Lung Cancer Flashcards
Describe the common presenting symptoms, including red-flag criteria
Haemoptysis Any of the following > 3 weeks: – Cough – Chest/shoulder pain – SOB or dyspnoea – Wt loss – Chest signs – Hoarseness – Finger clubbing – Cervical/SCF LN – Features suggestive of metastases (brain/bone/liver)
Outline presentations which should initiate suspected cancer referral pathway (2 week wait)
Refer people for this pathway if they:
• have chest X-ray findings that suggest lung cancer or
• are aged 40 and over with unexplained haemoptysis
Offer an urgent chest X-ray (to be performed 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 if they have ever smoked and have
1 or more of the following unexplained symptoms:
• cough
• fatigue
• shortness of breath
• chest pain
• weight loss
• appetite loss
Summarise the different pathological types of lung cancer
- Non Small Cell Lung Carcinoma (90%) : • Squamous cell carcinoma • Adenocarcinoma • Large cell carcinoma • Bronchioalveolar carcinoma • Mixed • NOS (Not Otherwise Specified)
- And Small Cell Lung Carcinoma (10%).
Describe the aetiology of lung cancer
- Smoking (90%) including passive smoking and any type of tobacco
Twenty-five cigarettes per day increases risk of developing lung cancer by about 25 times - Radon gas
- Genetic risk
- Previous cancer treatment
- Reduced immunity
- Occupational exposure e.g. asbestos
Describe prevention and current government practices aimed at controlling lung cancers
Prevention:
- Efficacy of anti-smoking campaigns being seen
- Banning asbestos
- All doctors expected to promote smoking cessation and provide help and encouragement to those who are willing to stop smoking
Screening:
- Low dose CT scanning remains under investigation. It may be helpful in targeted groups, but this is yet
to be clearly defined. Research is on-going.
List the different types of surgical operations available for lung cancer and be aware of factors that can make a lung cancer inoperable
- Pneumonectomy
- Lobectomy or bi-lobectomy
- Wedge resection (not usually recommended as considered to be a sub-optimal operation)
A tumour may be inoperable because of: • Size • Position (too close to central structures) • Medically inoperable – Poor respiratory function – Poor cardiac function – Co-morbidities
Explain the role of chemotherapy in small cell carcinoma of lung and the recent evidence for adjuvant chemotherapy following surgery for non-small cell lung
cancer
- High response rates to chemotherapy (70-80%)
- Concurrent chemoradiotherapy (twice daily RT)
- Sequential chemoradiotherapy if concurrent unable to be delivered
PLUS PCI (Prophylactic Cranial Irradiation) in:
• Limited stage (LSCS)
• Extensive stage (ESSC) where there has been a good response to chemotherapy - Surgical resection is NOT appropriate for SCLC (although this is being challenged more recently)
Outline the patient characteristics you must know in assessing a patient with lung cancer.
• Respiratory function/Lung function tests – FEV1 (% predicted) – Transfer factor – VO2 max • Cardiac function ECG/Echo/CPEST • Exercise tolerance • Performance Status • Co-morbidities • Motivation
Outline the WHO performance status.
0 Asymptomatic
1 Symptomatic, but ambulatory (able to carry out
light work)
2 In bed < 50% of day (unable to work but able to
live at home with some assistance)
3 In bed > 50% of day (unable to care for self)
4 Bedridden
Outline radical (curative) intent treatment of NSCLC.
– Surgery: • Lobectomy • Pneumonectomy • Wedge resection (sub-optimal) • Role for adjuvant chemotherapy
– Radical radiotherapy:
• Standard external beam
• SABR (Stereotactic Ablative Body Radiotherapy)
– Concurrent chemo radiotherapy (CT/RT)
– Neoadjuvant chemotherapy followed by surgery or radical radiotherapy (to prevent recurrence)
– Clinical trials
• Isotoxic (higher doses of radical radiotherapy)
Outline the palliative intent treatment of NSCLC.
Majority of lung cancer patients – Palliative chemotherapy or systemic therapy • To increase survival • To palliate symptoms • EGFR and Alk testing –targeted therapies – Palliative radiotherapy • High dose palliative • Low dose palliative – Palliative Team • Symptom management • Best supportive care (BSC)
Which pathological type of lung cancer is very responsive to chemotherapy?
Small cell lung cancer.
What are the treatment options in SCLC?
- Chemotherapy, chemotherapy, or chemotherapy!
- (Cisplatin or carboplatin with etoposide)
- High response rates to chemotherapy (70-80%)
- Concurrent chemoradiotherapy (twice daily RT)
- PLUS PCI (Prophylactic Cranial Irradiation) in:
• Limited stage (LSCS)
• Extensive stage (ESSC) where there has been a good response to chemotherapy - Surgical resection is NOT appropriate for SCLC
(although this is being challenged more recently)
What symptoms is palliative radiotherapy often used for in lung cancer?
– Haemoptysis
– Dyspnoea
– Cough
– Pain
What are the side-effects of radiotherapy in lung cancer?
– Dysphagia
– Chest discomfort
– Pneumonitis
– Neurological toxicity
