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Flashcards in Lung cancer Deck (39)
1

refer along 2 week suspected cancer pathway if:

- CXR finding suggest lung cancer
- aged over 40 with unexplained haemoptysis

2

offer urgent CXR within 2 weeks to assess for lung cancer in people aged 40 and over if they have 2 or more of the following unexplained symptoms or have ever smoked and have 1 of following

- cough
- fatigue
- SoB
- chest pain
- weight loss
- apetite loss

3

consider urgent CXR to assess for lung cancer in people aged 40 and over with any of the following

- persistent/recurrent chest infections
- finger clubbing
- supraclavicular lymphadenopathy
- chest signs consistent with lung cancer
- thrombocytosis

4

staging system for lung cancer

TNM
T - tumour
N - nodes
M - metastases

5

T1 tumour

less than 3 cm

6

T2 tumour

3-7 cm
or
involves main bronchus > 2cm from trache

7

T3 tumour

> 7 cm
OR
invades chest wall
OR
separate nodule same lobe

8

T4 tumour

invades local structures e.g. mediastinum, heart, trachea
(inoperable)

9

Nodal staging

N0 - no nodes
N1 - local ipsilateral node
N2 - ipsilateral mediastinal nodes
N3 - contralateral mediastinal nodes

10

brain metastases and lung cancer

1/3 those with lung cancers are thought to develop brain metastases

11

investigation of choice for Brain metastases

contrast enhanced brain MRI

12

management of brain mets w/ oedema

Dexamethasone 8mg BD PO

13

what should be checked prior to starting steroids

blood glucose

because steroids can exacerbate diabetes

14

what is the 1 year survival or patients diagnosed with lung cancer in the UK

30%

15

symptoms of SVC obstruction and how can they be relived instantly?

- dilated veins on upper chest
- red suffused eyes
- SoB: worse on lying down
- swelling of an arm

SVC stent

16

which lung cancer is more chemosensitive

small cell lung cancer

17

possible curative treatments for small cell lung cancers (4)

- chemotherapy followed by radiotherapy
- radiotherapy alone
- surgery alone
- surgery followed by radiotherapy

18

red flags for lung cancer (5)

- dry/productive cough
- haemoptysis
- hoarse voice
- chest pain
- constitutional symptoms: apetite/weight loss, fatigue

19

what are paraneoplastic syndromes

rare disorders caused by an immune response to cancer

20

3 paraneoplastic syndromes linked to small cell lung cancer

SiADH
ACTH
Lambert Eaton syndrome

21

what is SiADH + the management

ADH caused excessive retention causing hyponatraemia

manage: fluid restriction, vasopressin, demeclocycline

22

vasopressin

ADH receptor antagonist

23

effect of ACTH

bilateral adrenal hyperplasia --> high levels of cortisol --> hypokalaemic alkalosis
- muscle weakness
- hypertension
- hypokalaemia
- alkalosis

24

what is Lambert eaton syndrome

when an antibody is directed against pre synaptic voltage gated calcium channels in the peripheral nervous system resulting in repeated muscle contractions, limb girdle weakness, hyporeflexia and autonomic symptoms

25

name 4 paraneoplastic syndromes of squamous cell lung cancer

- clubbing
- PTH-rp
- HPOA (hypertrophic pulmonary osteoarthropathy)
- ectopic TSH

26

types of lung cancer

small cell lung cancer

non small cell lung cancer

27

3 subtypes of non small cell lung cancer

- squamous cell lung cancer
- adenocarcinoma
- large cell lung cancer

28

features of small cell lung cancer (15% cancers)

- central
- smoking related
- rapid growth
- arise from APUD cells
- associated with ectopic secretion

29

features of squamous cell carcinoma

- centrally located
- symptoms develop early
- smoking related

30

features of adenocarcinoma

- peripheral
- most common type in non smokers
- slower growth
- metastasise early
- can respond to newer agents such as tyrosine kinase inhibitors

31

features of large cell carcinoma

- typically peripheral
- may secrete b-hcg

32

investigations when suspecting lung cancer

- fbc
- renal function
- bone profile
- liver function
- ct scan
- pulmonary function tests
- bronchoscopy + biopsy
- PETCT

33

causes of lung collapse

COPD, CF, pneumonia

34

location of chest drain for tension pneumothorax

mid axillary 5th intercostal space

35

what does a PET CT show

metabolically active tumours

36

what is a unilateral pleural effusion caused by until proven otherwise

lung cancer

37

2 causes of lower lobe collapse

cancer, mucus plug

38

M1a

malignant effusion or separate tumour nodule

39

M1b

distant metastases