lung cancer Flashcards
what are the 4 main causes of lung cancer?
smoking
passive smoking
exposure to asbestos and air pollution
how is adenocarcinoma formed?
bronchioalveolar stem cells transform in the lung periphery
how is squamous cell carcinoma formed?
bronchial epithelial stem cells from central lung airways
what do simple and complex molecular backgrounds mean?
simple - not related to tobacco
complex - related to tobacco
what are 2 histological types of lung cancer?
3 types of nonsclc
small cell lung carcinoma (15%)
- small cell and neuroendocrine differentiation
non-small cell lung carcinoma (85%)
- adenocarcinoma [glandular]
- squamous cell carcinoma [squamous differentiation]
- large cell carcinoma [hypertrophied cell]
what are 4 main sites of lung cancer metastasis?
metastasis - the spread of cancer cells from the place where they first formed to another part of the body
liver
brain
bone
adrenal
what are 3 differential diagnoses of lung cancer?
community-acquired pneumonia
tuberculosis
lung abscess
what are 7 presentations of lung cancer?
C C C D H W W
cough
chest pain
chest infections
dyspnoea
haemoptysis
weight loss
wheeze
what are the 9 systemic symptoms of lung cancer?
D D H H L N P R S
dysphagia (difficulty swallowing)
diaphragmatic paralysis
- invasion of the phrenic nerve
hepatomegaly (liver enlargement)
horner’s syndrome
- Pancoast (pulmonary apex) tumour pressing sympathetic ganglion
-> Anhidrosis, miosis, ptosis
lymphadenopathy
- swollen lymph nodes)
nail clubbing
Pancoast T1 damage
- invasion to brachial plexus
-> upper limbs
raspy, hoarse voice
- tumour pressing left recurrent laryngeal nerve
super vena cava obstruction (SVCO)
- tumour pressing
- face swelling, difficulty breathing, distended chest and neck veins.
- pemberton’s sign
-> Raise hands over head
-> Facial congestion and cyanosis
what are 7 paraneoplastic presentations of lung cancer?
C D H H L L P
P and D both same disease
cushing’s syndrome
- secondary to ACTH secreting SCLC - - body has too much cortisol hormone over time.
dermatomyositis
- muscle inflammation and skin lesions
polymyositis
- muscle inflammation
hypercalcemia
- secondary to PTH secreting small cell carcinoma
- increased parathyroid hormone secretion
- increased calcium
- cancer spread to the bone
Hyponatraemia
- secondary to ADH secreting SCLC
- water intake exceeds reduced urine output
- water retention
- low-sodium due to water dilution
Lambert – Eaton myasthenic syndrome (LEMS)
limbic encephalitis (SCLC)
- immune system produces antibodies to brain tissues
- Inflammation
- anaemia
What are they looking for in the blood tests?
- full blood count
renal function
- U&E, uranalysis, creatinine protein
- increased calcium due to metastasis /paraneoplastic effect
- liver function
What do you look for in a chest x-ray?
- hilar enlargement
- pleural effusion (usually unilateral)
- peripheral opacity (lesion in the lung)
- collapse
Why do you use a CT-guided/ bronchoscopy biopsy?
- Confirms diagnosis
- guides treatment based on histology
What 3 things are used for metastatic assessment and staging of lung cancer?
- CT scan
- PET/CT
- TNM (tumour, node, metastasis) classification of malignant tumours
what are the ECOG performance scores of patient functionality?
0 - fully active
1 - can walk with their cancer symptoms
2 - rest for 50% in the day due to cancer symptoms, can’t work
3 - sit/lie down for more than 50% in the day due to cancer symptoms and struggles with self care
4 - bedbound
