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CARDIO & RESPIRATORY phase 1b > 1b Lung Cancer > Flashcards

1b Lung Cancer Flashcards

1
Q

What is the biggest modifiable risk factor for lung cancer?

A

Smoking (85%)

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2
Q

What can cause lung cancer other than smoking?

A

Chronic lung diseases (COPD, fibrosis)
Immunodeficiency
Familial/ genetic – several loci identified
passive smoking
asbestos
radon
indoor cooking fumes
air pollution

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3
Q

What is a DNA adduct?

A

pieces of DNA covalently bound to a cancer-causing chemical

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4
Q

How do DNA adducts form?

A

The interaction between inhaled carcinogens and the epithelium of upper and lower airways leads to the formation of DNA adducts

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5
Q

What do adducts lead to the formation of?

A

They can result in a mutation or genomic alteration

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6
Q

Which cancer originates from the bronchial epithelium and is generally centrally located?

A

Squamous Cell Carcinoma (30%)

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7
Q

Which lung cancer arises from the mucus producing glandular tissue, and is more peripherally located?

A

Adenocarcinoma (40%)

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8
Q

Which cancer type originates from pulmonary neuroendocrine cells and is highly malignant?

A

Small cell lung cancer (15%)

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9
Q

Which cancer type is from heterogenous group and is undifferentiated?

A

Large cell lung cancer (15%)

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10
Q

What is NSCLC?

A

Non Small Cell Lung Cancer

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11
Q

Mutations in which oncogene are important for directed treatment in women, asian ethnicity and never smokers?

A

epidermal growth factor receptor (EGFR) tyrosine kinase

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12
Q

Mutations in which oncogene are important for directed treatment in younger patients and never smokers?

A

Anaplastic lymphoma kinas3 (ALK) tyrosine kinase

c-ROS oncogene 1 (ROS1) receptor tyrosine kinase

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13
Q

Mutations in which oncogene are important for directed treatment in smokers especially?

A

BRAF

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14
Q

What are the clinical features of lung cancer?

A

Cough
Weight loss
Breathlessness
Fatigue
Chest pain
Haemoptysis

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15
Q

What are some features of advanced / metastatic disease?

A

Focal weakness
Seizures
Bone Pain
Paraneoplastic syndromes

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16
Q

What are some paraneoplastic symptoms?

A

clubbing, hypercalaemia, hyponatraemia, Cushing’s

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17
Q

What is pembertons sign?

A

Facial Redness and Congestion for One minute when the patient is asked to raise their hands above their head

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18
Q

What is horners syndrome?

A

constricted pupil (miosis)
drooping of the upper eyelid (ptosis)
absence of sweating of the face (anhidrosis), and sinking of the eyeball into the bony cavity that protects the eye (enophthalmos).

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19
Q

What imaging is done for a definitive staging process?

A

PET-CT (fluorodeoxyglucose)

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20
Q

When would a bronchoscopy be performed?

A

For tumours of the central airway, where staging the tissue is not important

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21
Q

Which biopsy technique is used to stage mediastinum and achieve tissue diagnosis?

A

Endobronchial ultrasound and transbronchial-needle aspiration of mediastinal lymph nodes (EBUS [TBNA])

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22
Q

Which biopsy technique is used to access peripheral lung tumours?

A

CT Guided Lung Biopsy

23
Q

What is the TMN system?

A

Tumour
Nodes
Metastasis

24
Q

What are some factors which determine how the cancer is treated?

A

Patient fitness
Cancer histology
Cancer stage
Patient preference
Health service factors

25
Q

What are the five stages in the WHO Performance Status Test?

A
  1. Asymptomatic
  2. Symptomatic but ambulatory
  3. Symptomatic but in bed less than 50% of the day
  4. Symptomatic but in bed >50% of the day, but not bed bound
  5. Bed Bound
  6. Death
26
Q

Which stages of the WHO PS is radical treatment restricted to?

A

PS 0-2

27
Q

What is the standard of care for early stage lung cancer disease?

A

Surgical resection

28
Q

What is the usual surgical approach for lung cancer?

A

Lobectomy + lymphadenectomy usual approach
sublobar resection if stage 1 (<= 3cm)

29
Q

What is the alternative for surgery for early stage disease?

A

Radical Radiotherapy - particularly if the patient has co-morbidities

30
Q

What is the technique of choice for radical radiotherapy?

A

SABR - Stereotactic ablative body radiotherapy (SABR)

High-precision targeting, multiple convergent beams

31
Q

What is the first line treatment for metastatic NSCLC with mutation?

A

Oncogene directed Systemic treatment - targetted towards EGFR (erlotinib, gefitinib, afatinib, dacomitinib, and osimertinib)
ALK (crizotinib, ceritinib, alectinib, brigatinib, lorlatinib)
ROS-1 (crizotinib, entrectinib)

Tyrosine Kinase Inhibitor

32
Q

What are the common side effects of oncogene directed systemic treatment?

A

rash, diarrhoea, and (uncommonly) pneumonitis

33
Q

Binding of what inhibits T cells from killing cancer cells?

A

PD-L1/PD1 binding

34
Q

What immunotherapy is used to treat lung cancer?

A

Blocking of PD-L1 or PD-1 allows the T cells to then kill the cancer cells

Pembrolizumab, atezolizumab, nivolumab

35
Q

What cancer is immunotherapy the first line of treatment for?

A

First line for metastatic NSCLC with no mutation (and PDL1 ≥50%)

36
Q

What are the side effects of immunotherapy to treat lung cancer?

A

Immune-related side-effects in 10-15% of cases (thyroid, skin, bowel, lung, liver)

37
Q

Describe how cytotoxic chemo works?

A

Targets apidly dividing cells using platinum based regimens
carboplatin, cisplatin, paclitaxel, pemetrexed

38
Q

What are the side effects of chemotherapy used to treat lung cancer?

A

Frequent: fatigue, nausea, bone marrow suppression, nephrotoxicity
quality of life poorly evaluated in trials

39
Q

What should be offered as a standard to all patients with advanced stage lung cancer?

A

palliative and supportive care

40
Q

What treatment is used for early stage disease?

A

Surgery or radiotherapy with curative intent

41
Q

What treatment is used for advanced, but local disease?

A
  • Surgery + adjuvant chemotherapy
  • Radiotherapy + chemotherapy +/- immunotherapy
42
Q

What treatment is used for metastatic disease with a targetable mutation?

A

tyrosine kinase inhibitor

43
Q

What treatment is used for metastatic disease with no mutation but PDL-1 Positive?

A

Immunotherapy alone

44
Q

What treatment is used for metastatic disease with no mutation but PDL-1 Negative ?

A

‘standard’ chemotherapy + immunotherapy

45
Q

What is the most common type of Lung Cancer?

A

Adenocarcinoma

46
Q

Why is it important to screen for lung cancer?

A

The tumour can get very large and develop very quickly before it starts to cause problems, by which point it might be too late

47
Q

Why does metastatic lung cancer cause focal weakness?

A

Due to cardiac vegetations which embolize to main cerebral arteries

48
Q

What causes the clubbing seen in metastatic lung cancer?

A

Due to increased blood flow to the area, leading to an accumulation of fluid in the soft tissues at the terminal portion of the finger

49
Q

Why can lung cancer lead to cushings?

A

Small cell lung cancer canoccasionally be a source of ectopic ACTH secretion

50
Q

Why does cachexia occur in lung cancer

A

Due to increased breakdown and depletion of skeletal muscle proteins

51
Q

When pemberton’s sign is present, which vessel is obstructed?

A

Superior Vena Cava

52
Q

What is PET most useful for in a diagnosis of lung cancer?

A

Detect occult metastasis and detects mediastinal lymph nodes

53
Q

The TNM8 lung cancer staging system uses primary tumour site, tumour size, regional lymph node metastases and which other characteristic to score lung cancer progression

A

Extrathoracic Metastasis

54
Q

What types of surgery is the usual approach to treat lung cancer?

A

Lobectomy + lymphadenectomy

CARDIO & RESPIRATORY phase 1b (14 decks)

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