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Respiratory and Cardio > Intrathoracic malignancy > Flashcards

Intrathoracic malignancy Flashcards

1
Q

Primary intrathoracic malignancies can be in the:

A

Lungs

Pleura

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2
Q

leading cause of cancer mortality in men and women =

A

Carcinoma of the lung

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3
Q

90% of carcinoma of the lung cases are caused by:

A

Smoking

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4
Q

Smoking risk increases with

A

Duration

Number per day

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5
Q

Risk with smoking declines following

A

Cessation

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6
Q

Carcinogenic substances can act:

A

Directly

Indirectly

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7
Q

Indirect effects of carcinogens =

A

Chronic inflammation
Hyperplasia
Metaplasia

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8
Q

Lung specific and most potent carcinogens in cigarettes:

A

Tobacco specific nitrosamides
Polycyclic aromatic hydrocarbons
Polonium 210

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9
Q

Carcinogenic metal =

A

Arsenic
Nickel
Cadmium
Chromium

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10
Q

Irritants can cause cancer by

A

Increasing cell turn over, cell more susceptible to mutation

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11
Q

Ex of irritant

A

Formaldehyde

Nitrogen dioxide

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12
Q

Causes of lung cancer:

A 
Smoking
Occupational exposure
Enviornmental radon
Air pollution
Chronic lung disease
FHx
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13
Q

Radon =

A

Radioactive gas found in soil and rocks

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14
Q

Chronic lung diseases which are a RF for lung cancer:

A

Pulmonary fibrosis
COPD
Tuberculosis

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15
Q

Smoking can interact with other RFs in what manners?

A

Additive

Synergistic

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16
Q

Driver mutations =

A

Mutations essential for tumour cell survival

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17
Q

Common driver mutations for adenocarcinoma:

A

Non-smokers: EGFR, ALK, RET, ROS1

Smokers = KRAS, BRAD

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18
Q

Drug for EGFR mutations

A

Tyrosine kinase inhibitors

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19
Q

Suffix of tyrosine kinase inhibitors =

A

-inib

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20
Q

Drug for ALK mutations

A

ALK inhibitors

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21
Q

Driver mutations of squamous cell carcinoma =

A

LOH
SOX2 amplification
TP53 inactivation
LOH

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22
Q

LOH =

A

Loss of heteogenicity

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23
Q

SOX2 =

A

Oncogene

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24
Q

Driver mutations of small cell carcinoma =

A

Inactivation of p53 and RB1

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25
Rb1 sequesters
EF2
26
What is a hallmark of small-cell lung cancers?
Rb1 mutation
27
Symptoms of lung cancer:
``` SOB Cough Weight loss Pain Hoarseness Increased sputum Haemoptysis Paraneoplastic ```
28
Locally, a lung cancer can effect what structures?
``` Airway Oesophagus Pleura Nerves: phrenic, recurrent laryngeal Chest wall SVC Sympathetic ganglia Heart ```
29
Effects of airway obstruction =
Pneumonia Lobar collapse Abscess
30
Effects of tumour spread to pleura =
Pleural effusion
31
Effects of invasion of recurrent laryngeal nerve =
Hoarseness
32
Effects of oesophageal invasion
Dysphagia
33
Effects of phrenic nerve invasion
Diaphragm paralysis
34
Effects of chest wall invasion
Rib destruction
35
SVC syndrome causes =
Facial oedema, arm oedema, flushed face
36
Evasion of synpathetic ganglia can cause =
Horner syndrome
37
What kind of tumor causes horner syndrome?
Pancoast tumor
38
Symptoms of horner syndrome =
Ptosis Miosis Anhydrosis
39
Effects of pericardial involvement:
Pericarditis | Tamponade
40
Pancoast tumors start at the
hilum
41
What can a pancoast tumor invade?
``` Top ribs Brachicephalic vein Subclavian artery Phrenic nerve Recurrent laryngeal nerve Vagus nerve Sympathetic ganglion ```
42
Metastatic spread can be via:
Direct Lymphatic Haemotagenous
43
What can a tumour cause (hint = hormones)
Paraneoplastic syndromes
44
Examples of paraneoplastic syndromes:
``` ADH = hyponatraemia ACTH = cushings PTH = hypercalcemia Calcitonin = hypocalcaemia Gonadotropins = gynaecomastia ```
45
Lambert-eaton myasethenic syndrome =
Auto-antibodies against neuronal calcium channels. Similar symptoms to myasthenia gravis
46
Systemic effects of lung carcinoma =
``` Metastatic spead Paraneoplastic syndromes Lamber-easton Peripheral sensory neuropathy Derm ```
47
Hypertrophic pulmonary osteoarthropathy =
Finger clubbing
48
Diagnosis of lung cancer is done via:
Imaging techniques = CXR, CT, MRI Bronchoscopy Sputum, bronchal brushing Biopsy
49
Main histological types of epithelial tumours =
Non-small cell | Small call
50
Most common type of lung cancer
Non-small cell/adenocarcinoma
51
Types of non-small cell carcinoma =
Adenocarcinoma Squamous cell carcinoma Large cell carcinoma
52
Adenocarcinomas are from
Glandular structures | Generate mucins
53
Squamous cell carcinomas are from
Square-shaped cells | Produce keratin
54
Large cell carcinomas lack
Glandular or squamous differentiation
55
Small cell carcinomas are from
Small, immature neuroendocrine cells
56
Which type grows and metastasises quickest?
Small cell carcinomas
57
Normal respiratory tract-type epithelium
Pseudostratified Columnar Ciliated
58
Pre-invasive lesion of adenocarcinoma =
Atypical adenomatous hyperplasia
59
What will be seen on staining of adenocarcinoma?
Abnormal acinar, glandular or papillary structures | Mucin production
60
What may be seen on cytology of squamous cell carcinoma
Exfoliated cells in sputum, broncial washing and brushing
61
What will be seen on staining of squamous cell carcinoma?
Excessive growth of abnormal squamous cells | Intercellular bridges and keratinisation
62
What will be seen on staining of small cell lung cancer?
``` Small Round Blue Hyperchromic nuclei, scanty cytoplasm High mitotic count Neuroendocrine differentiation = ribbons, rosettes, pseudorosettes ```
63
Types of treatments for lung cancer:
``` Surgery - lobectomy, pneumectomy Chemo Radio Targeted Immuno ```
64
Staging lung cancer is done via what scale?
TNM
65
If a cancer has metastasised, what stage is it automatically?
IV
66
Treatment of adeno/squamous in early TNM stages
Surgery | Radical radio
67
Treatment of adeno/squamous in late TNM
Palliative chemo and radio
68
KRAS mutation is found in what kind of cancers
Colorectal Pancreatice Adenocarcinoma
69
Treatment of limited SCC
Radical chemo and radio
70
Treatment of extensive SCC
Palliative chemo and radio
71
2 types of 'new' therapies =
Targeted | Immunotherapy
72
Targeted drugs are for which mutations in which kind of cancer?
Adenocarcinoma/non-small cell - EGFR - ALK - ROS1
73
Immunotherpay is used for which kind of cancer?
Non small cell
74
Immunotherapy =
PD-1 and PDL-1 inhibitors - stop tumor killing T cells
75
PD-1 is found on
Activated T cells
76
PD-L1 is found on
Tumor cells
77
Suffix of immunotherpay
-umab
78
Crizotinib =
Inhibits ALK
79
Erlotinib =
Tyrosine kinase inhibitors
80
Prembrolizumab =
PD-1, PDL-1 inhibitor
81
Cancer of pleura =
Malignant mesothelioma
82
>90% of cases of malignant mesothelioma is due to:
Asbestos exposure
83
Asbestos exposure can be:
Direct Indirect Neighbourhood Ambient
84
Most potent type of asbestos =
Blue/crocidolite
85
Asbestosis is
Diffuse interstitial fibrosis
86
Pleurodesis =
Sclerosis agent into cavity, adheres lung to chest wall - prevents pneumothoarx or pleural effusion

Respiratory and Cardio (14 decks)

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