Lung Cancer Flashcards
Why does lung cancer have such high mortality?
mostly diagnosed at late stage
What are the risk factors for lung cancer?
smoking, occupational exposure, passive smoking, domestic pollution
Why is there currently no role for screening with low dose CT for lung cancer?
because the false positive rate is 96%
What is the role of PET scanning in lung cancer?
sensitive and specific for mediastinal lymph nodes to avoid futile thoracotomy, and to exclude distant metastasis
not indicated in metastatic lung cancer
What is the role of CT in lung cancer?
standard of care for lung cancer staging
What are the positive prognostic factors for lung cancer?
stage of disease, good performance status, lack of substantial weight loss, female sex
What is the treatment for stage 1 lung cancer?
surgery or stereotactic surgery if patient not fit
What is the treatment for stage 2 lung cancer?
surgery or radiotherapy if not a surgical candidate
What surgery is recommended?
lobectomy and resection of draining lymph nodes
What patients can stereotactic radiotherapy be used for?
patients with node negative non bulky tumours
What is the chemotherapy for lung cancer?
cisplatin based combination treatment
What is the treatment for stage III NSCLC?
concurrent radiotherapy and chemotherapy followed by immunotherapy (durvalumab)
What factors need to be considered in treating stage IV NSCLC?
presence of driver mutation
presence of PDL-1
squamous vs non squamous
performance status
What is the most common mutation in NSCLC?
KRAS
What percentage of patients have small cell lung cancer?
15%
What are the two types of NSCLC?
squamous, non squamous
What are the two types of non squamous lung cancer?
large cell neuroendocrine carcinoma and adenocarcinoma
What are the actionable mutations in NSCLC?
ALK rearrangement, EGFR, ROS-1
Which patients commonly have EGFR mutations?
asian females, younger, non smoker
What is the treatment for acneiform rash?
topical or oral antibiotics (tetracyclines), topical steroids, skin care and sun protection
What percentage of NSCLC have ALK rearrangement mutations?
2-7%
What population typically get ALK rearrangement mutations?
asian, non smoking males with adenocarcinoma
What drugs are used to target ALK rearrangement?
crizotinib, alectenib
What are the side effects of crizotinib?
visual changes, neutropaenia, altered bowel habit, pulmonary toxicity, fluid retention, hepatotoxicity, bradycardia, prolonged QT, fatigue, cytochrome p450 interactions
What percentage of patients have ROS-1 rearrangement?
1% of NSCLC
What drug is used to target ROS-1 rearrangement?
crizotinib
What patients can immunotherapy be used in?
patients with high PDL1 status (>50%)
Which patients should you check PDL1 status in?
those without an actionable mutation or those with squamous cell lung cancer
What agent is used to treat PDL-1?
pembrolizumab
Can patients with low PDL-1 get treated with pembrolizumab?
yes but only as second line
Which lung cancer is strongly associated with smoking?
small cell lung cancer
What metastases are frequent with small cell lung cancer?
CNS
What is the recommended treatment for small cell lung cancer?
chemotherapy (platinum with etoposide) and radiotherapy if limited stage
What is mesothelioma?
a pleural malignancy related to asbestos exposure
What is the treatment for mesothelioma?
palliative intent chemotherapy (cisplatin and pemetrexed)
