lung cancer Flashcards
epidemiology of cancer
3rd most commpn cancer in uk
48000 diagnoses/yr
35000 deaths/ yr
leading cause of cancer death
what are some risk factors for lung cancer
age peak 75-90
sex m>f
lower socioeconomic status
smoking - duration, intensity, how long ago stopped
what are some other causes of cancer besides smoking
passive smoking asbestos exposure radon indoor cooking fumes chronic lung disease e.g copd, fibrosis immunodeficiency familial/genetics
what % of lung cancer cases are caused by smoking
approx 85%
what are the 4 types of lung cancer
squamous cell carcinoma
adenocarcinoma
large cell lung cancer
small cell lung cancer§
what % of cases does squamous cell carcinoma cause
30%
originates from bronchial epithelium
centrally located
what % of cases does adenocarcinoma cause
40%
most common from 1980s
originates from mucus producing glandular tissue
more peripherally located
what % of cases does large cell lung cancer cause
15%
heterogenous group - undifferentiated
everything else
what % of cases does small cell lung cancer cause
originates from neuroendocrine cells
highly malignant
very aggressive
stages of lung cancer development
normal epithelium - hyperplasia - squamous metaplasia - dysplasia - carcinoma in situ - invasive carcinoma
what are some important oncogenes involved in lung cancer
egfr tyrosine kinase
alk tyrosine kinase
ros1 receptor tyrosine kinase
braf
what are some key symptoms of lung cancer
cough, weight loss breathlessness fatigue chest pain haemoptysis or frequently asymptomatic
what are some features of advanced/metastatic cancer?
neurological features ; focal weakness, seizures, spinal cord compression
bone pain
paraneoplastic syndromes - clubbing, hypercalcaemia
hyponatraemia, cushings
what are some clinical signs of advanced lung cancer
cachexia
horners syndrome - tumour presses on thoracic outlet, reduces sympathetic supply to face
superior vena cava obstruction - pembertons sign
what is diagnostic strategy
establish most likely diagnosis establish fitness for treatment and investigation confirm diagnosis specifically what type of cancer confirm staging
what are some investigations you can do for lung cancer
chest x ray
staging ct
pet - most useful tp exclude occult metastases
biopsy
what are some methods of biopsy for lung
bronchoscopy
endobronchial ultrasound and transbronchial - needle aspiration of mediastinal lymph nodes (ebus(tbna))
ct guided biopsy - for peripheral tumours
how to stage cancer
tumour size
lymph node involvement
metastases and number
early vs locally advanced vs metastatic
what are some determinants of treatment
patient fitness cancer histology cancer stage patient preference health service factors
what do we use to classify patient fitness for treatment
who performance status 0 - asymptomatic 1 - symptomatic but ambulatory 2 -symptomatic but <50% in bed 3 - symptomatic >50% in bed 4 - bedbound 5 - death
comorbidity and lung function is also very important
what is the standard of care for early stage disease
surgical resection lobectomy and lymphadenectomy usual approach sublobar resection if stage 1 <3cm pneumonectomy VATS open thoracotomy
what is an alternative for surgery for early stage
radical radiotherapy
- particulary if comorbid
stereotactic ablative radiotherapy (sabr):
high precision targeting using multiple convergent beams
first line systemic treatment for nsclc with mutation
for egfr - erlotinib,gefitinib,dacomitinib and osimertinib
for alk - crizotinib, certinib, alectinib, brigatinib, lorlatinib
ros 1 - crizotinib,entrectinib
first line systemic treatment for metastatic nsclc with no mutation
immunotherapy
e.g pembrolizumab, atezolizumab,nivolumab
first line systemic treatment for metastatic nsclc with no mutation
with immunotherapy
cytotoxic chemotherapy
what is another key part of treatment for lung cancer
Pallative care
supportive care
treatment for locally advanced disease
surgery and adjuvant chemotherapy
radiotherapy and chemotherapy
