RESP: Malignancy Flashcards Preview

Year 3 Medicine Block > RESP: Malignancy > Flashcards

Flashcards in RESP: Malignancy Deck (22)
Loading flashcards...
1
Q

2 Main types of lung cancer?

A

Small cell- 15% of cases and worse prognosis

Non-small cell- more common

2
Q

Types of non-small cell lung cancer?

A

Adenocarcinoma
Squamous cell carcinoma
Large cell carcinoma

3
Q

Most common type of lung cancer?

A

Adenocarcinoma

4
Q

Symptoms of lung cancer?

A
Persistent cough 
Haemoptysis 
Dyspnoea 
Chest pain 
Weight loss and anorexia 
SVC obstruction
5
Q

What type of tumour causes a hoarse voice?

A

Pancoast tumour pressing on the recurrent laryngeal nerve

6
Q

Sign of lung cancer?

A

Cachexia
Finger Clubbing
Hypertrophic pulmonary osteoarthropathy
Anaemia
Horner’s syndrome (if the tumour is apical)
Enlargement of supraclavicular and axillary lymph nodes
Paraneoplastic syndromes: Cushing’s syndrome, SIADH, and Lambert-Eaton syndrome (suggest small-cell), hyperparathyroidism (suggests squamous cell)

7
Q

On auscultation of the lungs, how might lung cancer sound?

A

Features of consolidation (pneumonia); collapse (absent breath sounds, ipsilateral tracheal deviation); pleural effusion (Stony dull percussion, decreased vocal resonance and breath sounds)

8
Q

Features of squamous cell carcinoma?

A

Typically central tumour
Associated with PTHrP- hypercalcaemia, finger clubbing and hypertrophic pulmonary osteoarthropathy
May also get hyperthyroidism due to ectopic TSH

9
Q

Features of large cell carcinoma?

A

Peripheral
Usually anaplastic and poorly differentiated with poor prognosis
May secrete B-hCG

10
Q

Features of small cell carcinoma?

A

Associated with ectopic ADH–> hyponatraemia
ectopic ACTH–> hyperglycaemia, hypertension, hypokalaemia, alkalosis, muscle weakness–> may get bilateral hyperplasia of the adrenal glands
Lambert- Eaton syndrome

11
Q

What is Lambert- Eaton syndrome?

A

Antibodies to voltage gated calcium channel–> myasthenic like symptoms

12
Q

What is SVC obstruction?

A

Oncological emergency

Compression of the SVC most commonly due to lung cancer

13
Q

Features of SVC obstruction?

A
Dyspnoea 
Swelling of face and neck, conjunctival and periorbital oedema 
Headache- often worse in the morning 
Visual disturbance 
Pulseless jugular venous distension
14
Q

Management options for SVC obstruction?

A

Dependent on pt, options range from:
endovascular stenting for symptoms relief
Radical chemo or chemo-radio therapy
Glucocorticoids are usually given but evidence is weak

15
Q

Investigations in suspected lung cancer?

A

Cxr- may see nodules, lung collapse, pleural effusion, consolidation, and bony metastases

CT- confirm diagnosis and to stage it, ensure adrenals and liver are also scanned to have a look

Bronchoscopy- allow biopsy to be taken

PET scanning- usually in non-small cell lung cancer–> eligibility for curative treatment. Uses 18-fluorodeoxygenase which is preferentially taken up by neoplastic tissue

16
Q

Management of small cell lung cancer?

A

Most pts will be on palliative chemo

May try chemo-radiotherapy for some patients, however prognosis is poor

17
Q

Management of Non-small cell lung cancer?

A

Only 20% suitable for surgery, before surgery mediastinoscopy performed as CT doesn’t always show mediastinal involvement

Curative or palliative radiotherapy
Chemo may be offered palliatively

18
Q

Ddx for lung cancer?

A

pneumonia, bronchitis, exacerbation of COPD, mets from another site, sarcoidosis, TB

19
Q

What blood abnormality would you most likely see in lung cancer?

A

Raised platelets

20
Q

Context:Pt has lung cancer.

What scale is used to interpret a patient’s level of fitness?

A

WHO scale to find out performance status

21
Q

WHO scale for fitness level in pts with lung cancer is from 0 to 5. Describe each level.

A

0 - normal fitness - fully active without restriction
1 - restricted in physically strenuous activity. Ok with light work e.g. office work, light house work
2 - capable of all self care, ambulatory but can not carry out work activities. Active (up and about ) over 50% of waking hours
3 - capable of only limited self care. Confined to bed or chair for more than 50% of waking hours
4 - completely disabled. Can no self care. Totally confined to bed or chair.
5 - dead.

22
Q

Gold standard investigation for bronchiectasis?

A

High resolution (1/2) CT (1/)

Decks in Year 3 Medicine Block Class (56):