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CCC > Lung cancer > Flashcards

Lung cancer Flashcards

1
Q

What are the risk factors?

A
  • smoking (85%)

- occupation: asbestos exposure, uranium mining, ship building, petroleum refining

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2
Q

what areas of the lung most commonly give rise to tumours?

A
  • large and medium sized bronchi (rarely lung parenchyma)
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3
Q

what type of cells is small cell lung cancer derived from?

A
  • small cell (18%) derived from neuro-endocrine cells within the lung
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4
Q

Name the cell types of non-small cell lung cancer?

A
  • Non small cell make up 82% of lung cancer:
  • SCC
  • Adenocarcinoma
  • large cell carcinoma
  • non-small cell lung cancer
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5
Q

What mutation is adenocarcinoma most commonly associated with?

A
  • activating mutations in EGFR
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6
Q

how may the patient present?

A
  • cough
  • dyspnoea
  • haemoptysis
  • chest pain
  • recurrent chest infection
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7
Q

what cancer subtypes produce what paraneoplastic syndromes?

A
  • squamous cell carcinoma hypercalcaemia (PTHrP)
  • Small Cell lung cancer
    SIADH
  • Small Cell lung cancer, Carcinoid tumours
    Increased ACTH
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8
Q

What investigations would you do? and how reliable are they?

A
  • CXR (95% of tumours visible)
  • Sputum cytology (80% have malignant cells in sputum)
  • Bronchoscopy: allows visualisation of bronchial tree and tumour biopsy
  • CT chest and abdomen:
    extent of local and distant disease
  • PET scan
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9
Q

What non-specific tumour markers can be used?

A

Tumour markers: neuron specific enolase (NSE) and LDH

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10
Q

What kind of factors may be taken into account for assessing treatment options?

A
  • performance status (refer to notes)

- COPD, vascular disease, general debility

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11
Q

How is the tumour staged?

A

Tumour:
> T1 3cm or less, not invading a main bronchus
> T2 <7cm
>T3 local invasion of particular structures irrespective of tumour size
> T4: organ invasion (inoperable) mediastinum, heart, great vessels

Nodes:
> N1: ipsilateral bronchopulmonary and hilar nodes
> N2: ipsilateral mediastinal nodes (operable)
> N3: contralateral nodes (inoperable)

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12
Q

At what stage does it automatically become inoperable?

A

Stage 3b, most patients will have occult mets at presentation

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13
Q

How is SCLC staged?

A

Limited- confined to one hemithorax, local extension confined to ipsilateral side

Extensive- disease at sites beyond the definition of limited disease (2/3)

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14
Q

How is SCLC managed?

A
  • limited- radical radio/ chemotherapy

- extensive- chemotherapy

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15
Q

How well do small cell lung cancers respond to chemotherapy?

A
  • SCLC is one of the most chemosensitive tumours and responds within days
  • 90% will respond to combination chemotherapy
  • most patients will relapse with disease that is chemo-resistant and die from rapidly progressive disease
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16
Q

When is radiotherapy indicated in SCLC? (3 times)

A
  • Treatment of primary tumour: highly radiosensitive, used in combination with chemo
  • Prophylactic cranial irradiation: brain mets are frequent and cause significant morbidity. Reduces frequency of brain mets and improved survival
  • Palliative: radiotherapy may be used to palliate the symptoms of advanced SCLC.
17
Q

What is the scope for surgery?

A
  • 90% of patients do not undergo surgery.

- tumours <3cm confined to broncho-pulmonary and hilar nodes

18
Q

what is the prognosis of SCLC?

A
  • 2-4 months without treatment
  • approx a year with chemotherapy
  • limited disease, good performance status, favourable biochemistry have a 10-15% chance of long term survival
19
Q

What is the surgical indications in NSCLC?

A
  • Stage 1 and 2 (80% 5yr survival)

- mediastinal involvement is inoperable

20
Q

What are the indications for radiotherapy?

A
  • patients not suitable for surgery
  • following surgery
  • CHART radiotherapy (high dose) results in improved survival
  • complications e.g. SVCO, SCC
21
Q

What are the indications for chemotherapy?

A
  • Palliative, shrinks the tumour together with radical radiotherapy
  • Adjuvant chemo to surgery
22
Q

What kind of targeted therapy can be used?

A
  • Tyrosine kinase inhibitors (erlotinib/ gefitinib)
  • benificial in palliative NSCLC
  • Can be used in first line in patients who have activating mutations of EGFR.
23
Q

What is the prognosis?

A

Stage 1- 50% 5yr survival
Stage 2 - 40%
Stage 3a- 25%
Stage 3b- <5%

CCC (12 decks)

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