Lung Cancer Flashcards
What are the risk factors for lung cancer?
Cigarette smoking Passive smoking Asbestos Radon gas Diesel fumes Genetics Lung disease Previous malignancies
What are the signs of lung cancer?
Reduced breath sounds over a lobe Inspiratory crackles over a lobe Unilateral wheeze Clubbing Cachexia Anaemia
What are the complications of lung cancer?
Never compression Superior vena cava obstruction Pleural effusions Dysphagia Bone pain
What are the symptoms of lung cancer?
Respiratory: Cough Dyspnoea Chest pain Haemoptysis Wheezing
How can you investigate lung cancer?
CXR
CT scan
PET-CT scan
Biopsy
What are the two main types of lung cancer?
Non small cell lung cancer
Small cell lung cancer
What are the 3 main subtypes of NSCLC
Squamous cell lung cancer
Adenocarcinoma
Large cell lung cancer
What cytogenetic mutations can occur in adenocarcinomas?
Epidermal Growth Factor Receptor (EGFR)
Anaplastic lymphoma kinase (ALK)
KRAS
ROS1
BRAF
What happens if no mutations are identified?
Look at the expression of PD-1
High levels means immunotherapy is more appropriate
What to do if someone with lung cancer smokes?
Inform pts that smoking increases the risk of pulmonary complications after lung cancer surgery
Offer NRTs
Do not postpone surgery for lung cancer to allow pt to stop smoking
What are the treatment options?
Depends on staging of disease and pts performance status
Surgery Neoadjuvant chemoradiotherapy and surgery Radical radiotherapy Radical chemoradiotherapy Palliative chemo Symptomatic support and radiotherapy
Who is not a candidate for lung cancer surgery?
Those with metastatic cancer
Who is adjuvant chemotherapy for?
Recommended for stage 2 and 3 pts with surgically resectable disease
Given within 8 weeks after surgery
Good performance status required
What type of adjuvant chemotherapy is used?
Platinum based chemo
Cisplatin, Carboplatin
What are the pros and cons of cisplatin compared to carboplatin
(+) Increased overall survival
(-) More nausea and vomiting
(-) more thrombocytopenia and neurotoxicity with carboplatin
No difference in neutropenia, alopecia or renal toxicity
What is the purpose of palliative chemotherapy?
Symptomatic benefit
Prolonged survival in patients stage 3b and 4
Type of treatment based on type of malignancy/presence of mutations
What is the treatment for non squamous cancer?
If EGFR mutation is present: EGFR TKI targeted therapy
ALK positive - targeted therapy
No mutations but PD1 expression - 1st line is platinum based combination chemotherapy
What is the treatment for non squamous cancer where EGFR mutations are present?
EGFR tyrosine kinase inhibitors 1st line = Osimertinib others: Erlotinib Gefintinib Dacomitinib Afatinib
What are the side effects of EGFR inhibitors?
Acne like skin rash Diarrhoea Mucositis Nausea and loss of appetite Fatigue Eye problems Alopecia Respiratory effects
Who are EGFR mutations more common in?
Adenocarcinomas
Non smokers
Females
Asian
Who are ALK mutations more common in?
Light/non smokers
younger age
adenocarcinomas
Give examples of ALK inihbitors
Crizotinib
Ceritinib
Alectinib
Give examples of PD1 Pathway inhibitors
Nivolumab
Pembrolizumab
monoclonal antibodies directed at PD1 prevent PD1 from binding to PD-L1/2
What is the limited stage of small cell lung cancer?
Limited to one lung
What is the extensive stage of small cell lung cancer?
Cancer spread to other part of the body/other lung
What is the treatment for the limited stage of small cell lung cancer?
Combination chemotherapy and thoracic radiotherapy
What is the treatment for the extensive stage of small cell lung cancer?
chemotherapy
radiotherapy
PCI = Prophylactic cranial irradiation
What is the 1st line combination chemotherapy for small cell lung cancer?
Carboplatin and etoposide 4-6 cycles
*6 month rule = can re-treat w same regimen if responsive otherwise find alternative
How do you work out the dose of Carboplatin?
Dose = AUC x (GFR + 25) AUC = area under the curve
TNM staging for lung cancer
T1 = Smaller than 3cm T2 = 3-5cm T3 = 5-7cm T4 = Bigger than 7cm
N1 = intrapulmonary nodes/nodes surrounding tumour N2 = nodes in bronchia N3 = nodes on opposite lung
M0 = none M1A = tumour in other lung M1B = single outer lung tumour (one other organ) M1C = multiple outer lung tumour (more than 1 organ)
