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Respiratory AM > Neoplasia > Flashcards

Neoplasia Flashcards

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1
Q

What % of deaths in the UK are caused by lung cancer?

A

6%

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2
Q

What are the causes of lung cancer?

A 
Tobacco
Asbestos
Environmental radon
Occupational exposure to carcinogens
Ai pollution and urban environment
Other radiation
Pulmonary fibrosis
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3
Q

What is the most common cause of lung cancer?

A

Smoking- >85%

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4
Q

What % of smokers get lung cancer?

A

10%

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5
Q

Who is more susceptible to the carcinogens in cigarettes?

A

Females

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6
Q

How can the risk of lung cancer from smoking be decreased?

A

Risk decreases with abstinence, but slowly

Resisting genomic changes mean risk doesn’t full disappear

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7
Q

What carcinogen causes squamous small cell lung carcinoma?

A

Polycyclic aromatic hydrocarbons

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8
Q

What carcinogen causes adenocarcinoma?

A

N-nitrosamines

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9
Q

What are the 2 main pathways of carcinogens in the lung?

A

In the periphery

In the central lung airways

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10
Q

What is the pathway od carcinogenesis in the periphery of lungs?

A

Bronchioalveolar epithelial stem forms
Adenocarcinoma
Caused by N nitrosamines

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11
Q

What is the pathogenesis of carcinogenesis in the central lung airways?

A

Bronchial epithelial stem cell forms
Squamous cell carcinoma
Caused by polycyclic aromatic hydrocarbons

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12
Q

What does the KRAS mutation cause in the lungs and what % of patients have this?

A

Adenocarcinoma

35%

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13
Q

What does the EGFR mutation cause in the lungs and what % of patients have this?

A

Adenocarcinoma

15%

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14
Q

What does the BRAF mutation cause in the lungs and what % of patients have this?

A

Adenocarcinoma

2%

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15
Q

What does the HER2 mutation cause in the lungs and what % of patients have this?

A

Adenocarcinoma

2%

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16
Q

What do ALK rearrangements cause in the lungs and what % of patients have this?

A

Adenocarcinoma

2%

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17
Q

What genetic mutations are smoking induced?

A

KRAS

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18
Q

What mutations can be targeted by a therapeutic?

A

EGFR

ALK

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19
Q

What are the cell types of cancer?

A

Squamous cell
Adenocarcinoma
Small cell carcinoma
Large cell carcinoma

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20
Q

What % of lung cancer cases are of each cell type?

A

Squamous- 40%
Adenocarcinoma- 41%
Small cell carcinoma- 15%
Large cell carcinoma- 4%

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21
Q

What are the histological types of lung cancer?

A

Small cell

Non small cell

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22
Q

What % of patients have each histological type of lung cancer?

A

Small cell- 15%

Non small cell- 85%

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23
Q

What is non small cell lung carcinoma?

A

A histological classification of tumour when tumours cannot be exactly identified

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24
Q

What are the local bronchial effects of lung cancer?

A

Collapse
Endogenous lipid pneumonia
Infection/Abscess
Bronchiectasis

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25
What are the local pleural effects of lung cancer?
Inflammatory | Malignant
26
What are the local effects of lung cancer by direct invasion of nerves?
Phrenic= diaphragmatic paralysis Left recurrent laryngeal nerve= hoarse, bovine cough Brachial plexus= pan coast T1 damage Cervical sympathetic nerve= Horner's syndrome
27
Where can lung cancer directly invade?
Chest wall Nerves Medistinum
28
What are the local effects of lung cancer due to lymph node metastases?
Mass effect | Lymphangitis carcinomatosa
29
Where are the most common places for lung cancer to metastasise to?
``` Liver Adrenals Bone Brain Skin ```
30
What are the non metastatic skeletal effects of lung cancer?
Clubbing | Hypertrophic pulmonary osteoarthropathy
31
What are the non metastatic endocrine effects of lung cancer?
Carcinoid syndrome Gynecomastia Paraneoplastic syndrome caused by hormone secretion- ACTH, siADH, PTH
32
What are the non metastatic neurological effects of lung cancer?
Polyneuropathy Encephalopathy Cerebellar degeneration Myasthenia (Eaton Lambert)
33
What are the non metastatic cutaneous effects of lung cancer?
Acanthosis nigerians | Dermatomyositis
34
What are the non metastatic haemolytic effects of lung cancer?
Granulocytosis Eosiophilia DIC
35
What are the non metastatic CV effects of lung cancer?
Thrombophlebitis migrans
36
What are the non metastatic renal effects of lung cancer?
Nephrotic syndrome
37
What are the non metastatic effects of cancer due to?
Chemical/hormonal effect caused by the cancer other than the spread
38
How are the non metastatic effects of cancer mediated?
Autoimmune mediated | Immune system "conned" by tumour into attacking its own tissues
39
What are the most common clinical features of lung cancer?
``` Chronic cough Haemoptysis Wheeze Chest and bone pain Frequent chest infections ```
40
What are the less common features of lung cancer?
``` Difficulty swallowing Raspy hoarse voice SOB Unexplained weight loss Nail clubbing ```
41
What are the metastatic advanced disease symptoms of lung cancer?
Bone pain Spinal cord compression Cerebral metastases Thrombosis
42
What does spinal cord compression in lung cancer cause?
Limb weakness Paraesthesia Bladder/bowel dysfunction
43
What do cerebral metastases in lung cancer cause?
``` Headaches Vomiting Dizziness Ataxia Focal weakness ```
44
What are the paraneoplastic effects of advanced lung cancer?
``` Hyponatraemia Anaemia Hypocalcaemia Dermatomyocytosis/polymyositis Cerebellar ataxis Sensorimotor neuropathy ```
45
What causes hypercalcaemia in lung cancer?
Parathyroid hormone related protein | Bone metastases
46
What are the clinical signs of lung cancer?
``` Chest signs Clubbing Lymphadenopathy Horner's syndrome Pancoast tumour Hepatomegaly Skin nodules ```
47
What initial investigations are carried out to investigate for lung cancer?
CXR CT Clotting screen Tissue diagnosis
48
When is a CT scan carried out?
If CXR abnormal
49
What are the methods of tissue diagnosis?
``` Bronchoscopy Image guided lung biopsy Image guided liver biopsy Fine needle aspiration neck node/ skin metastases Excision of cerebral metastases Bone biopsy Mediastinoscopy Surgical excision biopsy Endobronchial ultrasound ```
50
When is bronchoscopy used for tissue diagnosis?
Most common | Used for central tumours
51
What does histology of tumours allow for?
Assessment of most appropriate treatment and prognosis
52
What type of staging is used for lung cancer?
TNM
53
What do the 3 areas of TNM staging assess?
Tumour size and proximity to chest wall Lymph node involvement Metastasis
54
What are PET scans used for?
Detect distant micrometastases
55
How do PET scans work to detect tumours?
Radionucleotide sugary contrast given to "light up" cancer cells
56
What is stage T1?
Tumour <3cm in greatest dimension, surrounded by lung or visceral pleura, no involvement of main bronchus T1a <1cm T1b <2cm T1c <3cm
57
What is stage T2?
Tumour 3-5cm, involving visceral pleura and main bronchus but not carina Associated with atelectasis or obstructive pneumonitis that extends to hilar region T2a 3-4cm T2b 4-5cm
58
What is stage T3?
``` Tumour 5-7cm or directly invades one of -chest wall -phernic nerve -parietal pericardium or has tumour nodules in same lobe as primary tumour ```
59
What is stage T4?
``` Tumour >7cm of invades one of -diaphragm -mediatinum -heart -great vessels -trachea -recurrent laryngeal -oesophagus -vertebral body -carina or has tumour nodes in a separate lobe ```
60
What is stage N0?
No regional lymph node metastases
61
What is stage N1?
Ipsilateral peribronchial, hilar, or intrapulmonary nodes including by direct extension
62
What is stage N2?
Ipsilateral mediastinal or subcarinal
63
What is stage N3?
Contralateral mediastinal, hilar, scalene or supraclavicular
64
What is stage M0?
No distant metastases
65
What is stage M1?
Distant metastases M1a- separate tumour nodules in contralateral lobe, tumour with pleural or pericardial nodules or malignant pleural or pericardial effusion M1b- single distant metastases M1c- multiple distant metastases
66
What is the prognosis for small cell carcinoma?
Bad
67
What is the prognosis for adenocarcinoma?
Good
68
What is performance status?
Assessment used to predict how patients will respond to treatment 0-2 likely have good prognosis
69
What are the performance statuses?
``` 0=fully active 1= symptomatic but ambulatory 2= up and about >50%, unable to work 3= up and about <50%, limited self care 4= bed or chair bound ```
70
What are the surgical treatment options?
Wedge resection Lobectomy Pneumonectomy
71
What % of patients can get surgery?
18%
72
What are the 3 types of radiotherapy?
Radical Palliative Sterotactic
73
How can chemotherapy be used?
Alone Combined Adjuvant
74
What are the 2 types of chemo?
Radical | Palliative
75
What are the aims of best supportive care?
Reduce pain | Increase quality of life
76
What is used in symptom control in best supportive care?
Chemo/radiotherapy Opiates, bisphosphates, benzodiazepines Treatment of hypercalcarmia, dehydration, hyponatraemia
77
What are the treatment options for non small cell lung cancer?
Surgery Chemo Radiotherapy
78
What is neoadjuvant and adjuvant therapy?
Pre and post operative therapy to increase chance of cure
79
What is the treatment of choice for small cell lung carcinoma?
Chemo
80
What are the ideal concurrent therapies for small cell lung carcinoma?
Chemo Thoracic radiotherapy Prophylactic cranial radiation
81
What is the treatment for expensive small cell lung cancer?
4 cycles of chemo Singl fraction radiotherapy if not fit for chemo Radiotherapy and steroids for brain metastases

Respiratory AM (10 decks)

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