Lung Cancer Flashcards
LC accounts for what percentage of cancers diagnosed?
14%
LC is more common in what gender?
Men
What is the median age of diagnosis with lung cancer?
70
What is the prognosis of diagnosis with LC?
80% die within 1 yr.
5% alive after 5 years.
What causes lung cancer?
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.
Other than smoking, what are the other risk factors for smoking?
Passive smoking, asbestos exposure, radon gas exposure, previous lung disease or family history of lung cancers.
What are the two types of LC?
Small cell lung cancer: 15%
Non-small cell lung cancer: 85%.
How do SCLCs and NSCLCs differ in terms of cells?
SCLC: Small cells, uniform.
NSCLC: Several different types: squamous cell, adenocarcinoma, large cell.
How do SCLCs and NSCLCs differ in terms of surgery for treatment?
SCLC: limited role for surgery.
NSCLC: surgery is used more often.
How do SCLCs and NSCLSs differ in terms of response to chemo?
SCLCs: responds well to chemo and radio therapy.
NSCLCs: Less responsive to chemo.
What are the main attributes of SCLCs?
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.
What are the main attributes of NSCLCs?
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.
How does LC typically present?
No symptoms in the early stage.
Symptoms are usually due to tumour causing pressure, pain or obstruction.
What are the typical presentation symptoms of LC?
Persistent chronic cough. SOB/Wheezing (dyspnoea) Haemoptysis - coughing up blood. Chest/Shoulder/Back pain. Weight loss Fatigue.
What percentage of patients will have metastatic disease at presentation?
> 50%
What type of LC is less responsive to chemo?
NSCLC
Surgery used more often.
Most common type.
Early LC can be mistaken for what?
COPD
Early LC can often be diagnosed on routine:
Chest X-Ray.
What are the main diagnostic tests for LC? [5]
- CXR
- Bronchoscopy/biopsy.
- Sputum cytology.
- CT scan (to assess suitability for surgery & sites of common metastases: Liver)
- Lung function tests to establish baseline condition.
What type of LC is less responsive/not treated with surgery?
SCLC.
Better response to chemo/radio
LC treatment is primarily determined by what?
The staging:
- size of tumour + location
- Invasive/not
- How many lymph nodes (if spread)
What are the two different stages of SCLC?
One of them accounts for 30% of cases, the other for the remaining 70%.
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.
What is the treatment pathway for limited stage (30% cases) SCLC?
5% undergo surgery + adjuvant chemo.
The remaining pts undergo chemo + radiotherapy.
What is the treatment pathway for extensive stage SCLC (70% cases)?
Simply palliative chemotherapy.
Often patients with SCLC will have a positive response to chemo - good tumour shrinkage and symptom relief. What then occurs?
They relapse.
What is the 1st line regimen in limited stage SCLC?
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.
How many cycles of _______/_________-based chemotherapy is first line for limited stage SCLC?
4-6 cycles.
Carboplatin/cisplatin.
What is second line treatment of SCLC?
Chemo with Anthracycline-containing regimen or further platinum chemo if pt has good response.
+
radiotherapy for palliation of symptoms.
What are the different treatment options for NSCLC?
- Surgery (to cure) followed by adjuvant chemo.
- Radiotherapy (to cure) followed by chemo/radiotherapy.
- Radiofrequency ablation.
- 1st line chemo/targeted Tx for advanced or metastatic NSCLC. Then mantenance chemo then 2nd line chemo or targeted Tx.
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.
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.
Surgery is only an option for NSCLC stage _ & _ disease.
I and II
Major complications occur in what percentage of pts undergoing surgery for lung cancer?
30%
What else should be initiated in a patient undergoing surgery for NSCLC stage I or II (IIa sometimes) disease?
Post surgery adjuvant chemotherapy using a cisplatin based chemotherapy.
What should all patients with Stage III-IV NSCLC be encouraged to do?
Stop smoking (all lung cancer patients really)
What does the treatment of advanced/metastatic NSCLC disease depend on?
The specific tumour histological subtype: Adenocarcinoma vs squamouse cell carcinoma.
Biomarkers/mutations: EGFR mutation, ALK gene translocation.
What is the treatment of choice for NSCLC adenocarcinoma with ALK translocation?
Crizotinib.
Oral ALK receptor inhibitor.
Oral ALK receptor inhibitor.
Crizotinib: treatment of chouce for NSCLC adenocarcinoma with ALK translocation.
Interstital lung disease occurs in _% of patients taking Crizotinib. Crizotinib is an ______ receptor inhibitor which is given ______.
3%
ALK receptor inhibitor.
Given orally.
The main side effect of Crizotinib is
Visual problems: 63% patients.
The first line treatment for adenocarcinoma with no EGFR/ALK mutation is cisplatin/pemetrexed chemotherapy for / cycles.
1st line = cisplatin/pemetrexed chemotherapy 4-6 cycles
What % of patients report visual problems when taking Crizotinib?
63%
The first line treatment for adenocarcinoma with no EGFR/ALK mutation is _______/________chemotherapy for / cycles.
The first line treatment for adenocarcinoma with no EGFR/ALK mutation is cisplatin/pemetrexed chemotherapy for 4-6 cycles. 21 day gap.
For how long is maintenance pemetrexed given following initial treatment of adenocarcinoma with no EGFR/ALK mutations?
Every 21 days until disease progression occurs - treatment step up required.
Cisplatin/pemetrexed treatment can cause [8]
N/V Myelosuppression Peripheral neuropathy. Ototoxicity. Nephrotoxicity. Stomatitis. Diarrhoea. Alopecia.
Pembrolizumab is NICE approved for treatment of ______ positive NSCLC after chemotherapy.
PD-L1 positive.
The eGFR of patients receiving treatment must be >__ml/min.
55ml/min, If lower, follow guidance in treatment protocol.
_L of IV fluids should be prescribed for before and after treatment with ______
3L, before and after cisplatin treatment.
Urine output must be >___ml.hr during and for _-_hours post cisplatin administration.
100ml/hr, during and for 6-8 hour afterward.
What type of agent is pemetrexed?
Antifolate.
Must be administered with vit B12 and folic acid to reduce toxicity - premed.
What premeds must be given before pemetrexed therapy?
vit B12 and folic acid.
Why must vit B12 and folic acid be given as premeds for pemetrexed therapy?
To reduce toxicity.
Why is dexamethasone given with pemetrexed?
To reduce skin reactions.
When must dexamethasone be given with pemetrexed?
For 3 days before starting chemo
What is Afatinib a treatment option for?
Squamous cell carcinoma with EGFR mutation.
What is Afatinib?
Oral Tyrosine Kinase Inhibitor (TKI) which targets the EGFR receptor.
Afatinib is only licensed in what patients?
Those which are EGFR mutation +VE.
What are the main side effects of Afatinib?
Skin reactions - 70%
Stomatitis - 70%
Paronychia - 58%
- something to do with nails.
