling effusion suggest?

A

Infection

86
Q

What do food particles in an effusion suggest?

A

Ruptured oesophagus

87
Q

What does a bilateral effusion suggest?

A

LVF, PE, drugs

88
Q

What is a transudate effusion?

A

Not much protein, due to osmotic pressure, does not always have a benign aetiology

89
Q

What is a exudate effusion?

A

High protein, always look for serous pathology

90
Q

What is mesothelioma?

A

Uncommon malignant tumour of the lining of the lungs or occasionally the abdominal cavity

91
Q

How long does it take for mesothelioma to develop?

A

Often 30-40 years

92
Q

How do you treat mesothelioma?

A

Pleurodese effusions, radiotherapy, chemotherapy, palliative care, report death

93
Q

What type of lung cancer can cause compression of nerves and blood vessels?

A

Adenocarcinoma

94
Q

What is the result when adenocarcinoma suppresses the recurrent laryngeal nerve?

A

Hoarseness

95
Q

What is the result when adenocarcinoma suppresses the sympathetic chain?

A

Horner’s syndrome (drooping of eyelids, constricted pupils and flushing of one side of face)

96
Q

What type of tumours is Horner’s syndrome most common in and what is this caused by?

A

Pancoast tumours causing sympathetic chain disruption

97
Q

What is a Pancoast tumour?

A

A tumour at the apex of the lungs

98
Q

As well as adrenocorticotropic hormone, what other hormone can small cell lung cancers produce?

A

ADH

99
Q

What is caused by high parathyroid hormone production in squamous cell carcinomas?

A

Hypercalcaemia, osteoporosis

100
Q

What is caused by increased ADH production in small cell cancer?

A

Increased water reabsorption so increased serum osmolarity and decreased urine osmolarity

101
Q

What will adenocarcinomas cause in non-smokers?

A

Mucous secretion

102
Q

Which investigation would you do to look for bone metastases?

A

PET scan

103
Q

What test do you use to stage cancer?

A

CT scan

104
Q

What scan is used to detect osteoporosis?

A

DEXA bone scan

Respiratory (16 decks)

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