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Cancer care > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

Percentage of types of lung tumours

A

87% non small cell
12-15% small cell
<1% neuroendocrine and mesothelioma

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2
Q

Presentation specific to non small cell tumours

A

Pancoast = horners syndrome - meiosis, anhydrosis, partial ptosis
Hypercalcaemia

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3
Q

Presentation specific to small cell tumours

A

SVCO
SIADH - dilutional hyponatraemia
Paraneoplastic syndrome (up to 50%)
Symptoms from mets e.g bone pain

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4
Q

General symptoms of lung cancer

A 
Cough
Haemoptysis (likely central tumour as invaded mediastinal BVs)
Dyspnoea
Chest pain 
Weight loss
Anorexia
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5
Q

General signs of lung cancer

A 
Anaemia
Clubbing
Cachexia
Lymphadenopathy 
Chest signs e.g dull on percussion (effusion or consolidation)
SVCO
Horners syndrome
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6
Q

Signs of SVCO

A

Facial and neck oedema
Facial redness
Dilated chest veins
Dyspnoea

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7
Q

Blood tests for lung cancer

A 
FBC
U&amp;Es
LFTs
Bone profile 
CRP
Tumour markers
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8
Q

Who is referred via 2 week wait

A

40 or over with unexplained haemoptysis

CXR suggestive of lung cancer

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9
Q

Age criteria for urgent CXR

A

40 or over

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10
Q

Symptoms on their own which meet criteria for urgent CXR

A 
Persistent or recurrent chest infection
Persistent supraclavicular or cervical lymphadenopathy 
Clubbing 
Chest signs of lung cancer
Thrombocytosis
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11
Q

Symptoms which you need 2 of or smoker with 1 to meet criteria for urgent CXR

A 
Cough 
Fatigue
SOB
Chest pain
Anorexia 
Weight loss
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12
Q

When can surgery be a treatment for SCLC

A

Tumour 5cm or less

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13
Q

Treatment for SCLC if not suitable for surgery

A

Consider cranial radiotherapy for prophylaxis of brain metastasis
Chemotherapy +/- thoracic radiotherapy

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14
Q

Treatment for SCLC relapse

A

Second line chemotherapy (no 3rd line!)
Or
Palliative supportive care

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15
Q

Criteria for prophylactic cranial radiotherapy in SCLC

A

Limited disease AND complete/good partial response to primary treatment

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16
Q

Criteria for thoracic radiotherapy in SCLC

A

Limited disease:
Alongside cycle of chemo OR after chemo if good partial response within thorax

Extensive disease:
After chemo if complete response at distant sites and good partial response within thorax

17
Q

Prognosis of SCLC limited vs extensive disease

A

Limited: 18-30 months
Extensive: 7-12 months

18
Q

How to stage NSCLC

A

TNM staging to convert into stage 1-4

19
Q

Describe stage 1A NSCLC

A

Tumour 3cm or less

No spread to LN

20
Q

Describe stage 1B NSCLC

A

Tumour 3-5cm

No spread to LN

21
Q

Describe stage 2 NSCLC

A

Tumour up to 7cm

+/- spread to peribronchial or hilar LN

22
Q

Describe stage 3A NSCLC

A

Tumour extends into surrounding tissue

Spread to ipsilateral LNs

23
Q

Describe stage 3B NSCLC

A

Spread to contralateral LNs
Or
Subcarinal or mediastinal LN spread with >1 tumour

24
Q

Describe stage 4 NSCLC

A

Metastatic spread i.e palliative

25
Q

Treatment of stage 1 and 2 NSCLC

A

Surgical resection + adjuvant chemo if >4cm

For non-operable: radical radiotherapy if performance score 0-1

26
Q

Treatment for stage 3 NSCLC

A

Chemoradiotherapy
Radical radiotherapy
Palliative chemotherapy
Palliative radiotherapy

27
Q

Treatment for stage 4 NSCLC

A

Palliative care:
Chemotherapy
Immunotherapy
Targeted therapy

28
Q

First line targeted therapy for Non-squamous lung cancers

Give examples

A

EGFR tyrosine kinase inhibitors

Gefitinib and erlotinib

29
Q

Examples of targeted therapy drugs for NSCLC

A

EGFR tyrosine kinase inhibitors

Pembroluzimab

30
Q

How do EGFR tyrosine kinase inhibitors work

A

Prevents KRAS mediated effects in the EGFR pathway therefore it prevents cell proliferation, cell survival and metastasis

31
Q

Describe the mechanism of action of pembroluzimab

A

Monoclonal antibody
Binds to PD1 receptor on T cells
Prevents T cell from binding to PD-L1 and PD-L2 on tumour cells
Reactivates T cell mediated immunity against the tumour cells

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