Lecture 18 lung cancer

Question 1

Describe the differences between small cell lung cancer and non-small cell lung cancer in terms of treatment options, progression, and sensitivity to chemotherapy and radiation therapy.

Answer 1

Small cell lung cancer accounts for 15% of cases and is best treated with chemotherapy and radiation therapy, being rapidly progressive without treatment. It is highly chemosensitive and radiosensitive. Non-small cell lung cancer, making up 85% of cases, is often treated with surgery and systemic anti-cancer therapy. It progresses less rapidly and is less sensitive to chemotherapy and radiation.

Question 2

What are the common signs and symptoms of lung cancer that individuals may experience?

Answer 2

Common signs and symptoms of lung cancer include persistent cough lasting over 3 weeks, coughing up blood, shortness of breath, wheezing, tiredness, unexplained weight loss, repeated pneumonia or bronchitis, swelling in face/neck/arm, finger clubbing, dysphagia, chest/shoulder pain, lung pain, boney pain, headache, and behavior changes.

Question 3

Identify the sites where lung cancer commonly metastasizes.

Answer 3

Lung cancer commonly metastasizes to the brain, bones, liver, and adrenals. These sites are often affected as the cancer progresses and spreads beyond the lungs.

Question 4

What are the risk factors associated with the development of lung cancer?

Answer 4

Risk factors for lung cancer include smoking (cigarettes, cigars, pipes), exposure to secondhand smoke, radon exposure, asbestos exposure, air pollution, lung diseases like tuberculosis, and a history of previous lung cancer. These factors can increase the likelihood of developing lung cancer.

Question 5

Explain the best chances for cure and treatment options for small cell lung cancer and non-small cell lung cancer.

Answer 5

Small cell lung cancer has the best chance of cure with chemotherapy and radiation therapy. Non-small cell lung cancer is often treated with surgery along with systemic anti-cancer therapy. The treatment approach varies based on the type of lung cancer and its characteristics.

Question 6

Describe the prognostic factors in non-small cell lung cancer (NSCLC) and the differences between adenocarcinoma and squamous cell carcinoma.

Answer 6

Prognostic factors in NSCLC include stage at presentation, performance status, weight loss, sex, age, and molecular markers like RAS mutations and EGFR over-expression. Adenocarcinoma is TTF-1 and CK7 positive, with peripheral lung lesions, while squamous cell carcinoma is p40, p63, CK5/6 positive, with central lesions.

Question 7

What are the characteristics of adenocarcinoma and squamous cell carcinoma in NSCLC, and how do they differ in terms of patient demographics and treatment options?

Answer 7

Adenocarcinoma in NSCLC is common in young, non/light smokers, with good general condition, and can be treated with Pemetrexed and Bevacizumab targeting oncogenes like EGFR and ALK. Squamous cell carcinoma is seen in elderly, heavy smokers, often with major co-morbidities, and can be targeted with drugs for oncogenes like NTRK, KRAS, and RET.

Question 8

Explain the impact of molecular pathways on the survival of patients with NSCLC, particularly in adenocarcinoma.

Answer 8

Significant advances in survival in adenocarcinoma NSCLC are primarily due to a better understanding of molecular pathways. This includes identifying druggable oncogenes like EGFR, ALK, and ROS-1, which have led to targeted therapies improving outcomes for patients.

Question 9

How do the clinical characteristics of squamous cell carcinoma in NSCLC differ from those of adenocarcinoma, and what are the implications for treatment selection?

Answer 9

Squamous cell carcinoma in NSCLC is distinct, with central lesions, typically affecting elderly, heavy smokers with major co-morbidities. Unlike adenocarcinoma, it does not respond to Pemetrexed but can be targeted with drugs for oncogenes like NTRK, KRAS, and RET, impacting treatment choices.

Question 10

Define the role of specific molecular markers like RAS mutations and EGFR over-expression in predicting outcomes for patients with NSCLC.

Answer 10

Molecular markers like RAS mutations and EGFR over-expression play a crucial role in predicting outcomes for NSCLC patients. These markers are associated with poorer prognosis and guide treatment decisions, highlighting the importance of molecular testing in personalized medicine for lung cancer.

Question 11

Describe the patient selection process for immunotherapy, including considerations such as medical history and previous autoimmune diseases. What is the importance of patient education in this context?

Answer 11

Patient selection for immunotherapy involves assessing medical history, including previous autoimmune diseases. Patient education is crucial to inform about immune-related adverse effects. These effects have a distinct spectrum arising from general immunologic enhancement, occurring weeks to months after treatment initiation and even up to a year after treatment cessation.

Question 12

What are the immune-related adverse effects associated with immunotherapy? When do these side effects typically manifest in relation to the treatment timeline?

Answer 12

Immune-related adverse effects from immunotherapy stem from general immunologic enhancement. These effects can manifest weeks to months after treatment initiation and may even occur up to a year after treatment discontinuation.

Question 13

Define the treatment options for advanced squamous cell non-small cell lung cancer as per NICE guidelines issued on July 23. What are the common side effects of Cisplatin, a recommended treatment?

Answer 13

NICE guidelines recommend Cisplatin for advanced squamous cell non-small cell lung cancer. Common side effects of Cisplatin include high levels of nausea and vomiting, renal toxicity, and depletion of magnesium levels.

Question 14

How do immune-related adverse effects differ from typical side effects of treatments like Cisplatin in cancer therapy? What is the significance of the timing of these adverse effects in immunotherapy?

Answer 14

Immune-related adverse effects in immunotherapy differ from typical side effects like those of Cisplatin by arising from general immunologic enhancement. These effects can occur weeks to months after treatment initiation and may persist for up to a year after treatment cessation, highlighting the importance of monitoring and managing them.

Question 15

Describe the impact of renal toxicity and magnesium level depletion as side effects of Cisplatin in cancer treatment. How do these side effects compare to the immune-related adverse effects seen in immunotherapy?

Answer 15

Cisplatin, used in cancer treatment, can lead to renal toxicity and depletion of magnesium levels. These side effects differ from immune-related adverse effects in immunotherapy, which arise from general immunologic enhancement and have a distinct spectrum of manifestations over a prolonged period post-treatment.

Question 16

Describe the recommended treatment for nausea and vomiting post-treatment, including medications and dosages.

Answer 16

The recommended treatment for nausea and vomiting post-treatment includes Levomepromazine, Ondansetron, Aprepitant, Dexamethasone, and Metoclopramide at specific dosages and schedules.

Question 17

How should renal toxicity be managed in patients receiving cisplatin?

Answer 17

Renal toxicity in patients receiving cisplatin should be managed by measuring creatinine clearance and ensuring adequate hydration before and after cisplatin administration.

Question 18

What are the common side effects associated with Carboplatin treatment?

Answer 18

Common side effects of Carboplatin treatment include nausea, vomiting, myelosuppression, and moderate renal toxicity, which are similar to those seen with cisplatin.

Question 19

Describe the side effects and specific timing of onset for Gemcitabine treatment.

Answer 19

Gemcitabine treatment is associated with myelosuppression, nausea, vomiting (low), rash with generalised onset 48-72 hours post-treatment, radiation recall, and interstitial pneumonitis.

Question 20

What are the key side effects and considerations for patients receiving Vinorelbine treatment?

Answer 20

Patients receiving Vinorelbine treatment may experience myelosuppression, neuropathy, constipation, minimal to moderate nausea and vomiting, and alopecia. Intravenous administration results in minimal nausea and vomiting compared to oral administration.

Question 21

Describe the treatment options for non-squamous cell non-small cell lung cancer without gene mutation according to NICE guidelines issued on September 22. Include details about Pemetrexed, its side effects, and the recommended supportive medications.

Answer 21

The treatment options for non-squamous cell non-small cell lung cancer without gene mutation as per NICE guidelines include Pemetrexed, which can cause myelosuppression, nausea, vomiting, diarrhea, constipation, and rash. Supportive medications like Dexamethasone, Folic acid, and Hydroxocobalmin are recommended to manage side effects and enhance drug efficacy.

Question 22

How should patients be instructed to take Folic acid and Hydroxocobalmin when undergoing Pemetrexed treatment for non-squamous cell non-small cell lung cancer without gene mutation?

Answer 22

Patients should take Folic acid 400mcg orally once daily starting seven days before Pemetrexed treatment, continuing throughout the treatment and for 21 days after the last dose. Hydroxocobalmin 1000mcg should be administered intramuscularly seven days before treatment initiation and repeated every nine weeks until treatment completion.

Question 23

Define the role of Oral TKI in the treatment of non-squamous cell non-small cell lung cancer without gene mutation. What are the notable aspects regarding drug interactions and the development of a rash during treatment?

Answer 23

Oral TKI is used in combination therapy to enhance drug efficacy and reduce toxicity in non-squamous cell non-small cell lung cancer without gene mutation. It is associated with drug interactions and the development of a rash 2-3 weeks into treatment, which can indicate improved survival outcomes and may lead to dry skin.

Question 24

Describe the conclusions drawn regardingocarcinoma/non-squamous NSCLC, including histology, therapeutic advances, targeted therapy, resistance, and treatment options for relapsed disease.

Answer 24

The conclusions highlight the favorable histology of adenocarcinoma/non-squamous NSCLC and the significant therapeutic advances in chemotherapy and targeted agents. They emphasize the era of personalized medicine with routine testing for common mutations and the challenge of overcoming resistance to targeted therapies. Additionally, new options for treating relapsed disease are discussed.

Question 25

What are the key takeaways regarding advanced lung cancer survival, histology, molecular testing, performance status, and treatment goals?

Answer 25

The key points emphasize the poor survival associated with advanced lung cancer, the importance of histology and molecular testing in advancing personalized medicine, the impact of performance status on treatment options, and the goal of maintaining quality of life while managing treatment toxicity.

Question 26

How do histology and molecular testing contribute to driving personalized medicine forward in the context of advanced lung cancer?

Answer 26

Histology and molecular testing play a crucial role in advancing personalized medicine by guiding treatment decisions based on individual characteristics, such as tumor type and genetic mutations. This personalized approach helps tailor therapies to specific patients, improving treatment outcomes and overall care.

Question 27

Discuss the significance of resistance to targeted therapies in the treatment of adenocarcinoma/non-squamous NSCLC and the ongoing efforts to address this challenge.

Answer 27

Resistance to targeted therapies poses a critical problem in the treatment of adenocarcinoma/non-squamous NSCLC. Efforts are underway to overcome this challenge through research and development of new strategies to enhance treatment efficacy and prolong patient survival despite resistance mechanisms.

Question 28

What factors should be considered when aiming to keep individuals with advanced lung cancer as well as possible for as long as possible, and why is the toxicity of treatment a crucial consideration?

Answer 28

When aiming to maintain the well-being of individuals with advanced lung cancer, factors such as performance status, treatment toxicity, and the goal of maximizing quality of life play a significant role. It is essential to balance treatment benefits with potential side effects to ensure optimal care and patient outcomes.