Lung Cancer Flashcards
Lung cancer is the _____ most diagnosed cancer
Second
What is the average age of diagnosis for lung cancer?
70
What are 5 risk factors of lung cancer?
- Smoking
- Radon
- Asbestos
- Occupational exposure
- Genetic predisposition
What is the primary risk factor for lung cancer?
Smoking
What would you recommend for the prevention of lung cancer?
Smoking reduction
What patient population are low dose CT scans recommended for?
High risk individuals
What are the 3 criteria that would make someone a high risk individual?
- Age 55-80
- > or = 30 pack yr smoking history
- Currently smoking or quit < 15 years ago
What is the most common symptom of lung cancer?
Cough
What are 8 signs and symptoms of lung cancer?
- Cough
- Hemoptysis
- Dyspnea
- Chest pain
- Wheezing/ stridor
- Hoarseness
- Pleural or pericardial effusion
- Weight loss
What are the 5 sites of metastases?
- Liver
- Lymph nodes
- Brain
- Bone
- Adrenal glands
What are the 3 criteria for diagnosing lung cancer?
- Location
- Evaluation of the tumor
- Obtaining tissue
What type of lung cancer is the most common?
Non small cell lung cancer
True or False: non small cell lung cancer is generally slow growing
True
How sensitive is non small cell lung cancer to radiation?
Moderately sensitive
How sensitive is non small cell lung cancer to chemotherapy?
Low sensitivity
What are the 3 subtypes of non small cell lung cancer?
- Adenocarcinoma
- Squamous cell carcinoma
- Large cell carcinoma
What is the most common subtype of lung cancer?
Adenocarcinoma
What subtype of non small cell lung cancer is slow growing and related to smoking?
Squamous cell carcinoma
What is the standard for stage I lung cancer?
Surgery
What is the least invasive type of surgery for lung cancer?
Wedge resection
What is the standard treatment for stage II lung cancer?
Surgical resection
What type of chemotherapy is standard for stage II?
Adjuvant chemotherapy
What is the the standard chemotherapy regimen for stage II?
Cisplatin + something
What is the standard of care for lung cancer?
Patient based chemotherapy
Treatment for stage IIIB lung cancer is _______
Unresectable
What is the treatment regimen for stage IIIB lung cancer?
Platinum based + XRT
What is the goal of therapy with stage IV lung cancer?
Improve quality of life
What does the choice of chemotherapy depend on?
- Performance status
- Driver mutations
How would you treat stage IV lung cancer with 0 or 1 performance status and no driver mutations?
Platinum doublet regimen
How many cycles of the platinum doublet is recommended?
4-6 cycles
How would you treat stage IV lung cancer in a pt with performance status of 2 or 3 with no driver mutations?
Single NON platinum agent
Why can’t you use platinum doublet regimen in patients with a performance status of 2 or 3?
Platinum doublet is too toxic
What do you use for the programmed death receptor ligands in NSCLC?
Immune checkpoint inhibitors
Pembrolizumab
KEYTRUDA
What is the pembrolizumab considered as?
An immune checkpoint inhibitor antibody
When can keytruda be used in a first line setting?
If tumor proportion score (TPS) is > or equal to 5%
What are the ADEs associated with pembrolizumab?
- Colitis
- Pneumonitis
- Thyroiditis
What is the frequency that shows if there is an EGFR mutation?
20%
What EGFR inhibitor is used in NSCLC?
Erlotinib
Erlotinib
TARCEVA
What are the 2 select toxicities of the EGFR inhibitors?
- Acne form rash
- Diarrhea
EGFR inhibitors are _____ of CYP3A4
Substrates
When can you used nivolumab?
In a second line setting
What is second line treatment for stage IV NSCLC? 3
- Reassess performance status and patient goals
- Alternative platinum doublet
- Single agents
Nivolumab
OPDIVO
What is opdivo considered as?
Immune checkpoint antibody
What platinum agent should you give in stage IV NSCLC?
Carboplatin
Which type of lung cancer has rapid proliferation?
Small cell lung cancer
What has no role in small cell lung cancer?
Surgery
How sensitive is small cell lung cancer to radiation and chemotherapy?
Highly sensitive
Small cell lung cancer has a clear relationship to_____
Smoking
What are the 2 stages of SCLC?
- Limited stage
- Extensive stage
How long can a patient survive without treatment in limited stage SCLC?
11 weeks
What is first line treatment for limited stage SCLC?
Radiation + combination chemotherapy
Prophylactic ___________ should be considered in patients with complete response
Cranial irradiation
What regimens are the standard first line therapy in limited stage SCLC?
Platinum based regimens
What is the most emetic agent?
Cisplatin
How long can patients survive extensive stage SCLC without treatment?
5 weeks
How long can treatment prolong survival in extensive stage SCLC?
7-11 months
What can radiation be used for in extensive stage NSCLC.
For palliation