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Respiratory > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

is a lung cancer more likely to be benign or malignant

A

malignant

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2
Q

what percentage of smokers die of lung cancer

A

20%

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3
Q

what are the risk factors for lung cancer

A

smoking, asbestos, nickel, chromates, radiation, atmosphere pollution

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4
Q

what are the local effects of a pulmonary neoplasia (3)

A

obstruction of airway (pneumonia), invasion of chest wall (pain), ulceration (haemoptysis)

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5
Q

what are the systemic effects of lung cancer

A

weight loss, eptopic hormone production

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6
Q

what hormone is produced in squamous cancer

A

parathyroid hormone (PTH)

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7
Q

what hormone is produced in small cell cancer

A

adrenocorticotropic hormone (ACTH)

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8
Q

what are the four most common smoking associated lung tumour classifications

A

adenocarcinoma, squamous carcinoma, small cell carcinoma, large cell carcinoma

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9
Q

what are the types of lung tumour less associated with smoking

A

neuroendocrine, bronchial gland

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10
Q

what is a squamous cell carcinoma definitely caused by

A

smoking

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11
Q

what type of lung cancer is most common in non smokers

A

adenocarcinoma

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12
Q

what methods are used to diagnose a tumour histologically

A

bronchoscopy and biopsy

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13
Q

why is classification of tumours important

A

for prognosis, treatment, pathogenesis/ biology, epidemiology

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14
Q

what is the type of lung cancer with the quickest mortality rate

A

small cell

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15
Q

which is worst; large cell, squamous or adenocarcinoma

A

large cell

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16
Q

what is the simplest classification of lung cancer

A

small cell lung cancer (SCLC) vs non (NSCLC)

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17
Q

how is lung cancer treated

A

surgical intervention, chemotherapy, new targeted treatments based on DNA

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18
Q

how can immunohistochemistry help distinguish between types of tumours

A

adenocarcinoma expresses thyroid factor 1, scc expresses nuclear antigen p63 + have high molecular weight

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19
Q

what mutation is seen exclusively in adencarcinoma

A

point mutations that render the EGFR gene active in the absence of a ligand

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20
Q

what do mutations with a EGFR gene mutation respond to

A

tyrosine kinase inhibitors

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21
Q

how can targeting the immune response be used in treat NSCLC

A

as it enhances the immune’s tumour killing response

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22
Q

list the two types of pulmonary epithelium from which carcinomas can arise and gives examples of each

A

bronchial (ciliated, mucous, neuroendocrine, reserve)

bronchioles/alveoli (clara cells, type 1 and 2 alveolar lining cells)

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23
Q

name the 4 bronchial (large airway) tumours

A

squamous metaplasia, dysplasia, carinoma in situ, invasive malignancy

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24
Q

what would you call the spread of neoplastic cells along alveolar walls

A

bronchioloalveolar carcinoma

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25
Q

what are the two prognosis indicators in lung cancer

A

tumour stage, tumour histological subtype

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26
Q

what is a primary malignant neoplasm called

A

mesothelioma

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27
Q

what type of tumours don’t tend to spread

A

carcinoid

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28
Q

what is cancer

A

uncontrolled growth of tumour cells

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29
Q

how can cancer spread

A

blood, lymph, serous cavities

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30
Q

what are paraneoplastic effects

A

systemic effect from biologically active molecules released from the tumour cell that mimic the effects of naturally occurring hormones

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31
Q

why does lung disease have such a poor prognosis

A

as symptoms don’t tend to develop until disease has reached an incurable stage

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32
Q

how is lung cancer presented

A

primary tumour, local invasion, metastases, non-metastatic (paraneoplastic)

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33
Q

what is haemoptysis

A

coughing up blood- tumour creates own fragile and leaky blood supply

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34
Q

why does a lung become smaller as a tumour grows

A

as the proximal divisions of the bronchial tree get obstructed and the lung tissue shrinks

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35
Q

what are the early symptoms of lung cancer (8)

A

haeoptysis, cough for more than 3 weeks, breathlessness, recurrent pneumonia/ chest infection that doenst clear up, weight loss, chest/ shoulder pains, tiredness, hoarse voice

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36
Q

what is stirdor

A

harsh inspiratory wheeze

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37
Q

what are the neighbouring structures that can be affected by local invasion (6)

A

recurrent laryngeal nerve, pericardium, oesophagus, brachial plexus, pleural cavity, superior vena cava

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38
Q

what causes a hoarse voice

A

paralysis of the vocal chords by invasion of the recurrent laryngeal nerve

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39
Q

what does local invasion of the pericardium cause

A

breathlessness, atrial fibrillation, pericardial effusion- fluid build up around heart, squashing it

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40
Q

what does invasion of the oesophagus cause

A

dysphagia- difficulty swallowing

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41
Q

what can muscle wasting of the hand be cause by

A

local invasion of the brachial plexus

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42
Q

what does pancoast mean

A

high up in lung

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43
Q

what is a pleural effusion

A

build up of fluid around lung

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44
Q

what is anasamoses

A

when the blood supply has to find an alternative route due to a blockage- invasion of the s.v.c

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45
Q

where are the common sites for primary lung cancer metastases (6)

A

liver, brain, bone, adrenal, skin, lung

46
Q

what is the clinical presentation of a cerebral metastases

A

insidious onset- weakness (mimics stroke), visual disturbance, fits (epileptic when involves cortex) , headaches (raised intracranial pressure)

47
Q

what are presentations of a bone metastases

A

pain, clinical fracture

48
Q

what are presentations of a liver metastases

A

pain, in rare cases jaundice

49
Q

what symptoms does adrenal metastases produce

A

usually none

50
Q

what can metastatic deposits help identify

A

the original source

51
Q

what are the non-metastatic symptoms of lungs cancer (paraneoplastic) (7)

A

finger clubbing, weight loss, thrombophlebitis, hypercalcaemia, hyponatraemia, weakness, hypertrophic pulmonary osteoarthropathy- HPOA

52
Q

what can spinal metastases cause

A

paralysis

53
Q

what is hyperthrophic pulmonary osteoarthropathy

A

pain caused by elevation of the periosteum from bone surface

54
Q

why does thrombophlebitis occur in cancer patients

A

increased coagulability

55
Q

hypercalcaemia;

stones

A

renal/biliary calculi

56
Q

hypercalcaemia;

bones

A

bone pain

57
Q

hypercalcaemia;

groans

A

abdominal pain/ constipation

58
Q

hypercalcaemia;

thrones

A

polyuria

59
Q

hypercalcaemia;

psychiatric overtones

A

anxiety, depression, coma

60
Q

what type of cancer usually causes hypercalcaemia

A

squamous

61
Q

how is hypercalcaemia treated

A

hydration, if severe iv bisphophonate

62
Q

what is a cause of the weight loss associated with lung cancer

A

COPD/ pulmonary fibrosis

63
Q

what is SIADH

A

syndrome of inappropriate antidiuretic hormone

64
Q

what is hypercalcaemia caused by

A

hormones released by tumour

65
Q

what type of cancer usually causes SIADH

A

small cell

66
Q

what does SIADH

A

low sodium conc, generalised symptoms (nausea, seizures etc)

67
Q

how id SIADH treated

A

treat cancer, fluid restriction

68
Q

what investigations are used to diagnose lung cancer

A

full blood count, spirometry, chest x ray, ct scan of thorax, bronchoscopy, endobronchial ultasound, coagulation screen, PET

69
Q

what investigation is not used to diagnose lung cancer

A

sputum cytology

70
Q

what is a PET and what does it do

A

positron emission tomography- assesses function rather than structure via tissue uptake of radiolabelled glucose

71
Q

what are the most common methods of making a tissue diagnosis (6)

A

bronchoscopy, CT guided biopsy, lymph node aspirate, aspiration of pleural fluid, endobonchial ultrasound, thoracoscopy

72
Q

what is a commonly misdiagnosed for lung cancer

A

tuberculosis

73
Q

what is another fusion oncogene that identifies a target for specific drug treatment

A

EML4-ALK

74
Q

how can a cancer be staged for surgery

A

bronchoscopy, CT scan of brain and thorax, PET scan, mediastinoscopy/EBUS

75
Q

describe small cell cancer

A

rapidly progressive, early metastases

76
Q

how does small cell cancer respond to treatment

A

rarely suitable for surgery, good initial response to chemotherapy

77
Q

describe how non small cell lung cancer (squamous and adeno carcinomas) are treated

A

curative options- surgery or radical radiology

palliative chemotherapies and new targeted treatment

78
Q

what does PET stand for

A

positron emission tomography

79
Q

outline the treatment for lung cancer after diagnosis

A

surgery, radiotherapy, chemotherapy, supportive care, palliative care

80
Q

name two types of small cell cancer

A

squamous and andeno carcinoma

81
Q

what needs to be considered before surgery

A

can it be removed, is it localised, will the patient survive, what will be the residual lung function

82
Q

when is a pneumonectomy possible

A

when there is 2cm of disease free bronchus to close the hole

83
Q

what is a pneumonectomy

A

removal of entire lung

84
Q

what is a lobectomy

A

removal of a lobe

85
Q

what is a thoracotomy

A

surgery to open chest

86
Q

what is a VATS

A

video assisted thoracic surgery

87
Q

what is the choice of chemotherapy drugs determined by

A

the cell type

88
Q

describe staging for chemotherapy (3)

A

bronchoscopy/ tissue sampling (determines small cell/non), CT scan (tumour size, local invasion, nodes, metastases, performance status/ ECOG score (fit to cope with stress)

89
Q

is cytotoxic chemotherapy curative

A

rarely, but longer survival

90
Q

what type of cancer responds best

A

small cell

91
Q

what is the biggest con of cytotoxic chemotherapy

A

major side effects

92
Q

describe how cytotoxic chemotherapy is administered and what it entails

A

IV infusions every 3-4 weeks, outpatient visits

93
Q

what does cytotoxic chemotherapy target

A

whole body- targets rapidly dividing cells

94
Q

can cytotoxic chemotherapy pass the blood brain barrier

A

yes

95
Q

what are the side effects of chemotherapy

A

nausea and vomiting, tiredness, bone marrow suppression (opportunistic infection and anaemia), hair loss, pulmonary fibrosis

96
Q

what do new lung cancer treatments target

A

genetic mutations

97
Q

describe radiotherapy (4)

A

ionising radiation- usully x rays, damage dividing cells
Radical- curative intent
palliative- useful for metastases, delaying
well tolerated

98
Q

what is the collateral damage of radiotherapy

A

spinal chord, oesophagus (oesophagitis), adjacent lung tissue

99
Q

what are two other cons of radiotherapy

A

maximum cumulative dose, only goes where its pointed- not god for sub clinical metastases

100
Q

what is SABR

A

stereotactic ablative radiotherapy

101
Q

compare SABR to normal radiotherapy

A

many more beams- each less powerful

102
Q

what is the benefits of SABR

A

less collateral damage, total dose delivers to tumour higher- more effective

103
Q

what is required for SABR

A

4D scanning

104
Q

what are endobronchial therapies used to do

A

remove blockages and help with symptoms

105
Q

how are endobronchial therapies completed?

A

with a bronchoscopy

106
Q

name three palliative endobronchial therapies

A

stent insertion for stridor, photodynamic therapy, other laser therapy

107
Q

what is co morbidity

A

presence of one or more diseases/disorders co-occurring with the primary disease

108
Q

what determines lung cancer treatment

A

cell type, extent of the disease, co-morbidity, patients wishes

109
Q

what is common co-morbidity in lung disease

A

smoking related diseases’ COPD, ischemic heart disease, peripheral vascular disease

110
Q

what are 5 priorities in palliative care

A

pain, breathlessness. cough, anxiety, poor mobility

111
Q

what is the average prognosis for lung cancer

A

half dead in 6 months, 1 in 20 survive for 5 years

112
Q

apart from smoking what can cause lung cancer

A

asbestos and radon

Respiratory (26 decks)

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