Lung cancer Flashcards
two types of lung cancer
small cell (SCLC)
non small cell (NSCLC)
makes up 80% of all lung cancer
NSCLC
LS vs ES-SCLC prognosis
- LS– 14-20 months
- ES— 8-13 months; worse
which type of cancer essentially has no long term survivors
extensive stage SCLC
NSCLC prognosis
15 month median Os
4 major signs and sx of lung cancer
- dyspnea
- hemoptysis
- cough
- chest pain
describe bronchoscopy
- insert optic bronchoscope to detect intrabronchial pathology
3 limitations of bronchoscopy
- peripheral lesions
- upper lobe
- minimal endobronchial component
main limitation of percutaneous image guided biopsy
central lesion
describe PET (3)
inject radioactive glucose
- heat map
- active in bone
- bad at anatomic differentiation
Brain MRI w/ staging (3)
- needs IV contrast
- better for soft tissue
- chemo cant get up thru BBB
review TNM staging (1-4)
- small & localized
- big & localized
- lymph node or locally advanced
- metastatic or incurable
4 most common sites for metastasis
- other lung
- adrenal glands
- liver
- bones
- brains
4 general paraneoplastic effects of lung cancer
- clubbing/hypertrophic pulmonary osteoarthropathy
- eatin-lambert
- hypercalcemia
- endocrine abnormalities
which type of lung cancer is eatin-lambert strongly associated with?
SCLC
what does eatin-lambert look like
proximal symmetric muscle weakness
2 endocrine abnormalities
- ectopic ACTH production– cushings, DM, HTN
- hyponatremia/SIADH
generally speaking, with which type of lung cancer can you cut out if no C/I?
NSCLC
who gets surgery?
- NSCLC w/o mediastinal LN or distant disease
aka stage 1 and 2
when can you do post-op chemo for NSCLC treatment?
- large primary tumor > 1cm
- positive nodes
most common treatment for stage 3
- chemo + radiation
- immunotherapy improves outcome
what is ‘performance status’?
Rough measure of how well someone will do on therapy of any kind
true or false
Bad idea to give chemo to ppl in bed or chair for more than half the day
true
while metastatic dz is primarily treated with chemo, what treament beats chemo?
targeted agents (EGFR, ALK/ROS, PD-L1)
____ is first line combination with chemo
immunotherapy
tx for LS-small cell lung cancer
aggressive chemo (platinum + etoposide)+ radiotherapy
imaging for lung cancer
- CT scan– good for anatomy but cant tell cancer from not cancer
- PET— brain blind but active in bone
- MRI– brain
which cancer is
- very responsive but briefly
- distant relapse to brain bones or liver is common
- maintenance immunotherapy
- Role of prophylactic cranial irradiation
- Limited role of surgery
limited state small cell
tx for extensive stage SCLC
chemo+ immunotherapy
(platinum + etoposie + atezolizumab)
which type of cancer
- limited role for radiation
- surgery has almost no role
- certain systemic relapse
- extensive stage SCLC
3 sx that palliative care is focused on
pain
nausea
dyspnea
performance status 0 vs 2 vs 3
0= symptomatic
2= symptomatic but can carry on
3= bed or chair for most of the day
Greater than 2 should NOT get chemo
3 screening tools
- Serial CXR
- Sputum cytology
- Low dose CT scan
top 3 treatment for metastatic NSCLC
- targeted therapy
- immunotherapy
- cytotoxic chemo
