Lung Cancer Flashcards
Are there any lung cancer screening programmes?
No
What are the risk factors for lung cancer?
Cigarette smoking, environment tobacco smoke (passive smoking), absestos, radon gas, diesel fumes, genetic predisposition, lung disease, previous malignancies
How does smoking cessation impact lung cancer treatment?
- patients should be advised that smoking increases the risk of pulmonary complications after surgery, and nicotine replacement should be offered.
- surgeries should not be postponed to allow patients to stop smoking
What are the signs and symptoms of lung cancer?
- tumour related, non specific systemic symptoms.
RESPIRATORY: cough, dysponea, chest pain, haemophysis, wheezing
signs: reduced breath sounds, clubbing, cracking anaemia
What are the complications of lung cancer?
- nerve compression
- superior vena cava obstruction
- pleural effusions
- dysphagia
- bone pain
What is non small cell lung cancer?
Squamos cell adenocarcinoma, large cell lung cancer. Central chest is where the symptoms present. It is the most common lung cancer present in the glandular cells within the periphery of the lungs. It develops quickly and often is not symptomatic until it has metastasised
What is small cell lung cancer?
Small cell relates to the shape of the cells. It is susceptible to chemotherapy but often returns.
Which cytogenetic mutations are associated with NSCLC?
EGFR, ALK, KRAS, ROS1, BRAF, PDL-1
What are the T stages related to NSCLC?
Tx - tumour in sputun
T0 - no evidence of tumour
Th - carcinoma in situ
T1 - less than 3cm surrounded by lung pleura, not involving the bronchus
T1a (mi) - minimally invasive
T1a - Less than 1cm
T1b - more than 1cm but less than 2cm
T1c - more than 2cm but less than 3cm
T2 - more than 3cm but less than 5cm, involves the bronchus or extends to ileum
T2a - more than 3cm but less than 4cm
T2b - more than 4cm but less than 5cm
T3 - more than 5cm but less than 7cm or tumour of any size than involves chest wall, pericardium or phenic nerve
T4 - more than 7cm and involvment of diaphragm, heart, great vessels, trachea, oesaphagus
What are the N stages related to NSCLC?
N1- nodes surrounding tumour
2 - nodes in bronchi
3 - nodes on the opposite side of the lung
What are the M stages of NSCLC?
M1 - distant metastases
M1A - Tumor in other lung
1b - single outer lung tumour
1c - multiple other lung tumour
What are the treatment options for NSCLC?
- Surgery - the bigger the tumour/further nodal involvement makes surgery less possible. If there is any distant metastases then surgery cannot happen
- Neoadjuvant chemo + surgery
- radical radiotherapy - potential curative
- radical chemo
- palliative chemo - in inoperable or metastatic disease
- symptomatic support
When is adjuvant chemotherapy indicated for NSCLC?
For stage 2 and 3 patients with surgically resectable disease, preferably within 8 weeks of surgery. The patient must have good performance status
Which agents are used for adjuvant chemotherapy for NSCLC?
Platinum based agents - cisplatin and carboplatin
Discuss cisplatin vs carboplatin
- increased overall survival with cisplatin
- equal responses when used with 3rd gen chemo agent
- cisplatin leads to more nausea and vomitting
- more thrombocytopenia and neurotoxicity with cisplatin