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Lung Cancer Flashcards

(112 cards)

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1
Q

is a lung cancer more likely to be benign or malignant

A

malignant

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2
Q

what percentage of smokers die of lung cancer

A

20%

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3
Q

what are the risk factors for lung cancer

A

smoking, asbestos, nickel, chromates, radiation, atmosphere pollution

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4
Q

what are the local effects of a pulmonary neoplasia (3)

A

obstruction of airway (pneumonia), invasion of chest wall (pain), ulceration (haemoptysis)

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5
Q

what are the systemic effects of lung cancer

A

weight loss, eptopic hormone production

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6
Q

what hormone is produced in squamous cancer

A

parathyroid hormone (PTH)

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7
Q

what hormone is produced in small cell cancer

A

adrenocorticotropic hormone (ACTH)

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8
Q

what are the four most common smoking associated lung tumour classifications

A

adenocarcinoma, squamous carcinoma, small cell carcinoma, large cell carcinoma

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9
Q

what are the types of lung tumour less associated with smoking

A

neuroendocrine, bronchial gland

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10
Q

what is a squamous cell carcinoma definitely caused by

A

smoking

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11
Q

what type of lung cancer is most common in non smokers

A

adenocarcinoma

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12
Q

what methods are used to diagnose a tumour histologically

A

bronchoscopy and biopsy

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13
Q

why is classification of tumours important

A

for prognosis, treatment, pathogenesis/ biology, epidemiology

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14
Q

what is the type of lung cancer with the quickest mortality rate

A

small cell

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15
Q

which is worst; large cell, squamous or adenocarcinoma

A

large cell

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16
Q

what is the simplest classification of lung cancer

A

small cell lung cancer (SCLC) vs non (NSCLC)

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17
Q

how is lung cancer treated

A

surgical intervention, chemotherapy, new targeted treatments based on DNA

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18
Q

how can immunohistochemistry help distinguish between types of tumours

A

adenocarcinoma expresses thyroid factor 1, scc expresses nuclear antigen p63 + have high molecular weight

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19
Q

what mutation is seen exclusively in adencarcinoma

A

point mutations that render the EGFR gene active in the absence of a ligand

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20
Q

what do mutations with a EGFR gene mutation respond to

A

tyrosine kinase inhibitors

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21
Q

how can targeting the immune response be used in treat NSCLC

A

as it enhances the immune’s tumour killing response

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22
Q

list the two types of pulmonary epithelium from which carcinomas can arise and gives examples of each

A

bronchial (ciliated, mucous, neuroendocrine, reserve)

bronchioles/alveoli (clara cells, type 1 and 2 alveolar lining cells)

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23
Q

name the 4 bronchial (large airway) tumours

A

squamous metaplasia, dysplasia, carinoma in situ, invasive malignancy

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24
Q

what would you call the spread of neoplastic cells along alveolar walls

A

bronchioloalveolar carcinoma

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25
what are the two prognosis indicators in lung cancer
tumour stage, tumour histological subtype
26
what is a primary malignant neoplasm called
mesothelioma
27
what type of tumours don't tend to spread
carcinoid
28
what is cancer
uncontrolled growth of tumour cells
29
how can cancer spread
blood, lymph, serous cavities
30
what are paraneoplastic effects
systemic effect from biologically active molecules released from the tumour cell that mimic the effects of naturally occurring hormones
31
why does lung disease have such a poor prognosis
as symptoms don't tend to develop until disease has reached an incurable stage
32
how is lung cancer presented
primary tumour, local invasion, metastases, non-metastatic (paraneoplastic)
33
what is haemoptysis
coughing up blood- tumour creates own fragile and leaky blood supply
34
why does a lung become smaller as a tumour grows
as the proximal divisions of the bronchial tree get obstructed and the lung tissue shrinks
35
what are the early symptoms of lung cancer (8)
haeoptysis, cough for more than 3 weeks, breathlessness, recurrent pneumonia/ chest infection that doenst clear up, weight loss, chest/ shoulder pains, tiredness, hoarse voice
36
what is stirdor
harsh inspiratory wheeze
37
what are the neighbouring structures that can be affected by local invasion (6)
recurrent laryngeal nerve, pericardium, oesophagus, brachial plexus, pleural cavity, superior vena cava
38
what causes a hoarse voice
paralysis of the vocal chords by invasion of the recurrent laryngeal nerve
39
what does local invasion of the pericardium cause
breathlessness, atrial fibrillation, pericardial effusion- fluid build up around heart, squashing it
40
what does invasion of the oesophagus cause
dysphagia- difficulty swallowing
41
what can muscle wasting of the hand be cause by
local invasion of the brachial plexus
42
what does pancoast mean
high up in lung
43
what is a pleural effusion
build up of fluid around lung
44
what is anasamoses
when the blood supply has to find an alternative route due to a blockage- invasion of the s.v.c
45
where are the common sites for primary lung cancer metastases (6)
liver, brain, bone, adrenal, skin, lung
46
what is the clinical presentation of a cerebral metastases
insidious onset- weakness (mimics stroke), visual disturbance, fits (epileptic when involves cortex) , headaches (raised intracranial pressure)
47
what are presentations of a bone metastases
pain, clinical fracture
48
what are presentations of a liver metastases
pain, in rare cases jaundice
49
what symptoms does adrenal metastases produce
usually none
50
what can metastatic deposits help identify
the original source
51
what are the non-metastatic symptoms of lungs cancer (paraneoplastic) (7)
finger clubbing, weight loss, thrombophlebitis, hypercalcaemia, hyponatraemia, weakness, hypertrophic pulmonary osteoarthropathy- HPOA
52
what can spinal metastases cause
paralysis
53
what is hyperthrophic pulmonary osteoarthropathy
pain caused by elevation of the periosteum from bone surface
54
why does thrombophlebitis occur in cancer patients
increased coagulability
55
hypercalcaemia; | stones
renal/biliary calculi
56
hypercalcaemia; | bones
bone pain
57
hypercalcaemia; | groans
abdominal pain/ constipation
58
hypercalcaemia; | thrones
polyuria
59
hypercalcaemia; | psychiatric overtones
anxiety, depression, coma
60
what type of cancer usually causes hypercalcaemia
squamous
61
how is hypercalcaemia treated
hydration, if severe iv bisphophonate
62
what is a cause of the weight loss associated with lung cancer
COPD/ pulmonary fibrosis
63
what is SIADH
syndrome of inappropriate antidiuretic hormone
64
what is hypercalcaemia caused by
hormones released by tumour
65
what type of cancer usually causes SIADH
small cell
66
what does SIADH
low sodium conc, generalised symptoms (nausea, seizures etc)
67
how id SIADH treated
treat cancer, fluid restriction
68
what investigations are used to diagnose lung cancer
full blood count, spirometry, chest x ray, ct scan of thorax, bronchoscopy, endobronchial ultasound, coagulation screen, PET
69
what investigation is not used to diagnose lung cancer
sputum cytology
70
what is a PET and what does it do
positron emission tomography- assesses function rather than structure via tissue uptake of radiolabelled glucose
71
what are the most common methods of making a tissue diagnosis (6)
bronchoscopy, CT guided biopsy, lymph node aspirate, aspiration of pleural fluid, endobonchial ultrasound, thoracoscopy
72
what is a commonly misdiagnosed for lung cancer
tuberculosis
73
what is another fusion oncogene that identifies a target for specific drug treatment
EML4-ALK
74
how can a cancer be staged for surgery
bronchoscopy, CT scan of brain and thorax, PET scan, mediastinoscopy/EBUS
75
describe small cell cancer
rapidly progressive, early metastases
76
how does small cell cancer respond to treatment
rarely suitable for surgery, good initial response to chemotherapy
77
describe how non small cell lung cancer (squamous and adeno carcinomas) are treated
curative options- surgery or radical radiology | palliative chemotherapies and new targeted treatment
78
what does PET stand for
positron emission tomography
79
outline the treatment for lung cancer after diagnosis
surgery, radiotherapy, chemotherapy, supportive care, palliative care
80
name two types of small cell cancer
squamous and andeno carcinoma
81
what needs to be considered before surgery
can it be removed, is it localised, will the patient survive, what will be the residual lung function
82
when is a pneumonectomy possible
when there is 2cm of disease free bronchus to close the hole
83
what is a pneumonectomy
removal of entire lung
84
what is a lobectomy
removal of a lobe
85
what is a thoracotomy
surgery to open chest
86
what is a VATS
video assisted thoracic surgery
87
what is the choice of chemotherapy drugs determined by
the cell type
88
describe staging for chemotherapy (3)
bronchoscopy/ tissue sampling (determines small cell/non), CT scan (tumour size, local invasion, nodes, metastases, performance status/ ECOG score (fit to cope with stress)
89
is cytotoxic chemotherapy curative
rarely, but longer survival
90
what type of cancer responds best
small cell
91
what is the biggest con of cytotoxic chemotherapy
major side effects
92
describe how cytotoxic chemotherapy is administered and what it entails
IV infusions every 3-4 weeks, outpatient visits
93
what does cytotoxic chemotherapy target
whole body- targets rapidly dividing cells
94
can cytotoxic chemotherapy pass the blood brain barrier
yes
95
what are the side effects of chemotherapy
nausea and vomiting, tiredness, bone marrow suppression (opportunistic infection and anaemia), hair loss, pulmonary fibrosis
96
what do new lung cancer treatments target
genetic mutations
97
describe radiotherapy (4)
ionising radiation- usully x rays, damage dividing cells Radical- curative intent palliative- useful for metastases, delaying well tolerated
98
what is the collateral damage of radiotherapy
spinal chord, oesophagus (oesophagitis), adjacent lung tissue
99
what are two other cons of radiotherapy
maximum cumulative dose, only goes where its pointed- not god for sub clinical metastases
100
what is SABR
stereotactic ablative radiotherapy
101
compare SABR to normal radiotherapy
many more beams- each less powerful
102
what is the benefits of SABR
less collateral damage, total dose delivers to tumour higher- more effective
103
what is required for SABR
4D scanning
104
what are endobronchial therapies used to do
remove blockages and help with symptoms
105
how are endobronchial therapies completed?
with a bronchoscopy
106
name three palliative endobronchial therapies
stent insertion for stridor, photodynamic therapy, other laser therapy
107
what is co morbidity
presence of one or more diseases/disorders co-occurring with the primary disease
108
what determines lung cancer treatment
cell type, extent of the disease, co-morbidity, patients wishes
109
what is common co-morbidity in lung disease
smoking related diseases' COPD, ischemic heart disease, peripheral vascular disease
110
what are 5 priorities in palliative care
pain, breathlessness. cough, anxiety, poor mobility
111
what is the average prognosis for lung cancer
half dead in 6 months, 1 in 20 survive for 5 years
112
apart from smoking what can cause lung cancer
asbestos and radon

Respiratory (26 decks)

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