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HLB > Lug cancer > Flashcards

Lug cancer Flashcards

1
Q

What are some examples of benign tumors in the lungs?

A

Hamartoma
Arteriovenous malformations (AVMs)
Granuloma

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2
Q

What are the two main categories of tumors in the lungs?

A

Benign tumors
Malignant tumors

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3
Q

What are some examples of malignant tumors in the lungs?

A

Primary lung cancer
Carcinoid tumor
Secondary tumors (metastases) from breast, colon, kidney, ovaries, prostate, thyroid

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4
Q

What is the most common type of malignant primary tumor of the lung?

A

Bronchogenic carcinoma

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5
Q

What are the two main subtypes of bronchogenic carcinoma?

A

Non-small cell lung cancer (arises from epithelial and glandular cells)
Small cell lung cancer (arises from neuroendocrine cells)

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6
Q

What is the previous name for adenocarcinoma in situ?

A

Bronchoalveolar cell carcinoma

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7
Q

What is the primary site of origin for mesothelioma?

A

Pleura (lining of the lungs)

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8
Q

What is a known risk factor associated with mesothelioma?

A

Asbestos exposure

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9
Q

What is the epidemiology of lung cancer?

A

Lung cancer is the most common fatal malignancy.
Approximately 34,000 deaths are attributed to lung cancer.
It is more common in females.
Lung cancer is usually diagnosed between the ages of 40-70 years.
It is more prevalent in the north of England.
Lung cancer is more common in lower socioeconomic groups.

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10
Q

What is the main risk factor for developing lung cancer?

A

Cigarette smoking

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11
Q

How does cigarette smoking contribute to the development of lung cancer?

A

Cigarette smoke contains carcinogens that can cause genetic mutations, increasing the risk of developing lung cancer.

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12
Q

What is the latent period between asbestos exposure and the development of bronchogenic lung cancer?

A

The latent period is approximately 30-40 years.

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13
Q

How does the combination of asbestos exposure and cigarette smoking affect the risk of developing lung cancer?

A

Asbestos and cigarette smoking act synergistically, increasing the risk of lung cancer by approximately 100 times.

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14
Q

Apart from lung cancer, with which type of cancer is asbestos exposure primarily associated?

A

Asbestos exposure is primarily associated with mesothelioma.

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15
Q

What are some sites of local invasion by lung cancer?

A

Parenchyma (ipsilateral or contralateral sides)
Pleura
Pericardium
Ribs
Muscle
Nerves (recurrent laryngeal nerve, phrenic nerve, sympathetic chain, brachial plexus)
Lymph nodes in thorax (hilar, mediastinal, subcarinal)

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16
Q

How does lung cancer spread to lymph nodes outside the thorax?

A

Lung cancer can spread to lymph nodes outside the thorax, mainly in the supraclavicular and cervical regions, through the lymphatic system.

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17
Q

What are some sites of distant spread for lung cancer through hematogenous spread?

A

Liver
Adrenals
Bones
Brain
Skin

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18
Q

What are some common symptoms of lung cancer?

A

Persistent cough (80%)
Breathlessness (60%)
Chest pain (50%)
Hemoptysis (30%)
Monophonic wheeze
Shoulder pain (Pancoast’s tumor causes invasion of brachial plexus)
Hoarse voice (vocal cord palsy secondary to left recurrent laryngeal nerve palsy)
Superior vena cava (SVC) obstruction (20%)
Enlarged lymph nodes
Skin nodules

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19
Q

What are some systemic symptoms associated with lung cancer?

A

Weight loss (cachexia)
Lethargy
Bone pain
Neurological symptoms (headache, limb weakness, peripheral neuropathy)
Spinal cord compression
Paraneoplastic symptoms caused by secretion of hormones or cytokines by small cell lung cancer (SCLC)

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20
Q

What are some signs that may be observed in patients with lung cancer?

A

Cachexia (extreme weight loss)
Clubbing (in 20% of cases with non-small cell lung cancer)
Hypertrophic pulmonary osteoarthropathy (HPOA) with adenocarcinoma: painful tender swelling of wrists and ankles
Hoarse voice
Horner’s syndrome (meiosis, ptosis, enophthalmos, and anhidrosis)
Cervical and supraclavicular lymphadenopathy
Tracheal deviation (upper lobe collapse, pleural effusion)
Superior vena cava obstruction (SVCO)
Clinical signs of pleural effusion (decreased chest expansion, decreased breath sounds, dullness on percussion, decreased tactile vocal fremitus, and decreased vocal resonance)

21
Q

What are some concerning findings on a chest X-ray in relation to lung cancer?

A

Mass
Cavitating lesion
Unilateral pleural effusion
Non-resolving consolidation
Solitary pulmonary nodule

22
Q

What imaging modality is essential for the initial staging of lung cancer?

A

CT (computed tomography) of the thorax and abdomen with contrast.

23
Q

What are the contraindications for using iodine-based contrast in CT scans for lung cancer staging?

A

Renal failure
Allergy to iodine or previous contrast

24
Q

How does a PET (positron emission tomography) scan contribute to lung cancer diagnosis and staging?

A

PET scans use FDG (fluorodeoxyglucose) to detect rapidly metabolizing cells, including cancer cells.
It can detect areas of high FDG uptake, which are indicative of cancer.
Dual PET/CT scans can correlate FDG-avid areas with anatomical structures.
PET scans are useful for detecting distant metastases, except for brain metastases.
The sensitivity of PET for lung cancer is 80%, and the specificity is 97%.

25
Q

What is the prognosis for lung cancer?

A

The prognosis for lung cancer varies depending on the stage at diagnosis and individual factors. Early-stage lung cancer generally has a better prognosis than advanced-stage cancer. Survival rates can also vary based on the specific type of lung cancer and treatment response.

26
Q

What are some other imaging modalities used in the evaluation of lung cancer?

A

Bone scan: To assess bone metastases and pathological fractures.
MRI (magnetic resonance imaging) of the thorax: Used to assess structural changes prior to surgery.
Brain CT scan: Conducted if brain metastases are suspected or prior to radical treatment.

27
Q

What are some blood tests that may be performed in patients with lung cancer?

A

Full blood count: To check for anemia, platelet count, and clotting abnormalities.
Urea & electrolytes: To evaluate for hyponatremia (low sodium level <139 mmol/L), which can occur secondary to the syndrome of inappropriate antidiuretic hormone (SIADH).
Liver function tests: May be abnormal if liver metastases are present.
Hypercalcemia: Elevated calcium levels may be seen in some cases.

28
Q

How does ectopic secretion of hormones occur in lung cancer paraneoplastic syndrome?

A

Small cell lung cancer (SCLC) arises from Kulchitsky neuroendocrine cells of the “amine uptake and decarboxylation (APUD)” system.
Ectopic secretion of hormones can occur, leading to paraneoplastic syndromes.
Examples include:
Anti-diuretic hormone (ADH) → Hyponatremia (low sodium levels)
Parathyroid hormone (PTH)-related peptide → Hypercalcemia (elevated calcium levels)
Adrenocorticotrophic hormone (ACTH) → Raised cortisol levels (Cushing’s syndrome)

29
Q

Why are pulmonary function tests (PFTs) performed for patients suspected of having lung cancer?

A

Most patients with lung cancer also have chronic obstructive pulmonary disease (COPD).
PFTs, including measurements such as FEV1 (forced expiratory volume in 1 second), FVC (forced vital capacity), FEV1/FVC ratio, and TLCO (transfer factor for carbon monoxide), are required:
Prior to obtaining a CT-guided lung biopsy.
Prior to considering surgery or radiotherapy.
PFTs help assess lung function and overall respiratory health.

30
Q

What are some methods for histological diagnosis of lung cancer?

A

Bronchoscopy and biopsy
Endobronchial ultrasound (EBUS)-guided biopsy
Transbronchial needle aspiration (TBNA) of lymph nodes
CT-guided lung biopsy
Ultrasound-guided lung biopsy
Fine needle aspiration (FNA) of lymph nodes in the neck
Pleural aspiration from malignant pleural effusion
Biopsy from other sites with metastases (e.g., liver, bone, adrenal)
Sputum cytology
Invasive procedures carry potential risks, so the patient’s fitness and lung function should be considered.
Risks of biopsy include bleeding and pneumothorax (collapsed lung).

31
Q

What are the two main types of bronchogenic lung cancer?

A

Non-small cell lung cancer (NSCLC) accounts for 80% of cases.
Small cell lung cancer (SCLC) accounts for 20% of cases.

32
Q

What are the subtypes of non-small cell lung cancer (NSCLC)?

A

Squamous cell lung cancer: Arises from squamous epithelial cells.
Adenocarcinoma: Arises from mucin-producing glandular epithelium.
Large cell lung cancer: Composed of undifferentiated cells.
Malignant carcinoid: Neuroendocrine tumor.
Mixed and others: Other less common subtypes.

33
Q

How does the prognosis of non-small cell lung cancer (NSCLC) compare to small cell lung cancer (SCLC)?

A

NSCLC generally has a better prognosis than SCLC.

34
Q

What is the origin of small cell lung cancer (SCLC)?

A

SCLC arises from the neuroendocrine cells of the lung.

35
Q

What is the typical behavior and prognosis of small cell lung cancer (SCLC)?

A

SCLC is known to be very aggressive and often metastasizes at the time of presentation. It carries a poor prognosis.

36
Q

How has molecular mutation testing impacted treatment options and survival in recent years?

A

Molecular mutation testing has improved treatment options, particularly with the use of targeted therapies and immunotherapy. It has contributed to improved survival rates in lung cancer patients.

37
Q

What factors influence the management approach for lung cancer patients?

A

Histology of lung cancer
Staging of cancer (TNM staging)
WHO performance status of the patient
Lung function
Co-morbidities
Patient’s wishes

38
Q

What is involved in the decision-making process for lung cancer management?

A

The decision-making process typically involves a multidisciplinary team (MDT) consisting of healthcare professionals such as respiratory physicians, radiologists, histopathologists, thoracic surgeons, medical oncologists, clinical oncologists, palliative care doctors, and lung cancer clinical nurse specialists.

39
Q

What are the options for radical therapy with curative intent in lung cancer?

A

Surgery: Surgical removal of the tumor.
Radiotherapy: Use of high-energy radiation to target and destroy cancer cells

40
Q

What are the options for palliative therapy in lung cancer?

A

Chemotherapy: Administration of anticancer drugs to control or shrink the tumor.
Immunotherapy: Use of medications to stimulate the body’s immune system to fight cancer.
Radiotherapy: Targeted radiation to relieve symptoms and control tumor growth.
Symptom control: Focus on managing symptoms such as pain, breathlessness, and improving quality of life.

41
Q

What is the role of palliative care in lung cancer patients?

A

Palliative care plays a crucial role in managing the symptoms, providing support, and improving the quality of life for lung cancer patients. It focuses on addressing physical, emotional, and psychosocial needs, relieving pain and other symptoms, and offering psychological and spiritual support to patients and their families throughout the course of the illness.

42
Q

What are the treatment options for non-small cell lung cancer (NSCLC)?

A

Surgery: Options include lobectomy (removal of a lung lobe), pneumonectomy (removal of one lung), or wedge resection/segmentectomy (removal of part of a lobe).
Radiotherapy: Use of high-energy radiation to target and destroy cancer cells.
Chemotherapy: Administration of anticancer drugs to control or shrink the tumor.
Immunotherapy: Use of medications to stimulate the body’s immune system to fight cancer.
Palliative care: Focus on symptom management and improving quality of life.

43
Q

What are the treatment options for small cell lung cancer (SCLC)?

A

Chemotherapy: Administration of anticancer drugs to target and destroy cancer cells.
Immunotherapy: Use of medications to stimulate the body’s immune system to fight cancer.
Palliative radiotherapy: Use of radiation to relieve symptoms and control tumor growth.
Palliative chemotherapy: Chemotherapy used to alleviate symptoms and improve quality of life.

44
Q

What are some targets of immunotherapy drugs for lung cancer?

A

Epithelial Growth Factor Receptor (EGFR) mutation
Vascular Endothelial Growth Factor (VEGF)
Checkpoint inhibitors that block proteins like PD-1 or PD-L1 to enhance the immune response against cancer cells.

45
Q

What is the aim of palliative care in lung cancer?

A

Relieving symptoms such as pain, breathlessness, cough, nausea, and excessive secretions.
Improving the overall quality of life for patients.
Early identification, assessment, and treatment of symptoms.
Prevention and relief of physical, psychological/emotional, spiritual, and social suffering associated with the disease.

46
Q

What is the overall 1-year survival rate for lung cancer?

A

The overall 1-year survival rate is approximately 30% for men and 35% for women.

47
Q

What are some measures for the prevention of lung cancer?

A

Smoking cessation: Quitting smoking is the most important preventive measure.
Reduce exposure to passive smoking: Avoid being in environments with secondhand smoke.
Reduce exposure to radiation: Minimize exposure to sources of ionizing radiation.
Legislation in the workplace: Implement regulations to ban asbestos and reduce exposure to coal dust.
Good nutrition: Maintain a healthy diet with a focus on fruits and vegetables.

48
Q

How can early detection of lung cancer be promoted?

A

Recognition of symptoms of lung cancer: Educate individuals about the common signs and symptoms associated with lung cancer.
Education of patients: Raise awareness among patients about the symptoms and encourage early reporting to their doctors.
Education of healthcare professionals: Provide training and information to healthcare professionals to recognize early symptoms and signs of lung cancer.
Early chest X-ray: Consider chest X-ray for individuals with concerning symptoms or risk factors.
Low-dose CT screening: Consider low-dose computed tomography (CT) screening for individuals at high risk for lung cancer, such as heavy smokers.

HLB (40 decks)

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