Lung Cancer

Question 1

Most common cause of cancer deaths?

Answer 1

Lung cancer
14% 5yr survival
Almost all long term survivors are NSCLC with early stage disease = 18-22%

2 = bowel cancer

Question 2

Is lung cancer screening recommended in Australia?

Answer 2

No

No survival benefit has been shown and high frequency of false positives

Question 3

Staging of lung cancer?

Answer 3

T1 = Tumor ≤3 cm in greatest dimension surrounded by lung or visceral pleura without invasion of main bronchus
T2 = Tumor >3 cm but ≤5 cm or tumor with any of the following features:
- Involves main bronchus without involvement of the carina
- Invades visceral pleura
- Associated with atelectasis or obstructive pneumonitis that extends to the hilar region, involving part or all of the lung
T3 = Tumor >5 cm but ≤7 cm in greatest dimension or associated with separate tumor nodule(s) in the same lobe as the primary tumor or directly invades any of the following structures: chest wall, phrenic nerve, parietal pericardium
T4 = Tumor >7 cm in greatest dimension or associated with separate tumor nodule(s) in a different ipsilateral lobe or invades

N1 = Metastasis in ipsilateral peribronchial and/or ipsilateral hilar lymph nodes and intrapulmonary nodes
N2 = Metastasis in ipsilateral mediastinal and/or subcarinal lymph node(s)
N3 = Metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node

M1 = Distant mets

Question 4

How to stage Lung cancer

Answer 4

PET-CT

More sensitive and specific then CT alone

Question 5

Chemotherapy to manage lung cancer?

Answer 5

Platinum based chemotherapy:

• Cisplat/paclitaxel
• Cisplat/gemcitabine
• Cisplat/docetaxel
• Carboplat/paclitaxel

Improves QOL and survival, however survival benefit is modest

SEs = neutropenia and anaemia, peripheral neuropathy and alopecia

Question 6

What about EGFR positive cancers?

Answer 6

15% of NSCLC have epidermal growth factor receptor mutations

Use erlotinib, gefitinib, and afatinib.
Side effects = rash and raised ALT

Question 7

What about ALK positive cancers?

Answer 7

5% of NSCLC have anaplastic lymphoma kinase mutations

Use crizotinib/ceritinib

Question 8

What about ROS1 positive cancers?

Answer 8

1% of NSCLCs

Use crizotinib

Question 9

What about mutation negative cancers?

Answer 9

Pembrolizumab or nivolumab for PD-1 ligand positive cancers = 30% of NSCLCs