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Resp JL > Bronchial Carcinoma > Flashcards

Bronchial Carcinoma Flashcards

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1
Q

What can recurrent episodes of pneumonia in the same lobe of the lung be a sign of?

A

Primary lung cancer

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2
Q

What happens to the affected lung in lung cancer over time?

A

It loses volume and gets smaller as the cancer grows

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3
Q

When looking at a lung cancer chest x-ray, which lung big or small, is likely to be the diseased one?

A

Small

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4
Q

What is stridor usually accompained by?

A

A course aurdible wheeze during inspiration

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5
Q

Name 6 anatomical places where local invastion of a cancer can occur?

A
  1. Recurrent laryngeal nerve
  2. Pericardium
  3. Oesophagus
  4. Bronchial plexus
  5. Pleural cavity
  6. Superior vena cava
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6
Q

What is a clinical feature of recurrent laryngeal nerve palsy?

A

Hoarse voice

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7
Q

What aspect of lung cancer can lead to atrial fibrilation?

A

Local invasion of the pericardium, accompanied by pericardial effusion

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8
Q

What clinical feature is a pointer for a tumour in the oesophagus?

A

Dysphagia

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9
Q

What is wasting of the small muscles in the hand due to?

A

T1 root infiltration by a primary lung cancer in the apex of the lung

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10
Q

What is a pancoast tumour and what can its local invasoin be?

A

Tumour of the pulmonary apex - brachial plexus invasion

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11
Q

What clinical sign occurs when the primary tumour invades the pleural space?

A

Pleural effusion

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12
Q

What can a symptom of pleural effusion be?

A

Breathlessness

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13
Q

What does local invasion of the SVC obstruct?

A

Drainage of blood from arms and head

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14
Q

What clinical features can local invasion of the SVC obstrucing drainage of blood from arms and head cause?

A

Puffy eyelids and headache

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15
Q

What could distended veins visible on the abdomen and thorax mean?

A

Blood flow is bypassing the obstructed SVC by opening up anastomoses with the IVC tributeries

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16
Q

What invasion can be described by localised chest wall pain, worse with movement and pain which is worse at night?

A

Chest wall invasion by lung cancer

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17
Q

What are 6 common sites for metastases from primary lung cancer?

A
  1. Liver
  2. Brain
  3. Bone
  4. Adrenal
  5. Skin
  6. Lung
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18
Q

What metastases has insidious onset, can lead to weakness, visual disturbance, headaches and is worse in the morning, not photophobic?

A

Cerebral metastases

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19
Q

What is the headache due to in cerebral metastases?

A

Increased intracranial pressure

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20
Q

If a cerebral metastases involves the cortex, what could the presenting feature be?

A

Epileptic fit

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21
Q

With liver metastases - what can be said about the LFVTs?

A

Abnormal, particularly alkaline phophatase

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22
Q

What are two clinical features of bone metastases?

A
  1. Localised pain which is worse at night

2. Pathalogical fracture - bone may fracture follwoin a trivial mechanical stress

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23
Q

What investigation can be used to investigate bone metastases?

A

Isotope bone scan

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24
Q

What 7 cloinical features are a result of a primary tumour but dont indicate metastatic disease?

A
  1. Finger clubbing
  2. Hypertrophic pulmonary osteoarthropathy (HPOA)
  3. Weight loss
  4. Thrombophlebitis
  5. Hypercalcaemia
  6. Hyponatraemia (SIADH)
  7. Weakness - Eaton Lambert syndrome
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25
Give 4 features of hypercalcaemia?
Headaches Confusion Thirst Constipation
26
What can hypercalcaemia result from?
Tumour producing a substance which mimics the effects of parathyroid hormone
27
What can hyponatraemia result from?
Production of a substance which mimics Anti-Diuretic-Hormone
28
What is the main symptom of Hypoatraemia?
Confusion
29
What does Eaton Lambert Syndrome mimic?
Myaesthenia gravis
30
What clinical feature do these diseases all have in common: liver disease, chronic hepatitis C, congenital cyanotic heart disease, bacterial endocarditis, bronchioectasis?
Finger clubbing
31
What clinical featrue can elevation of the periosteum away from bone surface result in?
Symptoms of pain and tenderness of the long bones near the adjacent joints
32
What investigation would you not do for lung cancer?
Sputum cytology
33
What 4 radiological investigations might you do for lung cancer?
CXR CT scan of thorax PET scan Endobronchial ultrasound
34
What is another invasive investigation you might do for lung cancer?
Bronchoscopy
35
What 4 non-invasive tests might you do to investigate lung cancer?
FBC Coagulation screen Na, K, Ca, Alk Phos Spirometry FEV1
36
What are the 4 common ways to make a tissue diagnosis of lung cancer?
1. Bronchoscopy 2. CT guided biopsy 3. Lymph node aspirate 4. Aspiration of pleural fluid
37
What does endobronchial ultrasound enable visualisation of?
Hilar and mediastinal structures
38
Name 6 differential diagnosis other than lung cancer for a patient presenting with Smoking, haemoptysis and abnormal CXR?
1. TB 2. Vasculitis 3. PE 4. Secondary cancer 5. Lymphoma 6. Bronchiectasis
39
Name a clinical feature that is direct consequence of the primary tumour?
Haemoptysis
40
What are smoking, asbestosis, nickel, chromates, radiation, atmospheric pollution and genetics all risk factors for?
Lung cancer
41
Give two examples of ectopic hormone production in lung cancer?
PTH (SQUAMOUS CANCER) | ACTH (SMALL CELL CANCER)
42
Name the 4 common smoking-associated types of lung tumours?
1. Adenocarcinoma (35%) 2. Squamous carcinoma (30%) 3. Small cell carcinoma (25%) 4. Large cell carcinoma (10%)
43
What is the most common lung tumour?
Adenocarcinoma
44
Other than smoking-associated types of tumour, what are the other two classifications?
Neuroendocrine tumours | Bronchial gland tumours
45
What process does squamous carcinoma do?
Keratinising
46
What process does adenocarcinoma do?
Gland forming
47
What is expressed most characteristically in small cell and adenocarcinoma?
TTF-1 (Thyroid Transcription Factor)
48
What is expressed in squamous cell carcinoma?
P63
49
What type of tumour has the worst survivial time?
Small cell
50
What type of cancer tumour, other than small cell, is worse than squamous or adenocarcinoma?
Large cell
51
Which lung tumour type is known to be chemosensitive but with rapidly emerging resistance?
Small cell
52
What is the treatment of choice for lung tumours, other than small cell?
Surgery
53
What is the most simple classification of lung cancer?
Small cell lung cancer | Non-small cell lung cancer
54
In small cell lung cancer, name the potential oncogene therapeutic target?
myc
55
In small cell lung cancer, name the three potential tumour suppressor genes for therapeutic targeting?
p53 Rb 3p
56
In non-small cell lung cancer, name the 3 oncogene potential therapeutic targets?
myc K-ras EGFR
57
In non-small cell lung cancer, name the 6 potential therapeutic targets (tumour suppressor genes)?
``` p53 1q 3p 9p 11p Rb ```
58
Most adenocarcinomas are smoking related and often show what?
K-ras mutation + wild-type EGFR
59
Name a tyrosine kinase inhibitor which shows activity in some NSCLC patients?
Gefitinib
60
What type of tumours are sensitive?
Adenocarcinomas
61
Tumours with what present are the only ones that respond?
Epidermal growth factor receptor (EGFR)
62
What is essential to do before prescribing treatment for lung cancer?
Molecular testing of tumour tissue
63
What are 4 features of bronchial (large airway) tumours?
1. Squamous metaplasia 2. Dysplasia 3. Carcinoma in situ 4. Invasive malignancy
64
What two features do peripheral adenocarcinomas have?
1. Atypical adenomatous hyperplasia | 2. Spread of neoplastic cells along alveolar walls (bronchioloalveolar carcinoma)
65
What are two prognostic indicators in lung cancer?
Tumour stage | Tumour histological subtype
66
What are carcinoid lung neoplasms?
Neuroendocrine neoplasms of low grade malignancy
67
Where are bronchial gland neoplasms often seen?
In salivary glands
68
Name two bronchial gland neoplasms?
Adenoid cystic carcinoma | Mucoepidermoid carcinoma
69
What is the median survival for lung cancer?
5.8 months
70
What type of lung cancer is a rapidly progressive disease, early metastases and is rarely suitable for surgery but has a good initial response to chemotherapy?
Small cell
71
What two types of tumours are included in the non-small cell catagory?
Squamous and adenocarcinomas
72
What type of lung cancer is sometimes cured by surgery or radical radiotherapy, and less responsive to chemotherapy - as well as accounting for the majority of lung cancer?
Non-small cell
73
What is the median survival for non-small cell cancer?
7.7 months
74
What is the median survivial for small cell cancer?
5.9 months
75
What are the 4 treatment choices for lung cancer?
Surgery Rdiotherapy Chemotherapy Palliative care
76
When staging for surgery, what 3 things is the surgeon looking for with bronchoscopy?
1. Vocal cord palsy 2. Proximety to carina 3. Cell type
77
When staging for surgery - what is the surgeon looking for with a mediastinoscopy?
Lymph nodes
78
When staging for surgery, what is the surgeon looking for with a CT scan of the brain?
Metastases
79
When staging for surgery, what is the surgeon looking for with a CT scan of thorax?
Tumour size Lymph nodes Metastases Local invasion
80
What are the two types of surgery for lung cancer?
Pneumonectomy or lobectomy
81
What does cytotoxic chemotherapy have a better response in?
Small cell lung cancer
82
How often are IV infusions needed when performing cytotoxic chemotherapy?
3-4 weeks
83
What are 4 side effects of chemotherapy?
``` Nausea and vomiting Tiredness Bone marrow suppression - opportunistic infection, anaemia Hair loss Pulmonary fibrosis ```
84
What kind of therapy involves ionising radiation?
Radiotherapy
85
What are 3 disadvangtages relating to radiotherapy?
1. Maximum cumulative dose 2. Collateral damage - spinal cord, oesophagus, adjacent lung tissue 3. Only goes where you put the beam
86
Name 4 endobronchial palliative therapies?
1. Stend insertion for stridor 2. Photodynamic therapy 3. Other laser therapy 4. Radioactive pellets

Resp JL (27 decks)

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