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Y1 Respiratory > Lung Cancer > Flashcards

Flashcards in Lung Cancer Deck (94):
1

General features of cancer

malignant growth, uncontrolled replication, local invasion, metastases, non-metastatic effects

2

Another name for non-metastatic effects?

paraneoplastic syndrome

3

What are non-metastatic effects?

rare, non-metastatic manifestations of malignancy mediated by hormones, cytokines or antibodies

4

Prognosis of lung cancer?

90% incurable at the time of lung cancer diagnosis
50% dead after 6 months

5

Potential reasons for poor lung cancer prognosis

Poor health at the time of diagnosis prevents treatment
Co-morbidities
Tends not to cause symptoms until advanced or metastatic

6

Potential Red Flags for Lung Cancer (8)

cough for 3 weeks or more
haemoptysis
breathless for no reason
recurrent or unresolved chest infections
unexplained weight loss
chest or shoulder pain
unexplained tiredness or lack of energy
hoarse voice

7

Differential diagnosis of haemoptysis

TB, Pneumonia, Aspergillus, Lung Cancer

8

Haemoptysis presents in around 70% of patients with lung cancer - true or false?

true

9

Patients presenting with haemoptysis should be _______ and sent for _____

referred, CT scan

10

Any ___ patient with pneumonia has a repeated xray after ______. If this is not resolved then the patient should be referred to CT.

50+, 6 weeks

11

On an xray, the affected lung may...

lose volume and appear smaller

12

Stridor (in context of lung cancer)

swelling in the airway due to tumour pressing on bronchioles

13

Common sites of local invasion in lung cancer (6)

recurrent laryngeal nerve
pericardium
oesophagus
brachial plexus
pleural cavity
SVC

14

What is the result of a tumour pressing on the recurrent laryngeal nerve?

hoarse voice
may cause the vocal cord not to move

15

What are the issues surrounding pericardial invasion by a tumour?

breathlessness
atrial fibrillation
pericardial effusion
dysrhythmias - tamponade
poor cardiac output

16

Tumour invasion of the oesophagus causes...

dysphagia

17

Pancoast tumour

apical lung cancer invading the brachial plexus

18

Symptoms of pancoasts tumour

pain, muscle wasting, sensory loss, weakness - occurring gradually in ipsilateral arm

19

Invasion of the pleural cavity causes...

pleural effusion - could contain answer if this is first presentation

20

Presentation of pleural effusion on examination

dull percussion
low - no breath sounds
white xray

21

Presentation of SVC obstruction due to lung cancer?

distension of jugular vein
pressure headaches and blurry vision
superficial veins

22

How might SVC obstruction be relieved in lung cancer?

stent or chemotherapy

23

Chest wall invasion can cause...

erosion of ribs, nerves and arteries

24

type of pain associated with chest wall invasion?

neuropathic burning sensation,
worsened by movement
localised
often described as worse at night

25

The patient is at risk of _______ _______ if the tumour starts to invade the pulmonary artery. This type of tumour may erode through the artery and the ________ to cause a sudden death due to massive _______.

Pulmonary embolis
bronchus
haemoptysis

26

Common sites of metastases in lung cancer (6)

liver
brain
bone
adrenal
skin
Lung

27

Features of cerebral metastases in lung cancer

Gradual onset of:
Weakness
visual disturbance
headaches
fits

28

Features of headaches due to metastases?

worse in the morning
worse with sneezing
not photophobic
due to increase in ICP

29

Treatment for cerebral metastases?

high dose corticosteroids i.e. dexamethasone (ICP)
radiotherapy (tumour)
chemotherapy (tumour)

30

Particularly abnormal in Liver Metastases?

Alkaline Phosphatase

31

Clinical presentation of bone metastases?

non-specific ache away from joint
unusual pain
fracture during trivial mechanical stress
localised pain worse at night

32

Metastases in the adrenal glands ______ cause symptoms but are indicators of ________ disease

don't
advanced

33

A CT is unable to determine if a growth on the adrenal gland is a benign adenoma or cancer. In lung cancer patients, why is it important to determine whether it is?

It is important to establish whether they can undergo further treatment.

34

Non-metastatic signs of lung cancer (7)

finger clubbing
hypertrophic pulmonary osteoarthropathy
weight loss
thrombophlebitis
hypercalcaemia
hyponatraemia
weakness

35

Other causes of finger clubbing (not lung cancer)

liver disease - hep C
congenital cyanotic heart disease
bacterial endocarditis
bronchiectasis

36

What is hypertrophic pulmonary osteoarthropathy?

inflammation and expansion of the outer layer of bone

37

Presentation of hypertrophic pulmonary osteoarthropathy?

pain and tenderness of long bones due to elevation of the periosteum away from the bone surface

38

Weight loss is very non-specific. What histories are required to understand weightloss in the context of lung cancer?

GI
Resp.
Bones
Age

39

What is thrombophlebitis?

inflammation of the veins - very common

40

What is the cause of thrombophlebitis?

increased coagulability of blood

41

What is hyponatreamia and how does it present?

low sodium causing confusion

42

Weakness is presented as Eaton Lambert Symdrome. This mimics...

myaethenia gravis which resolves if primary tumour is resected

43

I have a history of a cough, you ask...

How long has this occured?
Do you produce sputum?
What colour is the sputum?
Do you always have a cough?
Is there anything else associated with the cough?

44

Patients rarely volunteer information about...

haemoptysis

45

I come to you having coughed up some blood, what do you ask?

How much blood was it?
Has this happened before?
What colour is it, fresh red or dark red?

46

You are taking a history and I reveal I am a cigarette smoker, what questions might you ask?

How long have you smoked?
How many a day?
Am I thinking of stopping?
If you have stopped, how long and how many did you smoke?

47

Differential diagnosis for breathlessness?

PE, Pleural effusion, pericardial invasion, COPD, infection, lung cancer

48

On examination in a patient you might be concerned about lung cancer, what are you look, listening and feeling for?

finger clubbing
cough
bloated face
lymphadenopathy
dull percussion
enlarged liver
breathlessness
weightloss
hoarse voice
tracheal deviation
stridor

49

What investigations are common when investigating a potential lung cancer?

FBC
Spirometry - FEV1
CXR
CT of thorax
PET scan
Bronchoscopy
Endobronchial Ultrasound

50

What do you not test for when looking for lung cancer?

sputum cytology

51

Which FBCs and bloods do you need in lung cancer suspect?

FBC
Na, K, Ca, Alk Phos
LFTs
Coagulation screen

52

What areas do you expect to light up in a PET scan?

Bladder and brain
highish in liver and spleen

53

Differential diagnosis in a smoker with haemoptysis and abnormal CXR

Lung cancer
TB
Vasculitis
PE
Secondary cancer
Lymphoma
Bronchiectasis

54

What needs to be considered with CT guided biopsy?

if lung is healthy enough to withstand 10% chance of pneumothorax

55

Options for obtaining a tissue diagnosis?

bronchoscopy
CT guided biopsy
Lymph node aspirate
aspiration of pleural fluid
EBUS
Thoracoscopy

56

Benign neoplasm in the lung

hamartoma

57

Why are metastases in lung cancer very common?

the lungs get all the blood so it is easy for the cells to get around the body

58

What are common clinical presentations of patients experiencing the local effects of lung cancer?

obstruction of the airway (pneumonia)
invasion of the chest wall (pain)
Ulceration (haemopytsis)

59

4 common types of lung cancer

adenocarcinoma
squamous carcinoma
small cell carcinoma
large cell carcinoma

60

TNM staging is used for lung cancer...what does this stand for?

Tumour
Nodes
Metastases

61

What role does immunohistochemistry have to play in identifying cancer?

can identify specific expression of tumour suppression factors or oncogenes for targeting via drugs

62

What is mutated in the marjority of adenocarcinomas particularly in non-smokers and asian populations?

EGFR

63

What is Lambert-Eaton Syndrome?

Paraneoplastic syndrome - weakness that mimics myaesthenia gravis but resolves if primary tumour is resected.

64

How much fluid does the pleura normally contain?

4ml

65

How much pleural fluid is needed to be visualised on an x-ray?

200ml

66

What type of pleural effusions should cause concern?

large unilateral effusions

67

Investigates for a pleural effusion might be?

PA CXR
Pleural Aspirate
Biochemistry
Cytology
Culture
?CT chest

68

If you are unusure if the opacity is fluid on the CXR what can you do?

repeat CXR while patient is on their side, the fluid will move and create a straight line at the top

69

What might you suspect with straw-coloured effusion?

heart failure or hypoalbunaemia

70

What might you suspect with blood in the effusion?

malignancy, trauma, infection, infarction

71

What might you suspect with a milky or turbid effusion?

empyema, chylothorax

72

Transudates are...

protein <30g/L

73

Exudates are...

protein >30g/L

74

Transudates are associated with...(5)

HF
Liver Cirrhosis
Hypoalbuminaemia
Atelectasis
Peritoneal dialysis

75

Exudates are associated with...(4)

Malignancy
Infection incl. TB
Pulmonary infarct
Asbestos

76

A pH of less than 7.3 suggests...

pleural inflammation i.e. malignancy or RA

77

A pH of less than 7.2 must...

be draind

78

Where would glucose be expected to be low in an effusion?

Infection, RhA, Malignancy, oesophageal rupture, SLE

79

What two types of non-malignant cell type may be present in an effusion?

lymphocytes - TB, malignancy
Neutrophils - acute onset

80

apart from asbestos workers, who may also get mesothelioma?

people associated with those who worked with asbestos

81

how long does mesothelioma take to develop?

30-40 years post exposure

82

Symptoms that may present with mesothelioma (6)

breathlessness; chest pain; weight loss; fever; sweating; cough

83

Investigations in mesothelioma?

Imaging
Pleural fluid aspiration
Biopsy

84

Treatment options include:

Pleurodese effusions; radiotherapy; chemotherapy; surgery; palliative care

85

What might be done to relieve pleural effusions as a result of mesothelioma?

Talc slurry
Long term pleural catheters

86

Complications in the use of talc slurry (6)

pleuritic pain; fever; pneumonia; resp. failure; talc pneumonitis; secondary empyema

87

Complications of long-term pleural catheters (3)

incorrect placement; bleeding; infection

88

Which cancers particularly metastasise to the pleura?

lung; breast; upper GI; lymphoma; melanoma; ovarian

89

Median survival for mesothelioma

3-12 months

90

What score is used for predicting survival in mesothelioma?

LENT

91

L in LENT...

LDH in pleural fluid
<1500 = 0
>1500 = 1

92

E in LENT...

ECOG PS - functioning in daily life
0=0
1=1
2=2
3-4=3

93

N in LENT

Neutrophil to lymphocyte ratio
<9 = 0
>9 = 1

94

T in LENT

Tumour type
Lowest Risk (0); meso, haematological
Medium risk (1); breast, gynae, renal
HIgh risk (2); lung, other types