Lung Cancer Flashcards
Causes
• smoking
• air pollution
• family hx
• genetics
• precious respiratory condition
• exposure to randon gasses
• radiation
• low immunity
What 2 strategies are used to help for smoking cessation
• NHS stop smoking program
• stoptober
What is included in the NHS program
• NRT - patches, gums, inhalers
• bupropion (caution in depression)
Signs and symptoms of lung cancer
• SOB
• weight loss
• heamoptysis
• cough - painful, coloured phlegm
Signs and symptoms of metastasis
• clubbing of fingers
• decrease appetite
• on going chest infections
• back and chest pain
What is paranoplastic syndrome
This is when the lung cancer produces hormones, which are released into the blood stream and cause symptoms which are not related to the lung cancer itself
Paranoplastic syndrome - S/S
• pins and needles in fingers or toes
• breast swelling
• confusion
• dizziness
• blood clots
What the the 2 types of cancer
Small cell carcinoma
&
Non small cell lung cancer:
• squamous cell carcinoma
• adrenocarcinoma
• large cell carcinoma
How many stages are there
4
What is the staging system?
T - size of tumour
M - metastasis
N - spread to lymph nodes
Screening program - NHS lung health check
What is the patient eligibility criteria
• age 55-74
• registered with GP
• live in an area where this is offered
• previous or current smoker
What happens during consultation
• clinical assessment
• medical hx
• family hx
• lifestyle and health
After the consultation if there is no risk to the patient what happens
No further action
After the consultation it is established that patients is experiencing lung problems or breathing problems, what to do?
Refer to GP
After the consultation it is established that patients it at higher risk, what to do?
CT scan of lungs
Investigations/test
• chest x ray
• broncoscopy
• biopsy
• FBC
• LFT
• sputum test
What are the methods for lung screening
• CT
• low dose CT
• CXR
No national screening because
• expensive
• need specialised excipient
• high radiation exposure
• hard to locate high risk areas
Treatment options for NSCLC
Surgery - early stage disease (bronchoangioplastic)
• 30% of these people have operable tumours
PD-1 inhibitor or tyrosine kinase inhibitor
Which treatment option would be suitable for those with advanced NSCLC and EGFR mutation
TKIs - tyrosine kinase inhibitors
Which treatment option would be suitable for those with advanced NSCLC and without EGFR mutation
PD-1 inhibitor
PD-1 inhibitor moa
• block PD-L1 receptors on T cells
• T cells now attack and recognise cancer cells
(PD-L1 are overally expressed on cancer cells to evade immune system)
TKI moa
Tyrosine kinase cause cancer cells to grow and divide TKI stop this
Example of a PD-1
Pembrolizumab -IV
Examples of TKI
Erlotinib or Gefitinib
A common side effect of TKI?
Skin reactions
Manage:
• alcohol free emollient
• avoid skin exposure to sun (sun screen)
• bathe in look warm water and pat skin dry
• use soaps, lotions without alcohol or fragrance
Gefitinib - counselling advise?
• 1 tablet each day at the same time
• take whole don’t chew
• store in cool dry place
• inhibitors/inducers of cyp450 enzymes can interact with us so avoid grapefruit, ketokonszole
Which drugs are used to treat SCLC
Cisplatin + Etoposide
Cisplatin moa
Binds to FNA, damages it and causes apoptosis
A platinum based compound
Damages dna
Common ADRs
Nephrotic
Diarrhoea
Nausea
Etoposide Mia
Inhibits DNA synthesis by forming complex with topoisomerase II
Most common type of lung cancer amongst non smokers
Adenocarcinoma
Name of mechanism responsible for immune invasion in NSCLC
PD-1
Can cisplatin be used as adjuvant in NSCLC
Yea
If cancer is confined to one place what management would take place
Surgery
