Lung Cancer Flashcards
Lung cancer accounts for ___% of all cancer diagnosis in the U.S.
15%
Lung cancer prevalence peaks between the ages of ___ and ___.
55-65
Lung carcinomas arise from ____.
Normal bronchial epithelial cells
2 Types of Lung Cancer
NSCLC
SCLC
___% of lung cancer in the U.S. is attributed to tobacco use.
80%
____% of smokers develop lung cancer
Less than 20% of smokers actually develop lung cancer
Other compounds that lead to lung cancer
benzene
asbestos
80% of lung cancer puts have this type:
NSCLC
Major cell types in NSCLC
Squamous Cell carcinoma
Adenocarcinoma
Large Cell Carcinoma
Type of Lung Cancer that grows faster
SCLC grows faster than NSCLC
Type of NSCLC that is more prevalent in males
SCC
Type of NSCLC that has a STRONG DOSE-RESPONSE to tobacco
SCC
Common metastatic sites for SCC
Hilar and Mediastinal Lymph Nodes Liver Adrenal Glands Kidneys Bones GI Tract
Most common type of lung cancer
Adenocarcinoma
-accounts for half of all lung cancers
Most common NSCLC subtype in non-smokers
Adenocarcinoma
-accounts for half of all lung cancers
___ is a worse prognosis than SCC
Adenocarcinoma
-more likely to metastasize at early stage and spread to distant sites
Adenocarcinoma metastatic sites
Contralateral Lung Liver Bone Adrenal Glands Kidneys CNS***
LCC
Large Cell Carcinoma Undifferentiated Epithelial tumors -often dvx of exclusion -large and bulky tumors -assoc with similar poor prognosis as adenocarcinomas
___% of all lung cancers are SCLC
15%
SCLC
Very aggressive
-60-70% of pts present with disseminated dz
-occur in
major bronchi and
periphery of lung
May express neuroendocrine differentiation leading to paraneoplastic syndromes
SCLC major meta sites
Lymph Nodes Opposite Lung Liver Adrenal Glands Bone /and marrow CNS
Paraneoplastic Syndromes
S/S that occur at sites away from primary tumor or its metastases.
- Not assoc with direct tumor involvement
- Caused by prod. of biologically active subs or antibodies
- Occur more frequently with lung cancer than any other cancer.
- More freq with SCLC than NSCLC
NLST
National Lung Screening Trial
- compared LOW-dose CT (LDCT) to CXR with high risk pts.
- ages 55-74 and 30 pack year smokers
- 3 scans each 1 yr apart
- those with LDCT had 20% less chance of death
ASCO screening guidelines for lung cancer
Pts. who meet:
- 55-74 yr old
- Fairly good health
- at least 30 pack year hx
- smoked within last 15 yrs
Beta-carotene
study found that older pts who smoked and took beta-carotene were more likely to develop and die from lung cancer
Metastasis status at time of LC dgx
Over 50% distant metas
25% regional
15% localized
Most common initial s/s of LC
Cough
Dyspnea
CP or discomfort
Many pts also have co-morbidities: COPD, CVD, etc.
-may be assoc with paraneoplastic syndromes
Examples of paraneoplastic syndromes
Wt loss Cushing's syndrome Hypercalcemia SIADH Pulm hypertrophic osteoarth Clubbing Anemia Eaton-Lambert's Hypercoagulable state
Staging for NSCLC
TNM
Staging for SCLC
VA LC Study Group method
- Limited dz (LD) - single hemothorax
- Extensive dz (ED) - 60-70% of pts
- evenly bone, then liver, marrow, CNS
If untreated, most LC pts die ___
Within 1 year of dgx
Role of surgery in LC
Used in stages I-III NSCLC vs. radiation in SCLC
Role of radiation in NSCLC
Stages I and II ONLY with POSITIVE margins
All pts with N2 dz
Palliative tx
Systemic Tx in NSCLC
adjuvant and in unresectable/metastatic for palliation
Chemo options for NSCLC
Cisplatin or Carboplatin PLUS one of: Gemcitabine Paclitaxel Docetaxel Vinorelbine Pemetrexed
1st Line Tx for advanced NSCLC
ECOG 0-2
ECOG 3+ best supportive care
2nd and 3rd Line Tx of NSCLC
Offered to pts with ECOG 0-2 who experience dz progression after 1st line chemo MONOTHERAPY with: -pemetrexed -erlotinib -docetaxel If ECOG 3+, supportive care
1st Line Tx for NSCLC
Surgery for Stages I-III or single meta Then, radiation with pos. margins ONLY ECOG 0-2 Chemo DOC: Cisplatin or Carboplatin PLUS Gemcitabine Paclitaxel Docetaxel Vinorelbine Pemetrexed
ECOG 3+, supportive care
EGFR inhibitors
Must have EGFR (+) aka HER-1
- Afatinib
- Cetuximab
- Erlotinib
Pts most likely to respond to EGFR inhibitors
Pts who never smoked
Women (think HER)
Asians
Adenocarcinoma Histology
Mutations commonly seen in NSCLC
EGFR (w/ or w/o KRAS) aka HER-1
=erlotinib, cetuximb, afatinib
VEGF
=bevacizumab (added to CbP)
IF: Non-squamous cell
No bleeding/anticoag
No CNS metas
ALK
=crizotinibADEs of EGFR inhibitors
Acneiform Rash
Diarrhea
VEGF inhibitors
Bevacizumab
Bevacizumab
VEGF inhibitor
-also used in colorectal cancer
Combined w/carboplatin and paclitaxel (CbP)
**Watch for bleeding, anticoag, CNS meta
**Not in SCC
ALK Inhibitors
Crizotinib
ALK mutations seen more in non-smokers
and adenocarcinoma (where there are fewer)
Crizotinib
ALK Inhibitor -used more in non-smokers -used more in adenocarcinomas ADEs: -vision disorder -Pneumonitis
ADEs of crizotinib
Vision Disorder and Pneumonitis
Tx of SCLC (General)
Chemo +/- radiation
(not surgery in early stages like NSCLC)
Favorable prognostic factors for SCLC
Female
Early Stage
Less than 5% unintentional wt loss
DOC for SCLC Limited Dz (LD)
EC - Etoposide/Cisplatin
May sub carboplatin
Then, PCI if complete response
PCI
Prophylactic Cranial Irradiation (PCI)
-Offered to LD/ED SCLC pts who have
complete response
-Reduces brain mets and incr 3-yr survival
Tx of SCLC Extensive Dz (ED)
EC remains the DOC
(etoposide/cisplatin)
alt: cisplatin + irinotecan
If response, PCI
Tx of Recurrent dz in SCLC
If less than 3 mo:
-supportive care/clinical trial
If over 3 mo:
-TOPOTECAN (only use)
Topotecan
Used in recurrent SCLC IF occurred in over 3 months -Improves symptoms, NOT response rate, survival, time to progression
Evaluation of Tx Response in NSCLC
Evaluate tumor response after 2-3 cycles AND
every other cycle after that
Continue 4-6 cycles with response
After completed tx:
-PE
-CXR q3-4 mo x2 yr
-then q6 mo x 3 yr
-then annuallyEvaluation of Tx Response in SCLC
Evaluate tumor response after 2-3 cycles
Continue 4-6 cycles with response
Offer PCI if response
After completed tx:
-F/U visits q 3mo x3 yr
-then q4-6 mo x 2 yr
-then annually
