Lung Cancer Flashcards Preview

Respiratory > Lung Cancer > Flashcards

Flashcards in Lung Cancer Deck (71):
1

what is it called when biologically active molecules are released from tumour cells and mimic the effects of naturally occuring hormones?

paraneoplastic syndromes

2

compare incidence and prevalence of lung cancer?

incidence is high
prevalence is low (because patients dont live for long)

3

as the tumour enlarges what happens to the lung?

loses volume and gets smaller
(in CXR, smallest lung is likely to be the diseased one)

4

is stridor an inspiratroy or expiratroy sound?

inspiratory sounds

5

what 6 structures can a lung tumour locally invade into?

recurrent laryngeal nerve
pericardium
oesophagus
brachial plexus
pleural caivty
superior vena cava

6

why might a patient with a lung cancer get a hoarse voice?

tumour invaded into reccurent laryngeeal nerve

7

what can tumour invasion into the pericardium cause?

breathlessness
AF
pericardial effusion

8

what can tumour invasion into the oesphagus cause?

dysphagia

9

what is a pancoasts tumour?

a tumour of the lung apex

10

why can a patient with a lung cancer present with weakness in upper limbs?

invasion of brachial plexus

11

what often happens when a primary tumour invades the pleural space?

generates a large volume of pleural fluid
(can enhance SOB)

12

when a tumour has invaded bone (causing bone erosion) when will the patient complain the pain is worse?

pain worse at night

13

where are common sites of metastases from a primary lung cancer?

liver
brain
bone
adrenals
skin
lung

14

what 4 symptoms can be caused by brain metastases?

weakness
visual distrubances
headaches
fits

15

why can a headache occur in brain mets?

due to raised intracranial pressure
(usually worse in the morning)

16

what hormone does a tumour mimic to cause hypercalcaemia?

parathyroid hormone

17

what can hypercalcaemia cause?

headaches
confusion
thirst
constipation

18

what hormone does a tumour mimic to cause hyponatraemia (abnormally low Na levels)?

ADH

19

what is the name of a syndrome which mimics myaesthenia gravis? (and is a paraneoplastic syndrome caused by an underlying -usually small cell- lung carcinoma)

Eaton Lambert syndromeq

20

what can be some important symptoms of lung cancer? (name 7)

haemoptysis
weight loss
recurrent pneumonia
stridor
hoarse voice
breathlessness
cough

21

why must any patient with new finger clubbing have a CXR?

because lung cancer is the commonest cause

22

what paraneoplastic condition affects the bones? (not due to metastatic disease)

hypertrophic pulmonary osteoarthropathy

23

why is there pain and tenderness of the long bones in hypertrophic pulmonary osteoarthropathy

due to elevation of the periosteum away from the bbones surface

24

what is thrombophlebitis?

a blood clot in the vein

25

why is thrombophlebitis a paraneoplastic syndrome?

because of the increased coaguability of blood in cancer patients

26

what diagnostic investigation should be carried out if there is a possibility of lung cancer?

CXR
+ CT (regardless of CXR results)
+/- PET scan
+ bronchoscopy (if patient has a central lesion and is fit enough, if patient isn't fit enough- sputum cytology)
+/- percutaneous FNA biopsy

27

what does a PET scan allow you o see?

tissues with high metabolic activity

28

what are the 2 broad types of lung neoplasms?

benign (rare)
malignant (very common)

29

what are 6 risk factors for lung cancer?

smoking
asbestor
chromates
radiation
atmospheric pollution
genetics

30

what local effect of a lung cancer causes pneumonia?

obstruction of airways

31

what local effect of a lung cancer cause localised pain?

invasion of the chest wall

32

what local effect of a lung cancer causes haemoptysis?

ulceration

33

what is the name of hormone production from a site it shouldnt be? (ie paraneoplastic syndrome)

ectopic hormone production

34

what hormones does a squamous carcinoma release?

PTH
(parathyroid hormone)

35

what does release of PTH from a squamous carcinoma cause?

hypercalcaemia

36

what hormones does a small cell carcinoma release?

ACTH
(adrenocorticotrophic hormone)
ADH
(anti-diuretic hormone)

37

what does release of ACTH from a small cell carcinoma cause?

cushings syndrome

38

what does releases of ADH from a small cell cardinoma cause?

hyponatremia

39

how does immunohistochemistry help to subtype lung cancers on small biopsies?

by identifying specific antigens

40

what factor is expressed in small cell carcinomas and adenocarcinomas?

TTF-1
thyroid transcription factor

41

what factor is expressed in squamous cell carcinoma?

P63

42

what is the worst subtype of lung cancer in terms of prognosis?

small cell carcinoma

43

what is the treatment of choice in non-small cell cancers?

surgery

44

what drug is a tyrosine kinase inhibitor which shows some activity in non-small cell lung cancer patients?

gefitnib

45

why is getfitnib effective in non-small cell lung cancer patients?

because non-small cell lung cancers usually have mutated epidermal growth factor receptor (EGFR) and getfitnib only works in tumours with mutated EGFR

46

what is the pathogenesis of a squamous carcinoma?

squamous metaplasia
dysplasia
carcinoma in situ
invasive malignancy

47

what are carcinoids?

neuroendocrine neoplasms of low grade malignancy

48

what are the 2 types of pleural neoplasia?

benign (rare)
malignant mesothelioma

49

what happens if a tumout suppresses the nerves to the faces?

horners syndrome

50

where are small cell lung cancers more likely to be found?

centrally

51

what are the 4 main features of small cell lung cancer which effect the method of treatment?

rapidly progressive
early metastases
rarely suitable for surgery
good initial response to chemotherapy

52

why are small cell carcinomas more susceptible to cytotoxic chemotherapy compared to other types of lung cancer?

because of the rapid growth
(chemotherapy targets dividing cells)

53

what is the treatment of choice in small cell lung cancer?

chemotherapy
(often backed up with radiotherapy)

54

what are the 4 major management options for lung cancer?

surgery
radiotherapy
chemotherapy
palliative care

55

what lung cancer patients do well with surgery?

localised disease
very little co-morbidity

56

what is the role of bronchoscopy within staging for cancer resection?

too look for:
vocal cord palsy
proximity to carina
cell type

57

what is the role of mediastinoscopy within staging for cancer resection?

to look for lymph nodes with mets

58

what is the role of a CT scan of the brain within staging for cancer resection?

to look for brain mets

59

what is the role of a CT scan of the tohorax within staging for cancer resection?

tumour size
lymph nodes affected
mets
local invasion

60

what is the role of PET scan within staging for cancer resection?

metastases

61

how distal to the carina must a lung cancer tumour be in order to be operable?

2cm

62

if tumour is in a main bronchus, why do you need 2cm of disease free bronchus distal to the carina?

because you need at least 2cm of disease free bronchis to close the hole that will be left from ressection

63

what is the name for a whole lung resecection?

pneumonectomy

64

for chemotherapy, how often do you need IV infusions?

every 3/4 weeks

65

what are the 5 major side effects from chemotherapy?

nausea and vomiting
tiredness
bone marrow suppression
hair loss
pulmonary fibrosis

66

what is the result of bone marrow suppression? (which can be secondary to chemotherapy)

opportunistic infection
anaemia

67

when is radiotherapy (x-rays usually) used as a curative method for cancer?

if target is less than 5 cm in diameter

68

what are the 3 major cons about radiotherapy?

maximum cumulative dose
collateral damage
only goes where you point the beam (not good for subclinical mets)

69

where is the most common collateral damage from radiotherapy on a lung tumour?

spinal cord
oesophagus
adjacent lung tissue

70

what 4 type of endobronchial therapies are good palliative techniques?

stent insertion for stridor
photodynamic therapy
other laser therapy
radioactive pellets

71

what is treatment of lung cancer determined by?

patients wishes
type of cancer
staging of cancer
co-morbidity