28. Lung Cancer Flashcards
true or false: lung cancer is the most common cause of cancer mortality
true
what are some risk factors for lung cancer
- smoking!!!!!!
- personal hx of lung cancer
- family history of lung cancer
- asbestos
- age (> 40)
- second hand smoke
- radiation exposure
true or false: women are more susceptible to tobacco effects
true
what are the early symptoms of lung cancer
- cough
- dyspnea
- hemoptysis
- recurrent infections
- chest pain
what are the most common sites of metastases in lung cancer (+ their symptoms)
brain (seizures, confusion, personality changes, h/a, n/v), bones (pain), liver (weight loss, weakness) and adrenals (asymptomatic)
what % of lung cancers are small cell carcinomas
15%
what % of lung cancers are non-small cell carcinomas
85%
this type of lung cancer has the most aggressive clinical course of all lung tumors if left untreated
small cell lung cancer
true or false: small cell lung cancers are related to smoking
true
true or false: small cell lung cancers are located centrally
true
what are the 3 types of non-small cell lung cancer
- adenocarcinoma (45-50%)
- squamous cell carcinoma (25-30%)
- large cell carcinoma (5-10%)
this type of non-small cell lung cancer usually arises from the mucus-producing cells in the lung
adenocarcinoma
true or false: adenocarcinomas are mainly centrally located
false - 2/3 in outer part of lung, 1/3 develop in central part of lung
true or false: adenocarcinomas are related to smoking
false
true or false: adenocarcinomas are more common in women
true
this non-small cell carcinoma is slower growing and often causes bronchial obstruction
squamous cell carcinoma
true or false: squamous cell carcinoma is related to smoking
true
true or false: squamous cell carcinomas are located centrally
true
true or false: squamous cell carcinomas are more common in women
false
this non-small cell carcinoma tends to spread/metastasize early
large cell carcinoma
true or false: large cell carcinomas are related to smoking
false
true or false: large cell carcinomas are located centrally
false
what are some negative prognostic factors for lung cancer
- weight loss
- poor performance status
- mediastinal lymph node involvement
- male gender
- elevated LDH
- bone or liver metastasis
- adeno and large cell
know the stages of small cell lung cancer
limited - one side of the chest
extensive - both sides of the chest
know the stages of non-small cell lung cancer
stage 1 - small tumor that has not spread to lymph nodes or any other structures in the chest
stage 2 - tumor is bigger than stage 1 or it has spread to nearby lymph nodes or it has spread into the large bronchial tubes
stage 3a - tumor has spread to the lymph nodes or other structures in the middle of the chest
stage 3b - tumor has spread to the other side of the chest or mediastinal lymph nodes
stage 4 - BBLA involvement
what is the treatment for NSCLC stage Ia
surgery
(+ rads if surgical resection markers are positive)
what is the treatment for NSCLC stage Ib
surgery + adjuvant chemo
(+ rads if surgical resection markers are positive)
what is the treatment for NSCLC stage II
surgery + adjuvant chemo +/- immunotherapy
(+ rads if surgical rescetion markers are positive)
what is the treatment for NSCLC stage IIIa
surgery + adjuvant chemo +/- immunotherapy
(+ rads if surgical rescetion markers are positive)
what is the treatment for NSCLC stage IIIb
combined chemo/rads + maintenance Durvalumab x 12 months
what is the treatment for NSCLC stage IV
chemo or TT or immunotherapy or rads
how many cycles of chemo is used in all stages of NSCLC
4-6 cycles
what treatment is given if your patient has stage 4 NSCLC, PD-L1 > 50%, and the disease is not rapidly progressive/very extensive
Pembrolizumab
what treatment is given if your patient has stage 4 NSCLC, PD-L1 < 50%, and they have squamous histology
Pembrolizumab, Carboplatin & Paclitaxel
what treatment is given if your patient has stage 4 NSCLC, PD-L1 < 50% and they have adenocarcinoma histology
Pembrolizumab, Carboplatin & Pemotrexed
this mutation accounts for about 15% of NLCSC
EGFR
what is the most common EGFR inhibitor used
Osimertinib
this mutation accounts for about 5-7% of NSCLC
ALK
what are examples of ALK inhibitors
crizotinib, alectinib and lorlatinib
true or false: if a patient fails one ALK inibitor, they can try another one
true
how is the limited stage of small cell lung cancer treated
radiation + chemo (4-6 cycles of chemo)
how it the extensive stage of small cell lung cancer treated
4 cycles of chemotherapy with durvalumab then durvalumab monotherapy
