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Systems: Resp. WK > 33. Non-operative Management of Lung Cancer > Flashcards

33. Non-operative Management of Lung Cancer Flashcards

1
Q

What is the most common cancer in the world? (and most preventable)

A

lung cancer

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2
Q

How many people wordwide die from lung cancer when considering all cancer deaths?

A

1 in 5 estimated deaths from cancer worldwide

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3
Q

What diagnostic technique is the easiest to diagnose lung cancer?

A

chest x ray (easily accessible, cheap)

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4
Q

What are possible screening techniques used to diagnose cancer following a chest x ray to determine which segment cancer sits in? (2)

A
  • bronchoscopy

- CT of thorax

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5
Q

What are 2 major histological cancer sub-types?

A
  1. non-small cell lung cancer (85%)
  2. small cell lung cancer (15%); oat cell cancer
  3. pleural mesothelioma (epithelioid, sarcomatous, biphasic)
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6
Q

What are some types of non-small cell lung cancers? (4)

A
  1. adenocarcinoma
  2. squamous cell carcinoma
  3. large cell undifferentiated carcinomas (5%)
  4. NOS; not otherwise specified cancers
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7
Q

What is the most common non-small cell carcinoma?

A

adenocarcinoma

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8
Q

Where is squamous cell carcinoma mainly situated and who does it more commonly affect?

A
  • usually central

- more likely in males (esp. smokers)

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9
Q

Where is adenocarcinoma mainly situated and who does it more commonly affect?

A
  • usually more peripheral

- more likely in females

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10
Q

Which lung cancer type is most aggressive?

A

small cell carcinoma

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11
Q

What hormonal abnormalities do highly malignant forms of small cell lung cancer lead to?

A

it’s a neuroendocrine tumour; can affect ACTH and ADH secretion abnormality affecting hormone balance in the body

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12
Q

What does the TNM system stage tumours by?

A
  1. T= size
  2. M= mediastinal/other major structure invasion (metastasis)
  3. N- nodal involvement
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13
Q

What does stage 4 non-small lung cancer indicate about mets?

A

indicates distant metastasis

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14
Q

What is the maximum percentage of operable/resectable non-small cell lung cancers?

A

25%

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15
Q

What are possible therapeutic options once tumour results are in? (5)

A
  1. surgery
  2. radiotherapy (curative/radical or pallative)
  3. chemotherapy
  4. combination of all of the above
  5. targeted therapies
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16
Q

What is the Eastern Cooperative Group (ECOG) performance status management used for?

A

determining the optimal therapy for patient (including stage of cancer and pathology)

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17
Q

What is ECOG scale 0 of performance?

A

asymptomatic and well

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18
Q

What is ECOG scale 1 of performance?

A

symptomatic; able to do light work

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19
Q

What is ECOG scale 2 of performance?

A

has to rest but for< 50% of the day

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20
Q

What is ECOG scale 3 of performance?

A

has to rest for >50% of the day

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21
Q

What is the ECOG scale 4 of performance?

A

bedbound

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22
Q

What is the doubling time approximately of non-small cell lung cancer?

A

~129 days

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23
Q

What does surgical survival of non-small cell lung cancer depend on?

A

Depends on stage

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24
Q

What percentage of lung cancer patients are offered surgery?

A

~25%

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25
Q

40% of lung cancer patients have what survival rate?

A

5 years (which is high for lung cancer patients)

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26
Q

What are the large studies done for adjuvant and neoadjuvant therapies by determining gene sequencing?

A

Adjuvant therapy; IALT meta-analysis

Neoadjuvant therapy; LU22 and meta analysis

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27
Q

What is adjuvant therapy?

A

POSToperative therapy to increase chances of cure for patient (as much resection as possible was done but there is still small chance cancer could exist so therapies decreases chances of tumour re-growing again)

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28
Q

In which stages is radiotherapy adjuvant therapy detrimental to patient’s health?

A

stage 1 and 2

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29
Q

Which region does adjuvant therapy benefit when cancer spreads?

A

some benefit possible in mediastinal nodes (n2) or involved margins

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30
Q

What does adjuvant therapy involve? (2)

A

adjuvant radiotherapy and adjuvant chemotherapy

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31
Q

What 2 chemotherapy drugs are given as part of adjuvant therapy for stage Ib and II of lung cancer?

A
  1. cisplatin
  2. vinorelbine
    (5 year survival improved by 15%)
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32
Q

What is neoadjuvant therapy?

A

PREop therapy where chemotherapy is administered to increase chances of recovery after the surgery

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33
Q

Which stage/s of lung cancer are given neo-adjuvant therapy? (chemotherapy)

A

stage 3

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34
Q

What approximate percentage of patients present with advanced disease?

A

~80%

35
Q

How advanced is stage 3 lung cancer?

A
  • ~30% locally advanced

- mediastinal/major vessel invasion or mediastinal nodes involved

36
Q

How advanced is stage 4 lung cancer?

A

-~60% distant metastases

37
Q

What are treatment decisions regarding advanced disease affected by that is not tumour size or stage?

A

co-morbid diseases in patients (e.g. angina, COAD, COPD)

38
Q

What type of treatment is chemotheapy?

A

systemic treatment

39
Q

Is survival rate alone better with chemotherapy or radiotherapy?

A

radiotherapy alone

40
Q

What is the approximate survival rate for patients undergoing chemo radiotherapy?

A

extends life by approx. 2 years

41
Q

What 2 therapeutic options are there for stage 3 and 4 lung cancer?

A
  1. radiotherapy

2. chemo-radiotherapy

42
Q

What is the therapeutic option for stage 4 cancer?

A
  • incurable

- palliation essential

43
Q

In stage 4 patients, what is radiotherapy administered to?

A

to primary tumour (~70% symptom benefit)

44
Q

What are main advantages of chemotherapy for stage 4 patients?

A
  1. equal symptomatic benefit

2. survival advantage (median survival <12 months with chemo alone)

45
Q

How many chemo cycles are there usually in stage 3 and 4 patients?

A

3-6 cycles (on average it’s 4)

46
Q

What is best therapy option for painful bone mets in a stage 3/4 patient? (1)

A

radiotherapy on single fraction

47
Q

What is best therapy option for brain mets in stage 3/4 patient? (4)

A

resection, radiotherapy, steroids or erlotinib

48
Q

What is a common maintanance chemotherapy drug which is used for non-small cell lung cancer and improves survival by further 3-5 months?

A

Pemetrexed

49
Q

What should always be put at the centre of every decision regarding therapy?

A

patient’s quality of life (is it doing more good than harm?)

50
Q

What features of back pain indicate possible bone mets?

A
  • often worse at night (at any site)

- recurring back pain

51
Q

What therapy option is available for patients who present with bone mets?

A

palliative radiotherapy (palliative care)

52
Q

What are 4 common driver mutations in adenocarcinoma patients?

A
  1. EGFR
  2. ALK
  3. BRAF
  4. ROS
53
Q

What drugs are used for EGFR mutations in adenocarcinoma? (3)

A
  1. erlotinib
  2. gefitinib
  3. afatinib
54
Q

What drugs are used for ALK translocations in adenocarcinoma? (2)

A
  1. crizotinib

2. ceritinib

55
Q

What drugs are used for BRAF mutations in adenocarcinoma? (2)

A
  1. vemurafenib

2. dabrafenib

56
Q

What drug is used for ROS mutations in adenocarcinoma?

A

crizotinib

57
Q

What patients are selected for targeted drugs therapy?

A

patients not suitable for chemotherapy

58
Q

What are second line treatment options at progression of non-small cell lung cancer?(3)

A
  1. docetaxel +/- nintedanib
  2. pemetrexed
  3. erlotinib
59
Q

What type of inhibitors are drugs such as erlotinib, gefitinib and afatinib?

A

tyrosine kinase inhibitors

60
Q

Is there improvement in lung cancer survival rates on average?

A

Yes

61
Q

What does Nivolumab BMS, a drug to treat cancer, help the body do?

A
  • it blocks the binding of PD1 to PD-L1 and PD-L2 (death ligand)
  • it “wakes up the immune system” and make t cells work against the tumour again
  • prevents t cells from becoming inactivated and allows them to recognise tumours again
62
Q

Approximately what percentage of patients have small cell lung cancer?

A

~15%

63
Q

What is the doubling time for small cell lung cancer?

A

29 days (a lot more aggressive than non-small cell lung cancer and has worse prognosis)

64
Q

What system is small cell lung cancer linked to?

A

neuroendocrine system (has secretory syndromes due to its endocrine origin)

65
Q

What 2 syndromes are associated closely with small cell lung cancer?

A
  1. SIADH: syndrome of inappropriate antidiuretic hormone (low Na + confusion)
  2. ACTH; adrenocorticotropic hormone released by tumour leading to Cushing syndrome (ACTH signals adrenal glands to produce cortisol)
66
Q

What type of small cell lung cancer disease is “limited disease”?

A
  • staged to one hemithorax

- 30% patiens

67
Q

What type of small cell lung cancer disease is “extensive disease”?

A
  • more advanced
  • hard-sink tumour
  • majority of patients
68
Q

Are presentations of non-small cell lung cancer and small cell lung cancer the same?

A

Yes. they are the same

69
Q

What are 2 “conditions” of small cell lung cancer?

A
  1. limited disease

2. extensive disease

70
Q

What are the treatment options for limited disease small cell lung cancer? What are the drugs involved? (2)

A
  1. Chemotherapy treatment of choice ( combination of drugs e.g. cisplatin +etoposide)
  2. Early concurrent thoracic radiotherapy (at same time as chemo)
71
Q

What can improve the prognosis of small cell lung cancer?

A

preventive brain radiotherapy (prophylactic cranial radiation; PCI)

72
Q

Is surgery an option for small cell lung cancer?

A

a VERY rare option; usually too advanced

73
Q

What does small cell lung cancer of limited disease have NO advantage from? (5)

A
  • high dose chemo
  • alternating chemo
  • maintenance chemo
  • chemo “on demand”
  • maintenance interfreon, MMPI, targeted therapies
    (nothing seems to work)
74
Q

What is the approximate response rate and complete remission rate to treatment (chemo and radiotherapy) in small cell lung cancer patients?

A

response rate= 90%

complete remission= 60%

75
Q

What is the median survival of patients with and without treatment for small cell lung cancer?

A

no treatment= ~8 months
treatment = ~16 months
(2 year survival is ~25%)

76
Q

Is second line therapy used in small cell lung cancer?

A

it’s sub-optimal (not used most of the time as can cause more harm)

77
Q

What treatment options is there for extensive disease small cell lung cancer? (2)

A
  • 4 cycles only of combination chemotherapy

- radiotherapy

78
Q

If patient is not fit for chemo in extensive disease small cell lung cancer, what therapy option is chosen?

A

single fraction radiotherapy to palliate if not fit

79
Q

What is the general therapy option if patient with extensive disease small cell lung cancer has brain mets?

A

radiotherapy + steroids

80
Q

What are the response and complete remission rates for extensive disease small cell lung cancers?

A

response rate= ~80%

complete remission= ~30%

81
Q

What is the median survival rate for patients with and without treatment for extensive disease small cell lung cancer?

A

no treatment= ~8 weeks

treatment= ~8 months (can prolong life even for a few months and improve quality)

82
Q

What percentage of lung cancer patients are still diagnosed too late to cure?

A

~80%

83
Q

What improvements have been made to tackle lung cancer problem? (5)

A
  1. multi-disciplinary team meetings
  2. specialist nurses
  3. smoking ban
  4. screening programmes
  5. networks and national cancer research institute (NCRi)
84
Q

What improvements still need to be made to tackle lung cancer problem? (3)

A
  1. educate public/ remind GPs about treatment improvements
  2. minimise waiting times
  3. drug development

Systems: Resp. WK (40 decks)

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