lung cancer JH Flashcards

1
Q

what are the risk factors for lung cancer?

A

cigarette smoking
passive smoking
other occupational/ environmental hazards- radiation/ air polution
genetic predisposition
previous malignancies
general risk factors- old age, obesity, poor diet, physical inactivity, alcohol

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2
Q

how more common is lung cancer death in smokers?

A

15x

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3
Q

what type of lung cancer is smoking strongly linked with?

A

small cell lung cancer and squamous cell carcinoma

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4
Q

what are the different types of smoking cessation available?

A

12 week programme
NRT
champix
CO readings

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5
Q

what should you inform patients of in the smoking cessation following diagnosis?

A

smoking increases risk of pulmoary complications after surgery
advise to stop ASAP and tell why important
offer NRT/ champix
do not postpone surgery for lung cancer to allow patients to stop smoking

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6
Q

what are the signs and symptoms of lung cancer?

A
  • cough that won’t go away
  • A change in a cough you have had for a long time :
    – More painful
    – Sounds different
    – Bringing up coloured mucus of phlegm
  • Shortness of breath
  • Haemoptysis
  • Pain in chest or shoulder
  • Loss of appetite/weight
  • Fatigue
  • Ongoing chest infection
  • Reduced breath sounds over lobe, inspiratory crackles over a lobe, unilateral wheeze
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7
Q

what are the 3 different patholohys of lung cancer?

A

non-small-cell lung cancer- 80%
small cell lung cancer
mesothelioma

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8
Q

what are the different types of NSCLC

A

– Adenocarcinoma 40%
– Squamous cell carcinoma 30%
– Large cell lung cancer 10%

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9
Q

what is the pathology of NSCLC

A

grows at a slower rate

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10
Q

what is the pathology of SCLC?

A
  • Most aggressive
  • Has almost always metastasised by the time of diagnosis
  • chemo sensitive
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11
Q

what is the pathology of mesothelioma?

A
  • Alsoaggressive
  • 70-80% caused by asbestos exposure
  • Linked with heavy industry
  • Not common in certain areas and therefore specialist opinion may be sought
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12
Q

how do you treat NSCLC?

A
  • Surgery
    – Treatment of choice in stage I-II
  • Radical radiotherapy
    – Continuous Hyperfractionated Accelerated Radiotherapy
    (CHART)
  • Radical chemoradiotherapy
  • Neoadjuvant chemoradiotherapy+ surgery
  • Palliative chemotherapy
  • Symptomatic support+radiotherapy
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13
Q

what are the different types of surgery options available?

A

– Surgery alone
– Surgery + radiotherapy
– Surgery + chemotherapy

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14
Q

what is the benefit of chemo before or after sugrery?

A

before- neo-adjuvant- shrink cancer making it easier to remove
after- can help lower the risk of cancer coming back

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15
Q

what is the benefit of giving chemo before, after or alongside radiotherapy?

A

can sometimes help to get rid of early NSCLC in people who cant have surgery

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16
Q

what does the EGFr gene control?

A

controls growth and proliferation

17
Q

what are targeted therapies of the EGFR gene?

A

tyrosine kinase inhibitors
Erlotinib (Tarceva), Gefitinib (Iressa)and Afatinib (Giotrif

18
Q

what are some adverse effects of tyrosine kinase inhibitors?

A

acneiform rash, dry skin or itching

19
Q

what can EGFR inhibitors cause?

A

keratitis and ulcerative keratitis

20
Q

who is pallative chemo offered to?

A

stage 3b or 4 cancer

21
Q

what are examples of combination chemo for pallative care?

A

include docetaxel or gemcitabine with
either carboplatin or cisplatin

22
Q

what kind of cancer is small cell lung cancer ?

A

highly malignant tumour

23
Q

how is SCLC treated in limited stage disease?

A

cancer is contained in a single area that can be treated
chemotherapy is followed by radiotherapy or radiotherapy
very few cases of surgery

24
Q

how is extensive disease stage treated in SCLC?

A

treatment aims to control cancer for as long as possible and help with symptoms

25
what is first line chemotherapy for limited stage disease in SCLC?
– Carboplatin/cisplatin+etoposide – Four to six cycles should be given unless progressive disease or unacceptable toxicity – Give concurrent chemoradiotherapy to patients if they present with disease that can be targeted by radiotherapy – Sequential radiotherapy for patients who are unfit for concurrent chemoradiotherapy but who respond to chemotherapy
26
what is second line therapy for SCLC?
–a platinum based regumen as above CAV topotecan capsules
27
what physcical changes may the patient have living with lung cancer?
coping with breathlessness tiredness
28
what psychological changes are there living with lung cancer?
-shock and worry fear and anxiety smokers guilt grief depression isolation and loneliness
29
what are palliative care issues ?
endobronchial obstruction superior vena cava obstruction plural effusion breathlessness cough brain metastases hypercalcaemia