Lung cancer Flashcards
What are the risk factors for Lung cancer
- Cigarette smoking and passive smoking
- asbestos
- occupational/environmental hazards e.g diesel fumes
- genetic pre-disposition
- lung disease
- previous malignancies
Are there any screening tools in the UK for lung cancer
NO
What are the signs and symptoms of lung cancer
More than 90% are symptomatic and it could be
- tumour related
- non-specific systemic symptoms
- metastatic disease
Respiratory symptoms experienced:
- cough
- dyspnoea
- chest pain
- haemoptysis
- wheezing
Complications include:
- nerve compression
- superior vena cava obstruction (SVCO)
- pleural effusion
- dysphasgia
- bone pain
Signs include:
- unilateral wheeze
- inspiratory crackle over a lobe
- reduced breathe sound over a lobe
- clubbing
- cachexia (weakness/wasting of the body)
- anaemia
What are the investigations of lung cancer
- chest x-ray
- CT scan
- PET-CET - can indicate where the cancer is
- Biopsy
What are the two different types of lung cancer called
Non-small cell lung cancer (NSCLC)
- more difficult to diagnose and detect with chest X-ray as it associated with glandular cells located within the peripheral of the lung
Small cell lung cancer (SCLC)
-Strong associated with cigarette smoking and can be seen on x-rays because it is more at the centre of the lungs.
What cytogenetic mutation occurs with Lung cancer
- EGFR
- ALK (anapaestic lymphoma kinase) receptor
- ROS-1
- BRAF
- KRAS
- PD-1 expression
What is the staging of lung cancer
T - tumour size, extent of invasion and penetration of tumour boundaries
T1 - tumour 3cm or less
T2 - tumour more than 3cm but less than 5cm
T3 - tumour more than 5cm but less than 7cm
T4 - tumour more than 7cm
N- number and presence of lymph nodes involved
N0 - no regional lymph nodes metastasis
N1 - single node <2cm
N2 - single node 2-5cm
N3 - multiple nodes >5cm; multiple node involvement across the body
M - Metastasis
M0- no distant metastasis
M1 - distant metastasis
What are the treatment options for NSCLC
- surgery
- neo-adjuvant chemoradiotherapy + surgery
- radical radiotherapy
- radical chemotherapy
- palliative chemo - symptomatic support + radiotherapy
In NSCLC what types of patients is surgery indicated for
- anyone without metastasis
- small tumour + no nodal involvement
Who is adjuvant chemotherapy targeted towards
- for stage II and III patients
- patients with good performance status
- within 8 weeks of surgery
Compare Cisplatin to Carboplatin
Cisplatin:
- has an increased overall survival
- more nausea and vomiting associated with it
Carboplatin:
-more thrombocytopenia and neurotoxicity associated with it
The both have an equal response when used with 3rd gen chemo agents
They both have no difference in neutropenia, alopecia or renal toxicity
Who is palliative chemotherapy for and what is the recommended regimen
- its for symptomatic benefits and prolonged survival in patients with stage IIIB & IV
- recommended regimen is dependent on the type of malignancy and mutations present
What is Epidermal Growth Factor Receptor (EGFR)
- it controls cell proliferation and growth
- mutations in Tyrosine Kinase (intracellular domains) result in signalling activation
Who are EGFR mutations common in
- adenocarcinoma
- non smoker
- females
- asian patients
What is the targeted treatment for EGFR mutations (called EGFR inhibitors)
- Erlotinib
- Gefitinib
- Osimertinib
What is the most common EGFR inhibitor side-effect and what is the management of it
-skin rash - within 1st week of treatment
Management
- avoid irritants
- antibiotics
- liberal application of emollients
- avoid exposure to the sun
What does Anaplastic lymphoma kinase (ALK) receptor positive NSCLC mean
- An inversion in chromosome 2 juxtaposes the 5’ end EML4 gene with the 3’ end of ALK gene
- means the patient has an abnormal fusion of the ALK oncogene and another oncogene EML4
Who are ALK receptor mutations common in
- non/light smokers
- younger age
- adenocarcinoma with singlet ring
What is the targeted treatment for ALK receptor mutations
- Alectinib - 1st line
- Certinib
- Crizotinib
What monoclonal antibodies inhibit the PD-1 pathway and how does it occur
- Nivolumab
- Pembrolizumab
PD-1 is an inhibitory receptor expressed on activated T&B cells
-in normal cells it dampen the immune response when exposed to antigen
- in malignancies there is an over expression in PD-1 ligands
- PD-1 binds to PD-1 ligands and turn off immune response so the T-cell won’t fight against the tumour
So Pembrolizumab:
- inhibits lymphocytes PD-1 receptors, and blocks the ligands that would deactivate it and prevent an immune response.
- This allows the immune system to target and destroy cancer cells.
What is Nintedinib
-It is a small molecule tyrosine kinase inhibitor
It blocks 3 receptor classes that promotes angiogenesis and tumour growth
- Vascular EGFR
- Fibroblast growth factor receptors
- Platelet-derived growth factors (alpha and beta)
-licence for use with docetaxel for NSLC after 1st line chemo
Where does SCLC highly metastasis to
the brain
What is the staging for SCLC and when is treatment initiated
Limited stage:
- 12 weeks - no treatment
- 12 months - chemotherapy
Extensive stage:
- 6 weeks - no treatment
- 8 months - chemotherapy
What is the treatment for limited stage disease with good performance status of SCLC
-combined chemotherapy + thoracic radiotherapy
What is the treatment for extensive stage disease of SCLC
- chemotherapy is the main modality of treatment
- radiotherapy
- prophylactic cranial irradiation (PCI) - decreases risk of brain metastasis
What is the 1st and 2nd line chemotherapy used in SCLC
1st line chemo:
- carboplatin
- etoposide
2nd line chemo:
- topotecan
- CAV
What is the ‘6-month’ rule for treatment of SCLC
if sustained response occurs above or by 6 months then 1st line regimen can be reused
How is Carboplatin dosed
-Based entirely on RENAL function
What are some palliative care issues with Lung cancer
- Breathlessness
- Pain
- Haemoptysis
- Stridor
- Bone metastasis
- Superior vena cava obstruction (SVCO)
- Hypercalcaemia - associated with damage to bones
Complications of Lung cancer
- nerve compression
- SVCO
- Pleural effusion
- Dysphasia
- Bone pain
