Lung Cancer Flashcards
What are the types of lung cancer?
Small Cell Lung Cancer: 75%
- adenocarcinoma
- squamocellular carcinoma
- large cell carcinoma
Non-small Lung Cancer: 25%
Risk factors of lung cancer
- Smoking
- Other carcinogen exposure e.g. asbestos,
arsenic, heavy metals - HPV infection
- Passive smoking
Clinical features of lung cancer
- no early signs
- hemoptysis
- weight loss
- obstructive pneumonitis or atelectasis
distal from tumour - pleural effusion
- SVC compression syndrome
- Paraneoplastic syndrome e.g. SIADH
Diagnosis of lung cancer
- Bronchoscopy
- VATS
- X ray
- CT
- MDT meetings
- cytology of pleural effusion
Tumour staging of NSCLC
T1 - < 3cm
T2 - 3-5cm
T3 - 5-7cm (invades thoracic wall, pericardium)
T4 - > 7cm (invades aorta, heart)
What is the algorithm to determine the disease spread?
1) CT
2) Mediastinal LN (+/-)
- if negative, is tumour > 3cm or < 3cm ?
3) Endoscopy or VATS
4) Assess again if mediastinal LN (+/-)
5) Decide if surgery or multimodal treatment
What is the recommended treatment plan for nodal negative local disease?
Surgical resection + adjuvant therapy (CHT+/- RT)
*potentially resectable nodal positive: Multimodal approach (neoadjuvant)
When is targeted therapy indicated?
- genetic mutation
- EGFR, ALK, ROS, BRAF
PDL 1+ > 50% cells and PDL < 50% general treatment?
- PDL 1+ > 50% cells: immunotherapy (Pembro)
- PDL 1+ < 50% cells: immunotherapy and chemotherapy
ESMO local and locally advanced lung cancer guideline?
Imaging CT:
No enlarged LN and peripheral tumour -> Surgery and adjuvant chemotherapy (radiotherapy)
No enlarged LN but central tumour or hilar LN -> surgical multimodality treatment after MDT assessment (N2)
*N0 goes for surgery and adj. chemo
*N3 is unresectable
Extensive mediastinal N2 infiltration
-> unresectable, therefore non-surgical multimodal treatment
NSCLC IV treatment with target driver mutation
BRAF - Dafrafenib
EGFR - Gefitinib
ALK - Crizotinib
ROS1- Crizotinib
(BEAR for the mutation types)
*re-assess for disease progression for EGFR and ALK
No progression:
surgery and continue local tx e.g. RT
Sysemic Progression
Rebiospy/further testing and see if Omertinib (for EGFR) and Certinib (for ALK) is needed
Chemo platinum based is indicated following this
What are some facts about SCLC?
- highly aggressive LC
- biologically different to NSCLC
- > 50% px’s get distant metastases in CNS
- Cisplatin + Etopozoid (Atezolizumab) make the backbone of treatment
- fast relapse and poor prognosis
Treatment of SCLC?
Curative
- T1,2 N0 M0:
surgery + chemotx and prophylactic cranial irradiation
- T1-4 N2,3 M0:
concomitant chemotx prophylactic cranial irradiation (if near complete response) - T1-4, N1-3, M1ab (solitary and not confirmed)
concomitant chemotx prophylactic cranial irradiation (if near complete response)
Palliative
- T1-4, N1-3, M1ab (multiple and confirmed)
Chemotx and cranial irradiation if near any response
Treatment of relapse/progression of SCLC?
Relapse/progression > 3 months after 1st line complete
- repeat same regimen
Relapse/progression < 3 months after 1st line complete
- topoteken
Further relapses/progression
- single agent e.g. amrubicin, docetaxel, topotekan
What is mesothelioma and it’s main cause?
- rare aggressive primary pleural tumour
- 80% of its cause is from asbestos
- genetic predisposition e.g. BAP1
