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Oncology / Organ Transplant > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

Lung cancer accounts for ___% of all cancer diagnosis in the U.S.

A

15%

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2
Q

Lung cancer prevalence peaks between the ages of ___ and ___.

A

55-65

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3
Q

Lung carcinomas arise from ____.

A

Normal bronchial epithelial cells

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4
Q

2 Types of Lung Cancer

A

NSCLC

SCLC

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5
Q

___% of lung cancer in the U.S. is attributed to tobacco use.

A

80%

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6
Q

____% of smokers develop lung cancer

A

Less than 20% of smokers actually develop lung cancer

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7
Q

Other compounds that lead to lung cancer

A

benzene

asbestos

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8
Q

80% of lung cancer puts have this type:

A

NSCLC

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9
Q

Major cell types in NSCLC

A

Squamous Cell carcinoma
Adenocarcinoma
Large Cell Carcinoma

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10
Q

Type of Lung Cancer that grows faster

A

SCLC grows faster than NSCLC

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11
Q

Type of NSCLC that is more prevalent in males

A

SCC

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12
Q

Type of NSCLC that has a STRONG DOSE-RESPONSE to tobacco

A

SCC

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13
Q

Common metastatic sites for SCC

A 
Hilar and Mediastinal Lymph Nodes
Liver
Adrenal Glands
Kidneys
Bones
GI Tract
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14
Q

Most common type of lung cancer

A

Adenocarcinoma

-accounts for half of all lung cancers

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15
Q

Most common NSCLC subtype in non-smokers

A

Adenocarcinoma

-accounts for half of all lung cancers

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16
Q

___ is a worse prognosis than SCC

A

Adenocarcinoma

-more likely to metastasize at early stage and spread to distant sites

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17
Q

Adenocarcinoma metastatic sites

A 
Contralateral Lung
Liver
Bone
Adrenal Glands
Kidneys
CNS***
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18
Q

LCC

A 
Large Cell Carcinoma
Undifferentiated Epithelial tumors
-often dvx of exclusion
-large and bulky tumors
-assoc with similar poor prognosis as adenocarcinomas
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19
Q

___% of all lung cancers are SCLC

A

15%

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20
Q

SCLC

A

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

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21
Q

SCLC major meta sites

A 
Lymph Nodes
Opposite Lung
Liver
Adrenal Glands
Bone /and marrow
CNS
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22
Q

Paraneoplastic Syndromes

A

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
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23
Q

NLST

A

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
24
Q

ASCO screening guidelines for lung cancer

A

Pts. who meet:

  1. 55-74 yr old
  2. Fairly good health
  3. at least 30 pack year hx
  4. smoked within last 15 yrs
25
Beta-carotene
study found that older pts who smoked and took beta-carotene were more likely to develop and die from lung cancer
26
Metastasis status at time of LC dgx
Over 50% distant metas 25% regional 15% localized
27
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
28
Examples of paraneoplastic syndromes
``` Wt loss Cushing's syndrome Hypercalcemia SIADH Pulm hypertrophic osteoarth Clubbing Anemia Eaton-Lambert's Hypercoagulable state ```
29
Staging for NSCLC
TNM
30
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
31
If untreated, most LC pts die ___
Within 1 year of dgx
32
Role of surgery in LC
Used in stages I-III NSCLC vs. radiation in SCLC
33
Role of radiation in NSCLC
Stages I and II ONLY with POSITIVE margins All pts with N2 dz Palliative tx
34
Systemic Tx in NSCLC
adjuvant and in unresectable/metastatic for palliation
35
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
36
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 ```
37
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
38
EGFR inhibitors
Must have EGFR (+) aka HER-1 - Afatinib - Cetuximab - Erlotinib
39
Pts most likely to respond to EGFR inhibitors
Pts who never smoked Women (think HER) Asians Adenocarcinoma Histology
40
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 =crizotinib ```
41
ADEs of EGFR inhibitors
Acneiform Rash | Diarrhea
42
VEGF inhibitors
Bevacizumab
43
Bevacizumab
VEGF inhibitor -also used in colorectal cancer Combined w/carboplatin and paclitaxel (CbP) ***Watch for bleeding, anticoag, CNS meta ***Not in SCC
44
ALK Inhibitors
Crizotinib ALK mutations seen more in non-smokers and adenocarcinoma (where there are fewer)
45
Crizotinib
``` ALK Inhibitor -used more in non-smokers -used more in adenocarcinomas ADEs: -vision disorder -Pneumonitis ```
46
ADEs of crizotinib
Vision Disorder and Pneumonitis
47
Tx of SCLC (General)
Chemo +/- radiation | (not surgery in early stages like NSCLC)
48
Favorable prognostic factors for SCLC
Female Early Stage Less than 5% unintentional wt loss
49
DOC for SCLC Limited Dz (LD)
EC - Etoposide/Cisplatin May sub carboplatin Then, PCI if complete response
50
PCI
Prophylactic Cranial Irradiation (PCI) -Offered to LD/ED SCLC pts who have complete response -Reduces brain mets and incr 3-yr survival
51
Tx of SCLC Extensive Dz (ED)
EC remains the DOC (etoposide/cisplatin) alt: cisplatin + irinotecan If response, PCI
52
Tx of Recurrent dz in SCLC
If less than 3 mo: -supportive care/clinical trial If over 3 mo: -TOPOTECAN (only use)
53
Topotecan
``` Used in recurrent SCLC IF occurred in over 3 months -Improves symptoms, NOT response rate, survival, time to progression ```
54
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 annually ```
55
Evaluation 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 ```

Oncology / Organ Transplant (12 decks)

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