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Cancer Care > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

Decide the epidemiology of lung cancer.

A

3rd most common cancer.
Affects people usually over age 75.
Men > women

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2
Q

List the risk factors for lung cancer

A

Smoking
Family history
Radiotherapy
Occupational/toxins - asbestos, radon gas, arsenic
Lung disease - TB, COPD, pulmonary fibrosis
HIV

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3
Q

What is the most common type of lung cancer?

A

Non small cell lung cancer (NSCLC) - 87%

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4
Q

What are the main types of lung cancer?

A

Non small cell lung cancer

Small cell lung cancer

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5
Q

What are the subtypes of NSCLC?

A

Adenocarcinoma
Squamous cell carcinoma
Large cell carcinoma

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6
Q

Which lung cancer is most common in smokers?

A

Squamous cell

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7
Q

Which lung cancer is most common in non-smokers?

A

Adenocarcinoma

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8
Q

Which type of cancer (NSCLC or SCLC) is more metastatic?

A

SCLC

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9
Q

Which cancer has surgical resection as an option?

A

NSCLC

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10
Q

What are the NICE criteria for urgent 2ww referral for lung cancer?

A

Age 40+ with unexplained haemoptysis or CXR findings suggestive of lung cancer.

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11
Q

How is SCLC staged/classified?

A

Limited disease

Extensive disease

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12
Q

How is NSCLC staged?

A

I - 3cm - 5cm
II - spread to lymph nodes
IIIa - cancer extends into surrounding tissues and structure e.g. lining of the chest wall
IIIb - 2 or more tumours present, spread to contralateral lung and lymph nodes
4 - metastatic spread - bone, brain, liver, adrenal gland

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13
Q

What investigation would you order if a patient aged 44 came into your GP practise complaining of fatigue and SOB? He is not a smoker but smoked in his 20s. No Fx.

A

Urgent CXR

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14
Q

What is the first line treatment for stage I or II NSCLC?

A

Surgical resection

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15
Q

Why is surgical resection first line treatment for NSCLC?

A

Less responsive to chemotherapy

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16
Q

What oncological emergency is Squamous cell carcinoma of the lung associated with?

A

Hypercalcaemia

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17
Q

What type of lung cancer is associated with hypertrophic osteoarthropathy?

A

Adenocarcinoma of the lung

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18
Q

Which lung cancer is more associated with SIADH?

A

SCLC

19
Q

Which lung cancer is more associated with Pancoasts tumour?

A

NSCLC

20
Q

What receptor testing is done on NSCLC?

A

EGFR sensitising mutation

21
Q

What targeted therapy can be used to treat NSCLC?

A

Erlotinib

22
Q

How does Erlotinib work?

A

Inhibits tyrosine kinase inside tumour cell. Inhibiting epidermal growth factor, thereby stopping growth and reproduction of cancer cell.

23
Q

What drug therapy can be offered for relapsed NSCLC?

A

Pembrolizumab

24
Q

How does Pembrolizumab work?

A

Highly selective monoclonal IgG antibody that binds to the PD-1 receptor on the cell surface. Blocks brining and activity on of PD-L1 which causes activation of T-cell mediated immune responses against tumour cells.

25
Q

When might surgery be considered for SCLC?

A

Tumour is 5cm or less

26
Q

What is the mainstay treatment option for SCLC?

A

Chemoradiotherapy

Or chemotherapy followed by radiotherapy

27
Q

What preventative treatment should be considered for patients after undergoing treatment for SCLC? Why?

A

Prophylactic cranial radiotherapy.

10% of patient’s present with cranial brain mets. 40-50% develop brain mets.

28
Q

What are the symptom someone might complain of who had brain mets?

A

Headache
Nausea/vomiting
Focal neurology
Visual disturbances

29
Q

What is the prognosis for someone with SCLC?

A

Limited stage: 18-30 months

Extensive stage: 7-12 months

30
Q

What is associated with ectopic Cushing’s syndrome?

A

SCLC

31
Q

What is meant by ‘limited’ Disease?

A

Within a tolerable radiation field

32
Q

What is meant by extensive disease?

A

Distant metastases

33
Q

List the symptoms of lung cancer

A 
Cough
Haemoptysis 
Dyspnoea
Chest pain 
Recurrent chest infections 
Weight loss
Anorexia 
Fatigue
34
Q

What are the signs of lung cancer?

A 
Cachexia
Anaemia 
Clubbing 
Supraclavicular/cervical lymphadenopathy 
Pleural effusion 
SVOC
Horner’s Syndrome
35
Q

Outline the pathophysiology of humoral hypercalcaemia of malignancy

A

Tumour secretes PTH-Related peptide which binds to commoN PTH receptor

36
Q

What happens to the serum osmolality and serum sodium level in SIADH?

A

Both reduced (hypo)

37
Q

What are the symptoms of SIADH?

A 
Fatigue
Headache
Muscle weakness
Memory loss
Loss of consciousness  
Seizures
38
Q

What causes ectopic Cushing syndrome?

A

Uncontrolled secretion of ACTH from SCLC

39
Q

What investigations would you consider for a patient with lung cancer?

A

Bloods
CXR
CT scan - lobar masses, mediastinal lymphadenopathy, liver lesions, Thrombocytosis, PE
DEXA scan

40
Q

What is the first line treatment for medically inoperable stage 1 or stage 2 NSCL cancer?

A

Radical radiotherapy

41
Q

What conditions must be met if a patient with NSCLC is to receive radical radiotherapy?

A

PS: 0-1
Medically inoperable or declining surgery
Stage 1 or 2 or PET-CT
Adequate lung function e.g. FEV1 > 1litre

42
Q

Is chemotherapy used in NSCLC stage 1 or 2 disease?

A

No - no current evidence for it

43
Q

Why does erlotinib not work in all patients?

A

Some have mutation in KRAS gene - downstream of EGFR tyrosine kinase so downstream events still occur allowing tumour to continue to proliferate.
Erlotinib only works for wild type KRAS.

Cancer Care (16 decks)

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