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Lung Malignancies Flashcards

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1
Q

What imaging investigation is used before curative surgery or radiotherapy to ensure there are no occult metastases?

A

PET-CT scan

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2
Q

What imaging investigation is indicated in patients with long cancer who have bony pain or increased calcium/ALP?

A

Isotope bone scan

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3
Q

Which broad category of lung cancer is most likely to potentially be cured?

A

Non-small cell lung cancers

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4
Q

What treatment options are most likely to be used in the management of non-small cell lung cancer?

A

Surgery and radiotherapy

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5
Q

What treatment options are most likely to be used in the management of small cell lung cancer?

A

Chemotherapy

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6
Q

What are the two main curative treatment options for patients with early stage non-small cell lung cancer?

A

Surgical resection, high-dose radical radiotherapy

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7
Q

Other than smoking, what are some risk factors for the development of a primary lung cancer?

A

Passive smoking, asbestos exposure, radiotherapy to the lungs, family history

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8
Q

Mutations in which proto-oncogene are responsible for 10-30% of lung adenocarcinomas?

A

K-ras

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9
Q

Epidermal growth factor (EGFR) mutations can arise in which broad category of lung cancer?

A

Non-small cell lung cancers

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10
Q

What are the most common respiratory symptoms of lung cancer?

A

Cough and haemoptysis

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11
Q

What are the most common systemic symptoms of lung cancer?

A

Weight loss and fatigue

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12
Q

What are some less common symptoms of lung cancer which may occur secondary to a bronchial obstruction?

A

Shortness of breath and wheeze

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13
Q

Why may a primary lung cancer eventually cause chest pain?

A

Chest wall or mediastinal invasion

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14
Q

Name some abnormal features which may occur as a result of a Pancoast tumour?

A

Ipsilateral Horner’s syndrome and pain/weakness/paraesthesia of the hand and arm

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15
Q

Tumours in which location are more likely to cause haemoptysis- central or peripheral?

A

Central

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16
Q

SVC obstruction caused by a lung tumour may cause what symptoms?

A

Face/arm/neck swelling, dizziness, headaches, fixed and dilated neck veins

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17
Q

Recurrent laryngeal nerve palsy caused by a lung tumour will cause what symptom?

A

Hoarseness

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18
Q

Phrenic nerve palsy caused by a lung tumour will cause what symptom?

A

Worsening dyspnoea

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19
Q

What is the most common paraneoplastic syndrome experienced by patients with primary lung cancer?

A

Fever

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20
Q

What are some FBC abnormalities which may be seen in patients with lung cancer?

A

Anaemia of chronic disease and thrombocytosis

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21
Q

What paraneoplastic syndrome is commonly associated with squamous cell lung cancer?

A

PTH related peptide production, resulting in hypercalcaemia

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22
Q

Small cell lung cancers can result in the ectopic production of which hormones?

A

ADH and ACTH

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23
Q

Lambert-Eaton syndrome, causing limb weakness and autonomic dysfunction, is caused by what? Which type of lung cancer can this be associated with?

A

Anti-calcium channel antibodies, associated with small cell lung cancer

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24
Q

Primary lung cancers are most likely to metastasise to which lymph nodes?

A

Mediastinal, cervical, axillary

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25
What are some organs that primary lung cancers are likely to metastasise to?
Brain, bone, liver and adrenals
26
What is the standard investigation for any smoker aged > 50 with symptoms that could possibly be caused by lung cancer?
CXR
27
What are two blood tests that may be elevated in someone with bony metastases?
ALP and calcium
28
When are pulmonary function tests indicated in the investigation of individuals with lung cancer?
In all patients being considered for curative treatment
29
Other than a CXR, what further imaging is required in all patients with suspected lung cancer?
CT chest and abdo
30
Which imaging investigation(s) is/are indicated if a patient with suspected lung cancer has any neurological symptoms or signs?
Brain CT and/or MRI
31
What are the two curative surgical treatment options in the management of non-small cell lung cancers?
Lobectomy or pneumonectomy
32
Which patients are suitable for curative surgical treatment of non-small cell lung cancer?
Those with localised disease and no mediastinal invasion, and adequate lung function and performance status
33
In the management of non-small cell lung cancers, which patients receive curative radiotherapy?
Those who are not amenable to curative surgery
34
What is the use for low dose radiotherapy in the management of lung cancer?
Palliation of symptoms (in both small cell and non-small cell cancers)
35
EGFR inhibitors can be a useful treatment in the management of which type of lung cancer?
Adenocarcinomas with EGFR mutations
36
Small cell lung cancers respond rapidly to chemotherapy, but most patients relapse within how long?
A few months
37
How may a carcinoid tumour of the lung present?
Cough, lobar collapse, recurrent infections distal to bronchial obstruction
38
In carcinoid tumours of the lung, serotonin release can cause carcinoid syndrome. What symptoms does this cause?
Diarrhoea and skin flushing
39
What is the best treatment for carcinoid tumours of the lung?
Surgical excision
40
What medication may be useful in decreasing the symptoms associated with carcinoid syndrome?
Somatostatin analogues e.g. octreotide
41
What is the primary carcinogen responsible for causing mesothelioma?
Asbestos
42
What is the peak age of onset of mesothelioma?
50-70
43
What is the most common genetic abnormality associated with mesothelioma?
Chromosome 22 monosomy
44
What is the typical presentation of mesothelioma?
Pleural effusion, progressive breathlessness and chest pain, associated with systemic symptoms
45
What is the first line investigation for someone with a suspected mesothelioma? What might this show?
CXR- may show pleural thickening and/or pleural effusions
46
On average, how long is the delay between asbestos exposure and presenting with mesothelioma?
20-30 years
47
Which type of primary lung cancer may be described histologically as showing 'keratin pearls'?
Squamous cell carcinoma
48
Which type of primary lung cancer grows the most rapidly, and has usually metastasised by the time of presentation?
Small cell lung cancer
49
A CXR of which type of lung cancer is most likely to show patches of slow-growing consolidation, rather than a focal, well-defined mass?
Adenocarcinoma
50
Which type of lung cancer is most likely to occur in a non-smoker?
Adenocarcinoma
51
Which type of lung cancer is most often associated with hypercalcaemia?
Squamous cell carcinoma
52
Primary lung cancers arise from where?
Respiratory epithelium
53
What risk factor is responsible for causing 9/10 cases of primary lung cancer?
Cigarette smoking
54
At what age does the incidence of lung cancer peak?
80-84
55
Describe the two main categories of lung cancer, and give the sub-categories also?
Small cell lung cancer + non-small cell lung cancer (adenocarcinomas, squamous cell carcinoma, large cell carcinoma)
56
Which broad category of lung cancer is most common?
Non-small cell lung cancer
57
Which specific category of lung cancer is most common?
Adenocarcinoma
58
Which types of lung cancer are most likely to be located in the central airways?
Small cell and squamous cell carcinomas
59
Which types of lung cancer are most likely to be located in the peripheral lung?
Adenocarcinomas and large cell carcinomas
60
One of which two investigations must be performed to make a definitive diagnosis of lung cancer?
Biopsy for histopathology or sputum sample for cytology
61
What is the first line investigation when lung cancer is suspected?
CXR
62
Why is a tissue biopsy favoured over sputum cytology when making a definitive diagnosis of lung cancer?
Sputum cytology often gives false negatives
63
How is a biopsy taken for proximal lung cancers?
Bronchoscopy with endobronchial biopsies
64
How is a biopsy taken for peripheral tumours or lymph nodes?
Image guided needle biopsy
65
How is a biopsy taken for pleural effusions?
Thoracentesis (needle aspiration)
66
How is a biopsy taken for tumours/lymph nodes which cannot be samples in other ways as a last resort?
Surgical biopsy
67
The rapid response to chemotherapy seen with small cell lung cancers can increase the risk of what complication? What does this cause and how is it treated?
Tumour lysis syndrome- this causes electrolyte disturbances and renal failure, it should be treated with IV fluids and allopurinol
68
Name two management options for patients with brain metastases as a result of lung cancer?
Dexamethasone, whole brain irradiation
69
What treatment option is used to improve pain control in lung cancer patients with bony metastases?
Radiotherapy
70
After a diagnosis of small cell lung cancer, what is the mean survival time?
6 weeks
71
A unilateral pleural effusion in a middle-aged male patient must always raise the suspicion of what diagnosis?
Mesothelioma
72
If a patient has already had chemotherapy, what is an important differential for metastases to the lung?
Lung infections (as a result of immunosuppression)
73
Where are carcinoid tumours of the lung usually found?
In a major bronchus
74
Describe the typical growth pattern of carcinoid tumours of the lung?
Slow growing and locally invasive, often recur ofter excision, rarely metastasise
75
Name some hormones that may be produced by carcinoid tumours of the lung?
ACTH, serotonin, bradykinin
76
What is a pleural aspirate of a pleural effusion caused by a mesothelioma likely to show?
High protein (exudate), normal LDH, white and red blood cells
77
What investigation is required to diagnose a mesothelioma?
Radiologically guided or thoracoscopic biopsy (of the affected pleura)
78
Surgery is the only treatment option for mesothelioma that is potentially curative. Who would this treatment be indicated in?
Those with early stage disease and a good performance status
79
What is the purpose of radiotherapy in the management of mesothelioma?
Palliation of chest pain
80
What is the median survival time after a diagnosis of mesothelioma?
11 months

Gen Med (Resp) (4 decks)

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