lung cancer Flashcards
(14 cards)
The term lung cancer, or bronchogenic carcinoma, refers to malignancies that originate in the — or —.
95 % of all lung cancers are classified as either — lung cancer (SCLC)(~—%) or
—- cell lung cancer (NSCLC)(~—%)
The lungs are also a common site for metastatic disease form other – tumours ; breast, thyroid, bowel, melanoma, renal etc.
airway or pulmonary parenchyma
small cell ( 15%)
non small cell ( 80%)
primary
epidemiology:
1.8 million cases worldwide
1.6 million deaths per year
Commonest cause of cancer mortality worldwide
National Cancer Registry Ireland (2022 report)
Lung cancer was the leading cause of cancer death in both sexes during 2018-2020
2564 cases per year
Representing 19% of all female cancer deaths and 22% of all male cancer deaths
Incidence in — is increasing, slightly falling in—
women
men
types: histology
1- Non – Small Cell Lung Cancer (NSCLC):
Constitutes — % of all lung cancers
- —- (for — )
- — cell ( for – )
- —- cell (rare)
2-Small Cell Lung Cancer (SCLC)
Constitutes~ — % of all lung cancers
— in origin and often associated with — syndromes
80%
adenocarncima for non smokers
squamous for smokers
large cell
15%
endocrine
paraneoplastic sydnroms
risk factors:
1. Smoking
Accounts for — % of lung cancers
Risk dependent on – and — of smoking
1 in 8 smokers develop lung cancer
2/3 present with advanced disease
Passive smoking
Triggers cell — mutations which inhibit signals to stop —
2- environmental toxins:
- —- :
–>commonest causeof lung cancer in neversmokers
–>naturally occurring gas in the environment arisingfrom radioactive decay of uranium
–> Decaysquickly after inhalation and releases radioactive particles which causes cell DNA damage
- Asbestos : are — cause activation of reactive oxygen species leading to inflammation and DNA mutations -> lung cancer or —- )
-Heavy metals (arsenic, chromium, cadmium and nickel)
Induce —- leading to DNA damage
Ionizing radiation:
causes — damage to DNA by radiation rays
Polycyclic aromatic hydrocarbons:
Emitted by — organic compounds
90%
extent and duration
dna mutation
stop cell proliferation
radon gas
fibres
mesothelioma
oxidative stress
direct damage
burning
more risk factors:
3- Radiotherapy for other malignancies
e.g. Breast cancer, Hodgkin’s Lymphoma
Direct DNA damage by radiation rays
4. Age
Median age at diagnosis — years
More DNA mutations build up naturally overtime
5. Family History
e.g. germline mutation in EGFR
6. Idiopathic Pulmonary Fibrosis
— fold increased risk of lung cancer
Believed to have similar pathogenesis to lung cancer with similar — mutations and — factors
71
7 folds
gremlin and epigentic
pathogenesis:
-When carcinogenic agents are inhaled, they induce genetic mutations within the — cells (e.g. 3p deletion, p53 mutations, or mutation in one of the oncogenes like c-myc, EGFR, c-MET, c-KIT and most significantly — ).
-Continued carcinogen exposure allows additional mutations to accumulate and eventually leads to uncontrolled — of these abnormalcells.
-With smoking, there is a long delay (20 – 25 years) between —-onset and —-onset.
-Although cancer risk decreases after smoking cessation, existing initiated cells may progress if another carcinogen caused further mutations.
epithelial cells
K-RAS
proliferation
smoking and cancer
symptoms:
Most cases initially present to their GP
Certain proportion present to the emergency department as an emergency
Incidental (found by chance) finding on CXR (7-10%)
symptoms depends on — of tumour and stage aka — of the disease
Peripheral lesion :
– — finding with —
Central lesion :
Cough
Haemoptysis
Dyspnoea
Hoarseness
Pleural/mediastinal involvement:
Chest pain
Sensation of fullness in head and facial swelling (superior vena cava (SVC)obstruction causing venous —- )
Systemic/Constitutional:
Weight loss
Anorexia
Night sweats
Fevers
location
stage ( extent )
incidental no symptoms
Venous engorgment
signs of lung cancer:
- —
Lymphadenopathy (supra-clavicular)
Recurrent chest—
Localised —
—
—- syndrome
Tracheal deviation
Cachexia
Positive—- sign (SVC obstruction)
Signs of Metastatic disease:
Seizures
Headache
—- nerve defects
Confusion
Hepatomegaly
Bone pain
clubbing
infections
wheeze
stridor
horners syndrom
Pemberton’s
cranial nerve
symptoms explained:
Central lesion :
Cough (irritative effect from tumour),
Haemoptysis (friable tumour tissue / abnormal tumour vasculature)
Dyspnoea (bronchial obstruction/atelectasis/effusion/pneumothorax/unilateral phrenic nerve paralysis)
Hoarseness (recurrent laryngeal nerve palsy from tumour invasion)
Pleural / mediastinal involvement:
Chest pain (mediastinal, pleural, or chest wall extension, irritates nerves innervating these structures)
Sensation of fullness in head and facial swelling (—- obstruction causing facial venous — )
Systemic / Constitutional:
Weight loss
Anorexia
Night sweat
Fevers
the systemic symptoms are systemic signs of — and the release of — aka an —
SVC
engorgment
inflammation
cachectin
TNF
signs explained:
Clubbing ( — stimulates the release of platelet derived growth factors –> vascular proliferation in nail beds)
Lymphadenopathy (spread to lymph nodes which become filled with tumour)
Recurrent chest infections (narrowed bronchial — from obstruction –> — of secretions —> — —> — –> — formation)
Localised wheeze ( — bronchial obstruction)
Stridor ( — obstruction)
Horner’s syndrome (ipsilateral miosis, ptosis, and facial anhidrosis, sympathetic chain involvement; stellate ganglion)
Tracheal deviation (large pleural effusion / pneumothorax / lobar collapse due to obstructed airway)
Cachexia (increased —- not being met by caloric intake)
hypoxia
lumen
retention
infection
pneumonia
abscess
partial
tracheal
basal metabolic rate
signs :
SVC obstruction ( — neck veins; a prominent venous pattern on the chest; oedema of the face, neck, and upper extremities; and a – appearance; Positive — sign
more signs:
Metastatic disease
1-Seizures
2-Headache
3-Cranial nerve defects
4-Confusion
Hepatomegaly (liver swelling due to tumour)
Bone pain (bone)
from 1-4 its the mass effect ( brain ) and neauronal disruption
dilated
plethoric
pembertons
paraneoplastic syndroms:
1-Hypercalcaemia ( — Cell Carcinoma)
2-Syndrome of Inappropriate — secretion –> hyponatremia (SCLC)
3-Ectopic ACTH secretion –> excess cortisol secretion –> — syndrome (SCLC)
4-Cerebellar Syndrome ( — CLC)
5-Lambert-Eaton Myasthenic Syndrome (— CLC)
squamous
adh
crushing
smal
smal
differential diagnosis based on symptoms :
Pneumonia
SOB/chest pain/wheeze/cough/haemoptysis
Symptoms and CXR findings should resolve with treatment
Recurrent chest infection in active or ex-smoker should heighten suspicion of lung cancer
Pulmonary embolus
SOB/pleuritic chest pain/haemoptysis
But can also be a complication of lung cancer
Bronchiectasis
Cough productive of large amounts of mucopurulent sputum/SOB/wheeze/haemoptysis
Diurnal variation of cough (worse in the morning)
Tuberculosis
Chronic cough productive of sputum/haemoptysis/SOB/fevers/weight loss/anorexia/night sweats
RFs- residence in/visit to high-prevalence area; immunosuppressed status (e.g., HIV infection, immunosuppressant medication, transplant recipients, diabetes, dialysis treatment); TB close contact
COPD
Chronic cough with sputum/SOB/wheeze/smoking history
differential diagnosis based on imaging ± symptoms :
Lymphoma (non-productive cough/chest pain/fever/haemoptysis/SOB/night sweats/weight loss/lymphadenopathy; solitary or multiple nodules on imaging)
Granulomatosis with polyangiitis; formerly Wegener’s granulomatosis (cough/chest pain/SOB/haemoptysis/rhinorrhoea/epistaxis/ear/sinus pain/hoarseness/fever/fatigue/anorexia/weight loss)
Carcinoid tumour (carcinoid syndrome- flushing/diarrhoea/abdominal cramping/swelling of peripheries/wheezing)
Arteriovenous malformations
Hamartoma
arteriovenous malformation and hamartoma
