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Respiratory System > Lecture 10.1: Lung Cancer > Flashcards

Lecture 10.1: Lung Cancer Flashcards

(39 cards)

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1
Q

What are some Risk Factors of Lung Cancer? (8)

A
  • Smoking
  • Exposure to secondhand smoke
  • Previous radiation therapy
  • Exposure to radon gas
  • Exposure to asbestos and other carcinogens
  • Inhaled dusts-uranium and silica
  • Others-nickel chromates, coal tar distilleries,
    arsenic
  • Family history of lung cancer/Genetics
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2
Q

Signs and Symptoms of Lung Cancer (8)

A
  • A new cough that doesn’t go away
  • Coughing up blood, even a small amount
  • Shortness of breath
  • Chest pain
  • Hoarseness
  • Losing weight without trying
  • Bone pain
  • Headache
  • Nail Clubbing
  • Wheezing
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3
Q

Clinical Features of Regional Spread of Lung Cancer: Phrenic Nerve Paralysis (Palsy)

A
  • Elevated Hemidiaphragm
  • Breathlessness
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4
Q

Clinical Features of Regional Spread of Lung Cancer: Left Recurrent Laryngeal Nerve Palsy

A
  • Hoarseness/ Weak Voice
  • Eating Difficulties
  • Poor Cough
  • Repeated Chest Infections because of
    aspiration pneumonia
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5
Q

Clinical Features of Regional Spread of Lung Cancer: Sympathetic Chain Involvement

A

Horner’s Syndrome characterised by:
* Constricted pupil (miosis)
* Drooping of the upper eyelid (ptosis)
* Absence of sweating of the face (anhidrosis)
* Sinking of the eyeball into the bony cavity that
protects the eye (enophthalmos)

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6
Q

Clinical Features of Regional Spread of Lung Cancer: Brachial Plexus (Pancoast Tumour)

A
  • Pain in the inner arm and shoulder
  • Swelling in the upper arm
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7
Q

Clinical Features of Regional Spread of Lung Cancer: Compression of Oesophagus (effect)

A

Dysphagia

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8
Q

Clinical Features of Regional Spread of Lung Cancer: Pericardial Involvement (effect)

A

Difficulty Breathing

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9
Q

Clinical Features of Regional Spread of Lung Cancer: Pleural Involvement (effect)

A

Difficulty Breathing

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10
Q

Clinical Features of Regional Spread of Lung Cancer: Chest Wall Invasion (effect)

A

Chest Pain

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11
Q

Clinical Features of Distant Metastasis (7)

A
  • Bone pain secondary to fractures
  • CNS signs and symptoms
  • Seizures (due to brain mets)
  • Personality Changes (due to brain mets)
  • Abdominal Pain
  • Liver capsular pain from liver metastasis and
    elevated LFTs
  • Lymphadenopathy in the neck
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12
Q

What are Paraneoplastic Syndromes?

A

A group of rare disorders that are triggered by an abnormal immune system response to a cancerous tumour

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13
Q

Paraneoplastic Syndromes: Endocrine (3)

A
  • Hypercalcaemia (PTH squamous cell
    carcinoma)
  • Cushing’s syndrome (ectopic ACTH secretion)
  • Inappropriate ADH secretion (small cell
    carcinomas)
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14
Q

Paraneoplastic Syndromes: Haematological (2)

A
  • Anaemia
  • Thrombocytosis
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15
Q

Paraneoplastic Syndromes: Cutaneous (1)

A
  • Dermatomyositis
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16
Q

Paraneoplastic Syndromes: Skeletal (1)

Study These Flashcards
A
  • Finger clubbing (Hypertrophic
    osteoarthopathy)
17
Q

Investigations for Lung Cancer (6)

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A
  • CT Scan
  • Bronchoscopy
  • Biopsy
  • MRI
  • PET CT
  • Isotope Bone scan
18
Q

How do clinicians get lung tissue in a biopsy? (6 Steps)

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A

1) Transbronchial biopsy
2) Trans thoracic CT guided biopsy for peripheral
tumours
3) Fine needle aspirates of lymph nodes
4) EBUS for staging purposes and for initial
diagnosis
5) Pleural tap and Pleural biopsy
6) Mediastinal biopsy

19
Q

Why are tissue samples so important?

Study These Flashcards
A

Sampling allows staging and pathological sub-typing (immunohistochemical and
molecular analysis)

20
Q

What is Cytology?

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A

The analysis of a single cell type, as often found in fluid specimens

21
Q

Where are Cytology samples (for lung cancer) collected from? (5)

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A
  • Sputum
  • Bronchial lavage
  • Fine needle aspirate of lymph nodes
  • EBUS aspirates of lymph nodes
  • Pleural fluid
22
Q

What are the different types of tissue biopsies (for lung cancer)? (3)

Study These Flashcards
A
  • Trans bronchial biopsy
  • Transthoracic biopsy
  • Biopsy of metastasis (lymph nodes, liver or
    bone)
23
Q

Investigations to assess patient suitability for
major resections (2)

Study These Flashcards
A
  • Pulmonary function tests incl. transfer capacity
  • ECHO cardiogram
24
Q

What are Major Resections?

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A

Surgery to remove part or all of a damaged or diseased lung

25
Blood Tests for Lung Cancer (4)
* No specific tests * Sodium * Calcium * Liver function tests * TBC
26
What are the 3 Main Types of Lung Cancer?
* Non-Small Cell Carcinoma (75%) * Small Cell Carcinoma (15-20%) * Unusual tumours e.g. neuroendocrine tumour (5%)
27
What are the subtypes Non-Small Cell Carcinoma and their percentage incidence?
* Squamous cell carcinoma (20-30%) * Adenocarcinoma (30-40%) * Large cell carcinoma (10-15%)
28
Features of Lung Squamous Cell Carcinoma (7)
* Often central tumours * Angulate cells * Eosinophilic cytoplasm * Keratinisation * Intercellular bridges (prickles) * Keratin pearls * Immunocytochemistry (CK 5/6 &p63+)
29
Features of Lung Adenocarcinoma (7)
* Often peripheral * Columnar/cuboidal cells * Form glands (acini) * Papillary structures * May line alveoli (bronchioalveolar carcinoma) * Some produce mucin * Immunocytochemistry [Most TTF-1+ (about 70% of cases)]
30
Features of Lung Small Cell Carcinoma (7)
* “oat cell carcinoma” * Very cellular * Small nuclei * Little cytoplasm * Nuclear moulding * Often necrosis and lots of mitoses * Immunocytochemistry (CD56, Synaptophysin +)
31
Where are Lung Metastasis often found (secondary tumours)? (8)
* Breast * Colon * Endometrial * Melanoma * Sarcoma * Pharyngeal * Prostate * Kidney
32
Why is tissue diagnosis important? (4)
* Benign versus malignant * Is it a primary or secondary tumour * Is it small cell or non small cell carcinoma as treatment is different * Adenocarcinomas can be assessed for specific molecular alterations to guide further treatment
33
Consequences of Spread of Lung Cancer Locally in the Lung? (4)
* Necrosis --> cavitation) * Ulceration (occurs in 50%) --> haemoptysis * Infection --> abscess formation * Bronchial obstruction --> collapse, consolidation
34
Consequences of Spread of Lung Cancer Locally in the Thorax? (5)
* Direct spread or metastasis * Pleural/pericardial effusions * Mediastinal structures --> SVC obstruction, dysphagia * Recurrent laryngeal nerve --> Vocal chord palsy * Phrenic nerve --> Diaphragm palsy
35
Staging of Lung Cancer: T0
No tumours
36
Staging of Lung Cancer: T1
Tumours ≤ 3cm
37
Staging of Lung Cancer: T2 (4)
* 3cm < Tumour ≤ 7cm OR TUMOUR WITH ANY OF FOLLOWING * Tumour that invades visceral pleura * Involves main bronchus ≥ 2cm distal to carina * Atelectasis/obstructive pneumonia extending to hilum but not involving entire lung
38
Staging of Lung Cancer: T3 (6)
* Tumour > 7cm * Or there is more than one tumour in the same lobe of the lung OR CANCER HAS SPREAD INTO: * The chest wall * The outer lining of the chest cavity (the parietal pleura) * The nerve close to the lung (phrenic nerve) * The outer covering of the heart (the pericardium)
39
Staging of Lung Cancer: T4 (8)
Tumour of any size with invasion of: * Heart * Great Vessels * Trachea * Recurrent Laryngeal Nerve * Oesophagus * Vertebral Body * Carina * Separate tumour nodules in a different ipsilateral lobe

Respiratory System (19 decks)

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