Lung cancer Flashcards
Describe smoking cessation in lung cancer
Smoking increases risk of pulmonary complications after surgery
Advise to stop smoking as soon as diagnosis of lung cancer
Offer NRT
Do not postpone surgery for patient to stop smoking
What are the symptoms?
Cough 3 weeks or more
Long-standing cough getting worse
Multiple chest infections
Fatigue
Chest pain
Weight loss
Appetite loss
Haemoptysis
Often patients report too late because symptoms aren’t unusual
How do you refer?
Offer urgent chest radiography within 2 weeks if patient has 2 or more unexplained symptoms
Ever smoked = one symptom
What are the investigations?
X-ray first - when referred after an x-ray must be told what they’re being referred for
CT scan = more detailed image = can see stage of disease
Bronchoscopy = biopsy
Lung function test
PET-CT = show any metastases
What are you looking for in molecular diagnosis?
Mutation = can use targeted therapy
= have EGFR, KRAS + ALK
If NO mutation cannot use
How is PD-L1 different?
Can still use immunotherapy if level are low
= levels can rise + change as the the tumour changes
What is the staging?
T1 = <3, no involvement of bronchus
T2 = 3-5, bronchus involvement
T3 = 5-7
T4 = >7 or involves diaphragm
N1/2/3 = node involvement
M1a = tumour in contralateral lung
M1b = single extra thoracic metastasis
M1c = multiple
What is N?
N1 = nodes near tumour
N2 = central to lung
N3 = on other lung or high up
What are the different treatment options?
Surgery (neoadjuvant or adjuvant)
Chemo
Radiotherapy
Immunotherapy
Targeted
What targets EGFR?
TKIs
= Osimeritnib
What are the adverse effects of targeted therapy?
NOT as extensive as chemo
Dermatologic + GI issues = skin rash, dry skin, diarrhoea + photosensitivity
Cardiac + vascular effects = QT prolongation, bradycardia + HTN
Lung + respiratory toxicity = interstitial lung disease = with initiation of treatment
Liver + metabolic toxicity = elevated liver enzymes, fatigue + fever
What are the checkpoints in non-small cell lung cancer?
Monoclonal Abs that block inhibitory immune checkpoint PD-1+ PD-L1
= prevent cancer cells from binding to immune cells = reactivate immune system
What drugs target PD-1?
Nivolumab
Pembrolizumab
What drugs target PD-L1?
Atezolizumab - small cell
Avelumab
Durvalumab
What is the chemo for lung cancer?
Platinum-based chemo
Carboplatin preferred = lower toxicity
Cisplatin more potent BUT worse SEs
What is the chemo for NSCLC?
Carboplatin with pemetrexed (non-squamous) or paclitaxel/gemcitabine (squamous)
What is the chemo for SCLC?
Carboplatin with etoposide
How do you calculate Carboplatin dose?
Based entirely on renal function
Calculate BSA 1st (DuBois)
Then eGFR = Wright formula
Then dose = AUC X (GFR + 25)
How do you calculate pemetrexed doses?
Would use dose banding tables
Standard dose 500mg/m2 = X by BSA
Describe small cell lung cancer
Aggressive
Highly malignant tumour
High risk of brain metastases = give preventative cranial radiotherapy
Limited stage = in one lung
Extensive = spread outside lung
Carboplatin + etoposide + atezolizumab = extensive
Describe palliative care
Improve symptoms of lung cancer
Breathlessness, pain, haemoptysis, bone metastases + hypercalcaemia
Steroids decrease inflammation
Opioids for pain + breathlessness
NSAIDs for bone metastases
