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Cancer - All topics > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

LC accounts for what percentage of cancers diagnosed?

A

14%

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2
Q

LC is more common in what gender?

A

Men

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3
Q

What is the median age of diagnosis with lung cancer?

A

70

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4
Q

What is the prognosis of diagnosis with LC?

A

80% die within 1 yr.

5% alive after 5 years.

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5
Q

What causes lung cancer?

A

Smoking: >90% of cases.
Length of time spent as a smoker is more important than number of cigarettes per day.
Stopping smoking immediately reduces the risk. after 15 yrs non-smoking: same risk as that of non-smoker.

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6
Q

Other than smoking, what are the other risk factors for smoking?

A

Passive smoking, asbestos exposure, radon gas exposure, previous lung disease or family history of lung cancers.

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7
Q

What are the two types of LC?

A

Small cell lung cancer: 15%

Non-small cell lung cancer: 85%.

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8
Q

How do SCLCs and NSCLCs differ in terms of cells?

A

SCLC: Small cells, uniform.
NSCLC: Several different types: squamous cell, adenocarcinoma, large cell.

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9
Q

How do SCLCs and NSCLCs differ in terms of surgery for treatment?

A

SCLC: limited role for surgery.
NSCLC: surgery is used more often.

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10
Q

How do SCLCs and NSCLSs differ in terms of response to chemo?

A

SCLCs: responds well to chemo and radio therapy.
NSCLCs: Less responsive to chemo.

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11
Q

What are the main attributes of SCLCs?

A 
15% total cases of LC. 
Cells small and uniform. 
Aggresive tumours. 
Usually metastatic at diagnosis. 
Surgery has a limited role. 
Responds well to chemo + radiotherapy however. 
Overall survival 5-10% at 5 years.
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12
Q

What are the main attributes of NSCLCs?

A

Make up 85% of diagnosed cases.
Several different types: squamous, adenocarcinoma, large cell. Surgery is an option more often, less responsive to chemo: metastasises to the brain, liver and bones.

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13
Q

How does LC typically present?

A

No symptoms in the early stage.

Symptoms are usually due to tumour causing pressure, pain or obstruction.

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14
Q

What are the typical presentation symptoms of LC?

A 
Persistent chronic cough.
SOB/Wheezing (dyspnoea)
Haemoptysis - coughing up blood. 
Chest/Shoulder/Back pain. 
Weight loss
Fatigue.
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15
Q

What percentage of patients will have metastatic disease at presentation?

A

> 50%

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16
Q

What type of LC is less responsive to chemo?

A

NSCLC
Surgery used more often.
Most common type.

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17
Q

Early LC can be mistaken for what?

A

COPD

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18
Q

Early LC can often be diagnosed on routine:

A

Chest X-Ray.

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19
Q

What are the main diagnostic tests for LC? [5]

A
  1. CXR
  2. Bronchoscopy/biopsy.
  3. Sputum cytology.
  4. CT scan (to assess suitability for surgery & sites of common metastases: Liver)
  5. Lung function tests to establish baseline condition.
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20
Q

What type of LC is less responsive/not treated with surgery?

A

SCLC.

Better response to chemo/radio

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21
Q

LC treatment is primarily determined by what?

A

The staging:

  1. size of tumour + location
  2. Invasive/not
  3. How many lymph nodes (if spread)
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22
Q

What are the two different stages of SCLC?

One of them accounts for 30% of cases, the other for the remaining 70%.

A

Limited stage disease: 30%.
The cancer is confined to one side of the chest & involved lymph nodes can be treated with radiotherapy.

Extensive stage disease: 70% - cancer has metastasised to distant organs.

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23
Q

What is the treatment pathway for limited stage (30% cases) SCLC?

A

5% undergo surgery + adjuvant chemo.

The remaining pts undergo chemo + radiotherapy.

24
Q

What is the treatment pathway for extensive stage SCLC (70% cases)?

A

Simply palliative chemotherapy.

25
Q

Often patients with SCLC will have a positive response to chemo - good tumour shrinkage and symptom relief. What then occurs?

A

They relapse.

26
Q

What is the 1st line regimen in limited stage SCLC?

A

4-6 cycles of cisplatin/carboplatin-based chemotherapy.

Initial response rate of ~80%.

Extensive disease: platinum based therapy such as cisplatin etc. if patient can tolerate it.

27
Q

How many cycles of _______/_________-based chemotherapy is first line for limited stage SCLC?

A

4-6 cycles.

Carboplatin/cisplatin.

28
Q

What is second line treatment of SCLC?

A

Chemo with Anthracycline-containing regimen or further platinum chemo if pt has good response.

+

radiotherapy for palliation of symptoms.

29
Q

What are the different treatment options for NSCLC?

A
  1. Surgery (to cure) followed by adjuvant chemo.
  2. Radiotherapy (to cure) followed by chemo/radiotherapy.
  3. Radiofrequency ablation.
  4. 1st line chemo/targeted Tx for advanced or metastatic NSCLC. Then mantenance chemo then 2nd line chemo or targeted Tx.
30
Q

2nd line treatment for SCLC consits of chemotherapy with an _________-containing regimen or further platinum chemotherapy if patient has had good response to 1st line platinum. This is given alongside ____________ for palliation of symptoms.

A

2nd line treatment for SCLC consits of chemotherapy with an Anthracycline-containing regimen or further platinum chemotherapy if patient has had good response to 1st line platinum. This is given alongside Radiotherapy for palliation of symptoms.

31
Q

Surgery is only an option for NSCLC stage _ & _ disease.

A

I and II

32
Q

Major complications occur in what percentage of pts undergoing surgery for lung cancer?

A

30%

33
Q

What else should be initiated in a patient undergoing surgery for NSCLC stage I or II (IIa sometimes) disease?

A

Post surgery adjuvant chemotherapy using a cisplatin based chemotherapy.

34
Q

What should all patients with Stage III-IV NSCLC be encouraged to do?

A

Stop smoking (all lung cancer patients really)

35
Q

What does the treatment of advanced/metastatic NSCLC disease depend on?

A

The specific tumour histological subtype: Adenocarcinoma vs squamouse cell carcinoma.

Biomarkers/mutations: EGFR mutation, ALK gene translocation.

36
Q

What is the treatment of choice for NSCLC adenocarcinoma with ALK translocation?

A

Crizotinib.

Oral ALK receptor inhibitor.

37
Q

Oral ALK receptor inhibitor.

A

Crizotinib: treatment of chouce for NSCLC adenocarcinoma with ALK translocation.

38
Q

Interstital lung disease occurs in _% of patients taking Crizotinib. Crizotinib is an ______ receptor inhibitor which is given ______.

A

3%
ALK receptor inhibitor.
Given orally.

39
Q

The main side effect of Crizotinib is

A

Visual problems: 63% patients.

40
Q

The first line treatment for adenocarcinoma with no EGFR/ALK mutation is cisplatin/pemetrexed chemotherapy for / cycles.

A

1st line = cisplatin/pemetrexed chemotherapy 4-6 cycles

41
Q

What % of patients report visual problems when taking Crizotinib?

A

63%

42
Q

The first line treatment for adenocarcinoma with no EGFR/ALK mutation is _______/________chemotherapy for / cycles.

A

The first line treatment for adenocarcinoma with no EGFR/ALK mutation is cisplatin/pemetrexed chemotherapy for 4-6 cycles. 21 day gap.

43
Q

For how long is maintenance pemetrexed given following initial treatment of adenocarcinoma with no EGFR/ALK mutations?

A

Every 21 days until disease progression occurs - treatment step up required.

44
Q

Cisplatin/pemetrexed treatment can cause [8]

A 
N/V
Myelosuppression
Peripheral neuropathy. 
Ototoxicity. 
Nephrotoxicity. 
Stomatitis. 
Diarrhoea. 
Alopecia.
45
Q

Pembrolizumab is NICE approved for treatment of ______ positive NSCLC after chemotherapy.

A

PD-L1 positive.

46
Q

The eGFR of patients receiving treatment must be >__ml/min.

A

55ml/min, If lower, follow guidance in treatment protocol.

47
Q

_L of IV fluids should be prescribed for before and after treatment with ______

A

3L, before and after cisplatin treatment.

48
Q

Urine output must be >___ml.hr during and for _-_hours post cisplatin administration.

A

100ml/hr, during and for 6-8 hour afterward.

49
Q

What type of agent is pemetrexed?

A

Antifolate.

Must be administered with vit B12 and folic acid to reduce toxicity - premed.

50
Q

What premeds must be given before pemetrexed therapy?

A

vit B12 and folic acid.

51
Q

Why must vit B12 and folic acid be given as premeds for pemetrexed therapy?

A

To reduce toxicity.

52
Q

Why is dexamethasone given with pemetrexed?

A

To reduce skin reactions.

53
Q

When must dexamethasone be given with pemetrexed?

A

For 3 days before starting chemo

54
Q

What is Afatinib a treatment option for?

A

Squamous cell carcinoma with EGFR mutation.

55
Q

What is Afatinib?

A

Oral Tyrosine Kinase Inhibitor (TKI) which targets the EGFR receptor.

56
Q

Afatinib is only licensed in what patients?

A

Those which are EGFR mutation +VE.

57
Q

What are the main side effects of Afatinib?

A

Skin reactions - 70%
Stomatitis - 70%
Paronychia - 58%
- something to do with nails.

Cancer - All topics (32 decks)

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