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Lung cancer Flashcards

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1
Q

Pathology of neoplasia can present in 3 ways, what are they?

A 
Local effects (obstruction of airway etc.)
Metastases (nodes etc. )
Systemic effect (weight loss etc.)
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2
Q

What is the most common site of metastases of lung cancer?

A

the brain

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3
Q

A patient presents with pneumonia, how is this a presentation of lung cancer?

A

tumour partially obstructs bronchus of lobe, causing recurrent pneumonia infections

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4
Q

Localised chest wall pain, how could this be lung cancer?

A

Tumour invades chest wall, it can grow through intercostal spaces and the mass would lie deep to the pectoralis muscle.

Localised chest pain, worse with movement, if there is bone erosion, the pain can be described as worse at night.

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5
Q

A red flag for lung cancer is haemoptysis, what can cause this?

A

Fresh haemoptysis from the tumour which is ulcerating through the surface of the bronchial mucosa.

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6
Q

What are the neighbouring structures of the main bronchus which are prone to local invasion?

A 
Recurrent laryngeal nerve
Pericardium 
Oesophagus
Brachial plexus
Pleural cavity
Superior Vena Cava
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7
Q

Invasion of what would cause a hoarse voice?

A

recurrent laryngeal nerve - paralysis of vocal cord, tumour in upper lobe

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8
Q

Signs that a tumour has invaded the pericardium?

A

Atrial fibrillation
breathlessness
Pericardial effusion

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9
Q

Invasion of the oesophagus results in?

A

Dysphagia, particularly to solids

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10
Q

Which structure is invaded to cause weakness in the hand and what is the tumour called?

A

brachial plexus - Pancoast tumour

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11
Q

Lung cancers can cause ‘ectopic’ hormone production, give an example of this.

A

SIADH - Syndrome of Inappropriate antidiuretic hormone.

Results in low sodium concentration.

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12
Q

Which type of lung cancer is likely to cause SIADH?

A

small cell

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13
Q

What are signs of cerebral metastases?

A 
Insidious onset
Weakness 
Visual disturbance
Headaches - worse in morning
Fits
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14
Q

Which type of lung cancer is most common in smokers?

A

small cell

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15
Q

What are the types of carcinoma that make up NSCCs?

A

Large cell carcinoma
Squamous cell carcinoma
Adenocarcinoma

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16
Q

Which type of lung cancer is most common in non-smokers?

A

adenocarcinoma

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17
Q

How do you histologically diagnose lung cancer?

A

bronchoscopy + biopsy of tumour (if seen)

Biopsy ot needle aspiration of metastases - guided by USS. (mediastinal or supraclavicular lymph nodes)

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18
Q

Which cells do squamous cell carcinomas arise from?

A

epithelial cells

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19
Q

Hypercalcaemia due to ectopic production of PTH is associated with which carcinoma?

A

squamous cell

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20
Q

Which cells do adenocarcinomas arise from?

A

mucus-secreting glandular cells

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21
Q

Which cells do small cell carcinomas arise from?

A

endocrine cells

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22
Q

Which cells do large cell carcinomas originate from?

A

transformed epithelial cells

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23
Q

Which carcinoma is keratinising?

A

squamous

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24
Q

Which is the most malignant?

A

small cell

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25
Which carcinoma is most likely to cavitate?
squamous cell
26
Which carcinoma is diagnosed by exclusion?
large cell
27
Which carcinoma is poorly differentiated?
large cell
28
Which carcinoma has the worst prognosis?
small cell
29
Which out of the NSCCs has the worst prognosis?
large cell
30
What are the prognostic indicators?
tumour stage and histological subtype
31
Which atypical hyperplasia is becoming commoner?
peripheral adenocarcinoma | - the spread of neoplastic cells along alveolar walls - bronchioalveolar carcinoma
32
What is a CT scan used for in the prognosis?
TNM staging
33
What is the primary malignant pleural neoplasm?
mesothelioma
34
What is a mesothelioma?
An uncommon malignant tumour of the lining of the lung
35
What increases the likelihood of developing mesothelioma?
The degree and length of time exposed to asbestos.
36
What are some of the presenting signs of mesothelioma?
Used to work near asbestos (30-40 years ago). | SOB, chest pain, weight loss, fever, sweating & cough.
37
What would imaging investigations find of mesothelioma?
Pleural nodularity Circumferential pleural thickening Local invasion Lung entrapment
38
What is the management of mesotheliomas?
``` Radiotherapy Surgery Chemotherapy Palliative care Report deaths to fiscal ```
39
What is a pleural effusion?
Abnormal collection of fluid in the pleural space
40
Which types of effusion should raise concern?
large, unilateral effusion
41
Which is the workup process of a pleural effusion?
``` History + exam PA CXR Pleural aspirate (if not convincingly cardiac failure) Biochemistry (transudate/exudate) Cytology Culture ```
42
What is the protein content of a transudate effusion?
<30g/L
43
What is the protein content of an exudative effusion?
>30g/L
44
What are some of the causes of transudate effusions?
``` Heart failure Liver cirrhosis Hypoalbuminaemia Hypothyroidism Peritoneal dialysis - renal failure ITU / post-surgery ```
45
Cardiac failure and hypoalbuminaemia would cause what colour of pleural fluid appearance?
straw-coloured
46
What are some of the causes of exudative effusion?
malignancy infection, including TB pulmonary infarct asbestos
47
Trauma, malignancy, infection and infarction ... what colour of pleural fluid?
bloody
48
What causes a mild coloured pleural fluid?
empyema | chylothorax
49
Food particles would be found in the pleural fluid if...?
the oesophagus was ruptured
50
What would cause the pleural fluid to smell bad?
anaerobic empyema
51
What would cause bilateral effusion?
LVF PTE drugs systemic pathology
52
What is the main/palliative treatment for malignant pleural effusions?
long-term pleural catheters
53
What score is used to predict survival or malignant pleural effusions?
``` LENT score L- LDH E - ECOG PS (patient fitness score) N - (serum) Neutrophil to lymphocyte ratio T - tumour type ```
54
In which type of cancer can surgery be curative?
early stage NSCC
55
What is the treatment for SCC?
chemo + radiotherapy
56
What is the treatment for NSCC?
surgery ± chemo
57
What are the deciding factors for surgery to be a viable option?
Tumour not too near hilum No evidence of metastases FEV1 > 1.5L No vocal cord paralysis
58
What is the less invasive version of a thoracotomy?
minimal access VATS
59
What is the intent of radical radiotherapy?
curative
60
What is the aim of palliative radiotherapy?
delaying tactic - useful when metastasised
61
Radiotherapy is well tolerated but what is the disadvantage?
Collateral damage; oesophagus, spinal cord, adjacent lung tissue
62
What are the main things palliative treatment aims to improve/reduce in order to improve the patient's quality of life?
``` pain breathlessness cough anxiety poor mobility ```
63
What is the purpose of endo-bronchial palliative therapy?
Stent placement for stridor. | Stridor is distressing difficulty breathing (rope tightening) accompanied by an audible inspiratory wheeze.
64
What are the signs that a tumour has invaded the SVC?
Puffy eyelids Headache Distended external jugular vein
65
What are the signs of hypercalcaemia?
``` Stones - renal/biliary stones Bones - bone pain Groans - abo pain, constipation Thrones - polyuria Psychiatric overtones - depression, anxiety, reduced GCS, coma ``` + cardiac arrhythmias
66
What is the treatment for hypercalcaemia?
Rehydration If calcium still high and unchanged by fluids -> IV Bisphosphate Treat underlying cancer (squamous)

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