Lung cancer Flashcards
Most common type of lung cancer?
Squamous cell (NSCLC) - typically central, can secrete PTHrP (–> hypercalcaemia)
NSCLC = 82% of which squamous cell is 32%
1st line management of NSLCL for stage 1/2 without chest wall invasion?
Surgery + adjuvant chemo
80% 5 year survival
Management of NSLCL if surgery is not possible?
Radiotherapy + concurrent chemo
What metastases would palliative radiotherapy be indicated for?
Brain mets, SVCO, SCC
Chemotherapy options for NSCLC
Carboplatin + gemcitabine/paclitaxel
Targeted therapy option for NSCLC
TKI - erlotimab
Often used in a palliative setting
5 year survival of different stages of NSCLC
1 = 50% 2 = 40% 3a = 25% 3b = <5%
(4 = 6 months to live)
Proportion of lung cancers that are small cell in origin?
20%
What treatment options are SCLC particularly responsive to?
Radio and chemotherapy
Paraneoplastic syndromes of SCLC?
ADH –> hyponatremia
ACTH –> cushings –> muscle weakness, hypokalemia, HTN, oedema
Lambert-eaton syndrome - antibodies for voltage gated calcium channel –> myasthenia like syndrome
Usual presentation of SCLC? (i.e. local or disseminated)
Usually metastasised at presentation (poor prognosis)
Management of limited SCLC (i.e. fairly localised)
If tumour is at very ealry stages (12a, N0, M0) then can do surgery
Most patients = Chemo + concurrent radial radiotherapy
Management of extensive SCLC?
Chemo (palliative)
90% responsive but high relapse rates
Risk factors for LC?
Age>40
Smoking
occupation (asbestos, uranium mining, ship building etc)
Causes of lung cancer?
TSG inactivation via chromosomal deletions Oncogene overexpression - RAS, myc EGFR activation (common in adenocarcinoma)
Clinical presentation?
Non-specific: Persistent cough +/- haemoptysis Dyspnoea Recurrent chest infections Chest pain
Syndromal (dependent on tumour location):
- Apical tumours –> horner’s, pancout’s syndrome
- Paraneoplastic
- Mediastinal –> SVCO, recurrent laryngeal nerve palsy (voiceless)
Investigations?
- CXR - 95% tumours visible at presentation
- Sputum cytology - can detect and analyse malignant cells
- Bronchoscopy - take biopsy
- Trans-thoracic biopsy if peripheral tumour
- CT chest + upper abdomen + head - metastases/staging
- PET scan - for patients with operable disease to check for distant mets
(7. tumour markers - NSE and LDH, not routinely used)
Also: Function test e.g. spirometry
T, N and M
T1 = <3cm (surrounded by pleura) T2 = <7cm (invades main bronchus) T3 = >7cm (Local invasion e.g. chest wall) T4 = organ invasion (inoperable)
N1 = I/L Bronchopulmonary and hilar LN N2 = I/L mediastinal or subcarinal LN N3 = Supraclavicular or contralateral LN
M1a - C/L lung
M1b - distant metastases
Staging
Stage 1 = T1/T2, N0, M0 Stage 2 = T1/T2, N1, M0 or T3, N0, M0 Stage 3a = T1/T2/T3, N2, N0 or T3/T4, N1, M0 Stage 3b = T4, N2, M0 or any N + M0 Stage 4 = M1 (any)
At what stage does lung cancer become inoperable?
Stage 3b
Definition of limited disease?
one hemithorax (I/L mediastinal and supraclavicular LN)
