Lung Cancer Flashcards
round to fusiform shape with scant cytoplasma and finely granular nuclear chromatitine and absent or incospicious nucleoli
Small cell lung cancer - neuroendocrine cancer
makes up about 15% of all lung cancers and biggest risk factor is tobacco abuse
Treatment of SCLC
based on stage.
on limited stage SCLC - means one radiation field - ipsilateral hemithorax and regional lymph nodes
early on- very small we use surgery to cut area and/or plantinum based chemotherapy.
what is considered metastatic SCLC?
when there’s dx that cannot be limited to one radiation field (mets to brain, adrenals, bone, and liver)
Treatment of limited stage SCLC?
platinum based chemotherapy + radiation therapy; aim for curative intent.
molecular testing is not routinely done.
Treatment of extensive stage SCLC?
Offer platinum based chemotherapy plus immunotherapy with radiation. Those who respond to chemotherapy often receive subsequent chest and or prophylactic cranial irradiation. used palliative for symptomatic metastatic dx such as bone or brain mets.
who gets small cell lung cancer?
heavy smokers and most cases involve the central airway (hilar mass) and manifest with cough, dyspnea hemoptysis and weight loss and fatigue
Extensive stage small cell lung cancer
involvement of contralateral lymph nodes, malignant pericardial or pleural effusion or distant metastasis
For small cell lung cancer first choice of treatment is:
etoposide plus cisplatin chemotherapy first. Then can get radiation or prophylactic head radiation
non small cell lung cancer treatment is often based on:
molecular profiling in order to determine 1st line treatment (endothelial growth factor receptor tyrosine kinase inhibitos)
early stage non small cell lung cancer:
lobectomy is 1st line if early NSCLC but that’s only if there’s no mediastinal lesions or contraindications to surgery.
advanced non small cell lung cancer is treated with:
tumor molecular markers
tx is based on age, functional status, and comorbodities
non elderly pts with good performance status get treated with cytotoxic agents (platinum compounds) or targeted agents EGFR inhibitors, ALK fusion inhibitors, monoclonal antibodies.
elderly pts with good performance status may be treated.
elderly with poor performance status need palliative care.
what is associated with squamous cell carcinoma
super vena cava syndrome
treatment for squamous cell carcinoma stage I and II
surgical resection
stage III squamous cell carcinoma treatment
chemoradiation
squamous cell carcinoma of the lung is likely to cause this paraneoplastic syndrome
hypercalcemia
which cancer causes hyponatremia
small cell lung cancer causes small sodium
Kulchitsky cells located in the central airways
think small cell carcioma
histology shows small highly basophilic cells that are poorly differentiated
small cell lung cancer
Associated paraneoplastic syndromes with small cell lung cancer
SIADH
hyponatremia
hypokalemia
hypochloremia
Lambert Eaten - muscle weakness from antibodies against pre synaptic calcium channels
Cushings syndrome with ectopic ACTH production
central weight gain
adenocarcinomas are located on the
periphery of lung parenchyma
large cell carcinoma are located with
highly malignant with early metastasis; undifferentiated anaplastic with large nuclei in histology
poorly responsive to chemotherapy and treated surgically
generally poor prognosis
psammona bodies seen on histology
mesothelioma which is found on adjacent to pleura and unrelated to smoking.
can cause pleural effusions with hemorrhages
bronchial carcinoid tumors of the lung
low grade malignant neuroendocrine tumor that rarely metastasizes and see carcinoid syndrome with wheezing, flushing diarrhea and hypotension.
prior to surgery for resectable Stage 1 and 2 NON small cell cancer need to do:
get rigorous functional evaluation to predict anticipated pulmonary reserve after surgery
look at FEV1 and DLCO
If mild to moderate impairment then need to get exercise testing
how do you TREAT pts who are NON SURGICAL candidates and have Stage 1 and 2 NON small cell cancer
stereotactic body radiation and other ablative treatments that can be used to treat the primary tumor - works for small tumors.
Larger tumors need conventional chemotherapy
If you have stage I or II NON small cell lung cancer when do you get radiation therapy?
pts who have been treated surgically who have positive margins
they get post op radiation
those who are non surgical candidates
When do you give chemotherapy in pts who have stage I or II NON small cell lung cancer?
give to people who have gotten surgery for resection.
Get cisplastin based adjuvant chemotherapy
get four cycles
cisplatin + EITHER
vinorelbine, pemetrexed, gemcitabine and docetaxel.
what improves survival in stage II and stage III non small cell cancer?
cisplatin based chemotherapy as adjuvant therapy
get four cycles
cisplatin + EITHER
vinorelbine, pemetrexed, gemcitabine and docetaxel.
follow up surveillance for resected and treated non small cell lung cancer:
CT scan q6 months for 1st two years and annually
stop smoking.
locally advanced non small cell lung cancer is defined as:
presence of clinically detectable LAD in mediastinum or by a primary tumor that invades into local structures (mediastinum, heart, trachea, esophagus, or great vessels)
Tx is with better surgery
all get neoadjuvant or adjuvant platinum based chemotherapy or radiation
those with dx and bulky adenopathy should get combo platinum based chemoradiation.
metastatic NON small cell lung cancer
- get palliative care early on
- get palliative performance status
- test for mutations for possible treatment (EGFR, ALK and ROS1)
- give platinum based chemotherapy doublet + bevacizumab
side effects of bevacizumab
stroke, MI, thrombosis and hemoptysis
Immunotherapy is
agents that act upon cells via the programmed cell death ligand PDL1 to kill non small cell lung cancer cells. Used in metastatic situations
when do we use pembrolizumab?
in pts who have NSCLC and have >50% PDL1 expression
allows for greater progression free survival and overal survival compared to standard therapy.
Treatment of Small cell lung cancer
if small tumor = surgical resection
get treated adjuvant chemotherapy
No radiation if surgerical margins were negative
Treatment of limited disease small cell lung cancer
combined cisplatin plus etoposide and radiation
chemotherapy is continued after radiation for up to six cycles
after new diagnosis of Small cell lung cancer need to get
CT C/A/P and MRI brain for staging
and whole bone scintigraphy
if pt has limited disease small cell lung cancer and responsive to treat and no signs of brain metastasis what to do?
need to under prophylactic whole brain radiation
