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Respiratory Disease Profiles > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

what are the three most common cancers in the UK?

A

breast cancer
prostate cancer
lung cancer

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2
Q

what is the most common cause of lung cancer?

A

smoking

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3
Q

what percentage of lung cancer is thought to be preventable?

A

80%

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4
Q

what are the two types of lung cancer and what percentage is each?

A

small cell lung cancer - around 20%
non-small cell lung cancer - around 80%

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5
Q

what are the types of non-small cell lung cancer and what percentage is each (of total lung cancers) ?

A

adenocarcinoma - 40%
squamous cell carcinoma - 20%
large cell carcinoma - 10%
other type - 10%

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6
Q

what do squamous cell carcinomas contain?

A

neurosecretory granules that secret neuroendocrine hormones

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7
Q

what can neuroendocrine hormones cause?

A

can cause various paraneoplastic syndromes

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8
Q

what is a mesothelioma?

A

a malignancy that affects the mesothelial cells of the pleura

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9
Q

what is strongly linked to mesotheliomas?

A

asbestos exposure
can have a latent period between exposure and development of mesothelioma
up to 45yrs

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10
Q

what is the prognosis of mesothelioma?

A

poor
chemo can help survival
essentially palliative

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11
Q

what are presenting features of lung cancer?

A

shortness of breath
cough
haemoptosis
weight loss
finger clubbing
lymphadenopathy - supracavicular often first
recurrent pneumonia

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12
Q

what is sometimes the first evidence of lung cancer in otherwise asymptomatic patients?

A

extra pulmonary manifestations and paraneoplastic syndromes

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13
Q

what are examples of extra pulmonary manifestations of lung cancer?

A

recurrent laryngeal nerve palsy
pharyngeal nerve palsy
superior vena cava obstruction
Horner’s syndrome
syndrome of inappropriate ADH
Cushing’s syndrome
hypercalcaemia
limbic encephalitis
Lamert-Eaton myasthenic syndrome

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14
Q

what does recurrent laryngeal nerve palsy present as?

A

hoarse voice

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15
Q

what causes recurrent laryngeal nerve palsy?

A

tumour pressing on the recurrent laryngeal nerve as it passes through the mediastinum

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16
Q

what does pharyngeal nerve palsy present as?

A

shortness of breath

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17
Q

what causes pharyngeal nerve palsy?

A

tumour compressing the pharyngeal never which causes diaphragm weakness

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18
Q

what does a superior vena cava obstruction present as?

A

facial swelling
difficulty breathing
distended chest and neck veins

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19
Q

what causes a superior vena cava obstruction in lung cancer?

A

a tumour pressing directly on the superior vena cava

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20
Q

what is Pemberton’s sign and what does it indicate?

A

when hands are lifted above the head there is facial congestion and cyanosis
indiction of superior vena cava obstruction

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21
Q

what does Horner’s syndrome present like?

A

triad of:
- partial ptosis - dropping eyelid
- annidrosis - absence of sweating
- miosis - smaller pupil

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22
Q

what causes Horner’s syndrome?

A

a pan coast tumour pressing on the sympathetic ganglion which interrupts the sympathetic nerve supply to the face

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23
Q

what is a Pancoast tumour?

A

a tumour in the pulmonary apex at the top of the lung

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24
Q

what does syndrome of inappropriate ADH - antidiuretic hormone (SIADH) present as?

A

hyponatreamia - low sodium

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25
Q

what causes SIADH ( syndrome of inappropriate antidiuretic hormone ) ?

A

ectopic antidiuretic hormone (ADH) secreted by small-cell lung cancer

26
Q

what caused Cushing’s syndrome in lung cancer?

A

ectopic adrenocroticotropic hormone secreted by small cell lung cancer

27
Q

what causes hypercalcaemia in lung cancer ?

A

ectopic parathyroid hormone secreted by squamous cell carcinoma

28
Q

what is limbic encephalitis?

A

a paraneoplasic syndrome that makes the immune system produce antibodies to brain tissues causing inflammation in these areas

29
Q

what does limbic encephalitis cause/present as?

A

short-term memory impairment
seizures
hallucinations
confusion

30
Q

what is Lambert-Eaton myasthenic syndrome?

A

when antibodies against small cell lung cancer are produces but also target and damage voltage gated io channels on presynaptic terminals in motor neurones

31
Q

what does Lambert-Eaton syndrome cause/present as?

A

weakness ;
- proximal muscles
- intraocular muscles =diplopia (double vision)
- levator muscles in eyelid = ptosis (dropping eyelid)
- pharyngeal muscles = slurred speach and dysphagia

32
Q

what can Lambert-Eaton syndrome other cause, besides muscle weakness?

A

autonomic dysfunction =
- dry mouth
- blurred vision
- impotence
- dizziness

33
Q

what is the referral criteria for an urgent ( within 2 weeks ) chest X-ray in suspected lung cancer?

A

over 40 and;
- lymphadenopathy - supravclavicular or persistent abnormal cervical nodes
- clubbing
- recurrent or persistent chest infections
- raised platelet count -thrombocytosis
- chest signs of lung cancer

34
Q

what else indicates an urgent chest X-ray for suspected lung cancer?

A

2+ unexplained and never smoked
1+ unexplained if ever smoked or asbestos exposure;
- cough
- shortness of breathe
- chest pain
- fatigue
- weight loss
- loss of appetite

35
Q

what would indicate lung cancer when looking at a chest xray ?

A

hilar enlargement
peripheral opacity - visible lesions in lung field
pleural effusion - usually unilateral in lung cancer
collapse of lung tissues

36
Q

what body of the body would a staging CT scan be done in lung cancer and why?

A

chest, abdomen, pelvis
asses the stage, lymph node involvement and presence of metastases

37
Q

what is a staging CT usually contrast enhanced?

A

inject contrast to give more detail of the tissues

38
Q

what is a PET-CT scan?

A

positron emission tomography CT
scans with injecting a radioactive tracer, usually attached to glucose molecules, tot ak eimages using a CT scanner and gamma ray detector

39
Q

what does a PET-CT scan do?

A

visualise how metabolically active tissues are
helps to identify metastases - they will have increased metabolic acitivity

40
Q

what is a bronchoscopy with endobronchial ultrasound (EBUS) ?

A

an endoscopy with and ultrasound on the end

41
Q

what does an EBUS do?

A

allows for a detailed assessment of the tumour and ultrasound guided biopsy

42
Q

why are biopsies needed?

A

for histological diagnosis
to check the cell type of the tumour

43
Q

what two types of biopsy can be used for lung cancer?

A

bronchoscopy
percutaneous (through skin)

44
Q

how is treatment of lung cancer decided?

A

in an MDT meeting

45
Q

what is first line treatment for min-small cell lung cancer?

A

surgery if in an isolated area
aim to remove entire tumour = cure

46
Q

what is the benefits of radiotherapy in small cell lung cancer?

A

can be curative if diagnosed early

47
Q

in small cell lung cancer when is chemotherapy used?

A

can be used in combination with surgery/radiotherapy in certain patents to improve outcomes - adjuvant chemotherapy
can be used in late-stage non-small cell cancer to improve survival and quality of life - palliative chemotherapy

48
Q

what is the treatment of small cell lung cancer?

A

usually a combination of chemotherapy and radiotherapy
prognosis is sully poorer than non-small cell lung cancer

49
Q

what does endobronchial treatment do?

A

puts in stents or debunking of tumour in bronchial obstrucion

50
Q

what is end-bronchial treatment used for?

A

palliative treatment
helps relieve bronchial obstruction

51
Q

what are the options for removing a lung tumour?

A

segmentectomy/wedge resection = remove segment or wedge (portion of a lobe)
lobectomy = remove whole lobe
pneumonectomy = remove entire lung

52
Q

what is the most common way to remove a lung tumour?

A

lobectomy

53
Q

what types of surgery can be done to remove a lung tumour?

A

thoracotomy
video-assisted thorascopic surgery (VATS)
robotic surgery

54
Q

what is a thoracotomy?

A

open surgey with an incision and separation of ribs to access the thoracic cavity

55
Q

what incisions can be used in a thoracotomy?

A

anterolateral - incision around the front and side
axillary - incision in the axilla
posterolaterla - around the back and side

56
Q

what is the most common incision for a thoracotomy to remove lung cancer?

A

porsterolateral -around back and side

57
Q

what is video-assisted thorascopic surgery?

A

minimally invasive, ‘keyhole’ surgery
generally prefers as it has a faster recovery and less complications

58
Q

what does a thoracotomy scar indicate?

A

lobectomy, pneumonectomy or lung volume reduction surfer for COPD

59
Q

what does a right-sided mini-thoracotomy scar indicate?

A

in cardio station - minimally invasive mitral valve urgent?

60
Q

what breath sounds indicate a lobectomy?

A

focal asset breath sounds

61
Q

what breath sounds indicate a pneumonectomy?

A

absent breath sounds on an entire side

62
Q

what are lobectomies and pneumonectomies used to treat?

A

lung cancer
used to be used to treat tuberculosis - be mindful in older patients

Respiratory Disease Profiles (1 decks)

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