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Flashcards in Cancer Deck (104):
1

What are paraneoplastic factors?

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

2

What can lung cancer present as?

Primary tumour, local invasion, metastases, paraneoplastic factors

3

What are symptoms of lung cancer?

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

4

What is bronchial mucosa lined with?

Ciliated epithelium

5

What does lung cancer cause in terms of histology?

Reddened mucosa

6

What often happens to a lung as the cancer progresses?

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

7

What is stridor?

Difficulty breathing in and an inspiratory wheeze

8

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

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

9

What does invasion in the pericardium cause?

Breathlessness, AF, pericardial effusion

10

What does invasion in the oesophagus cause?

Dysphagia

11

What is a Pancoast tumour?

A tumour at the apex of the lungs

12

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

Brachial plexus

13

What does invasion of the brachial plexus present as?

Weakness in the hand due to T1 root infiltration

14

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

When the tumour invades the pleural space- presents with breathlessness

15

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

Invasion of the SVC abstructing drainage from head/arms

16

What does bone erosion present as?

Pain which is worse at night

17

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

Sudden death with massive haemoptysis

18

What are common sites for metastases for lung cancer?

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

19

What are signs of cerebral metastases?

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

20

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

High dose corticosteroids

21

What can liver metastases present as?

Pain, and sometimes jaundice

22

What will bone metastases show on a CXR?

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

23

What will bone metastases present as?

Localised pain worse at night, pathological fracture

24

What must happen if new finger clubbing is found?

CXR

25

What are paraneoplastic factors of lung cancer?

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

26

What do paraneoplastic factors result fro?

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

27

What is the cause of hypercalcaemia?

Tumour producing a substance which mimics the parathyroid hormone

28

What are symptoms of a tumour mimicking parathyroid hormone?

Headaches, thirst, confusion, constipation

29

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

Substance mimics ADH- main symptom is confusion

30

What are symptoms of HPO?

Pain/tenderness in long bones near joints

31

What does thrombophlebitis present as?

Painful cord like structure

32

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

Chronic bronchitis

33

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

Like they need to cough something up but it never comes

34

What are causes of breathlessness in terms of lung cancer?

Pleural effusion, PE, pericardial invasion

35

What does localised chest wall pain usually suggest?

Tumour invading the chest wall

36

What investigations do you do for lung cancer?

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

37

What test do you not do in suspected lung cancer?

Sputum cytology

38

What are differentials of lung cancer?

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

39

What are ways to make a diagnosis from tissue?

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

40

What are risk factors for lung cancer?

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

41

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

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

42

What are systemic effects of lung cancer?

Weight loss and 'ectopic' hormone production

43

What hormone do squamous carcinomas release?

Parathyroid hormone

44

What hormone does small cell cancer release?

Adrenocorticotropic hormone (stimulates cortisol release from adrenal glands)

45

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

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

46

What are non-smoking associated tumours?

Neuroendocrine tumours or bronchial gland tumours

47

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

Bronchoscopy and biopsy

48

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

Needle aspiration or biopsy of metastases

49

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

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

50

How is small cell cancer treated?

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

51

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

Surgery if there has been no metastases

52

What type of lung cancer expresses thyroid transcription factor 1?

Adenocarcinoma

53

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

Small cell carcinomas

54

What type of cancer are mutations almost exclusively seen in?

Adenocarcinomas

55

What do adenocarcinomas involving mutations respond to?

Tyrosine kinase inhibitors

56

What are the different types of primary bronchial epithelium?

Mucous, ciliated, neuroendocrine, reserve

57

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

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

58

What is the pathological transformation of bronchial tumours?

Squamous metaplasia, dysplasia, carcinoma in situ, invasive malignancy

59

What is the pathological transformation of peripheral adenocarcinomas?

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

60

What are carcinoid lung neoplasms?

Neuroendocrine neoplasms of low grade malignancies

61

What are bronchial gland neoplasms?

Adenoid cystic carcinomas, mucoepidermoid carcinomas

62

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

Mesothelioma

63

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

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

64

What often goes along with chemotherapy for SCC?

Radiation

65

What are treatment options for NSCC?

Surgery or radical radiotherapy

66

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

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

67

What is a big risk of surgery for lung cancer?

The cancer may return later in life

68

When will a tumour be impossible to remove?

Within 2cm of the carina

69

What are surgery options for lung cancer?

Pneumonectomy or lobectomy via thoracotomy or keyhole surgery

70

What is the disadvantage of a thoracotomy?

Long recovery time

71

Why is performance status measured before chemotherapy?

A patient has to be fairly fir to undergo it

72

What is the purpose of chemotherapy in lung cancer?

Rarely curative but gives longer survival

73

What do side effects of chemotherapy include?

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

74

Where does radiation often cause collateral damage to?

Spinal cord, oesophagus, surrounding lung tissue

75

What does visceral pleura cover and form?

Covers the lungs and forms the inter-lobular fissures

76

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

Lower

77

Where is there no pleura?

At the hilum

78

What cancers metastasise to the pleura?

Virtually all

79

What type of pleural effusions should always raise alarms?

Large unilateral ones

80

What tests do you do to diagnose a pleural malignancy?

CXR, pleural aspirate, biochemistry, cytology, culture

81

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

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

82

What can small bilateral pleural effusions be due to?

Heart failure or PE

83

What does a straw coloured effusion suggest?

Cardiac failure

84

What does a bloody pleural effusion suggest?

Trauma, malignancy, infection, infarction

85

What does a milky/foul smelling effusion suggest?

Infection

86

What do food particles in an effusion suggest?

Ruptured oesophagus

87

What does a bilateral effusion suggest?

LVF, PE, drugs

88

What is a transudate effusion?

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

89

What is a exudate effusion?

High protein, always look for serous pathology

90

What is mesothelioma?

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

91

How long does it take for mesothelioma to develop?

Often 30-40 years

92

How do you treat mesothelioma?

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

93

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

Adenocarcinoma

94

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

Hoarseness

95

What is the result when adenocarcinoma suppresses the sympathetic chain?

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

96

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

Pancoast tumours causing sympathetic chain disruption

97

What is a Pancoast tumour?

A tumour at the apex of the lungs

98

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

ADH

99

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

Hypercalcaemia, osteoporosis

100

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

Increased water reabsorption so increased serum osmolarity and decreased urine osmolarity

101

What will adenocarcinomas cause in non-smokers?

Mucous secretion

102

Which investigation would you do to look for bone metastases?

PET scan

103

What test do you use to stage cancer?

CT scan

104

What scan is used to detect osteoporosis?

DEXA bone scan