lung cancer JH Flashcards
what are the risk factors for lung cancer?
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
how more common is lung cancer death in smokers?
15x
what type of lung cancer is smoking strongly linked with?
small cell lung cancer and squamous cell carcinoma
what are the different types of smoking cessation available?
12 week programme
NRT
champix
CO readings
what should you inform patients of in the smoking cessation following diagnosis?
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
what are the signs and symptoms of lung cancer?
- 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
what are the 3 different patholohys of lung cancer?
non-small-cell lung cancer- 80%
small cell lung cancer
mesothelioma
what are the different types of NSCLC
– Adenocarcinoma 40%
– Squamous cell carcinoma 30%
– Large cell lung cancer 10%
what is the pathology of NSCLC
grows at a slower rate
what is the pathology of SCLC?
- Most aggressive
- Has almost always metastasised by the time of diagnosis
- chemo sensitive
what is the pathology of mesothelioma?
- Alsoaggressive
- 70-80% caused by asbestos exposure
- Linked with heavy industry
- Not common in certain areas and therefore specialist opinion may be sought
how do you treat NSCLC?
- 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
what are the different types of surgery options available?
– Surgery alone
– Surgery + radiotherapy
– Surgery + chemotherapy
what is the benefit of chemo before or after sugrery?
before- neo-adjuvant- shrink cancer making it easier to remove
after- can help lower the risk of cancer coming back
what is the benefit of giving chemo before, after or alongside radiotherapy?
can sometimes help to get rid of early NSCLC in people who cant have surgery
what does the EGFr gene control?
controls growth and proliferation
what are targeted therapies of the EGFR gene?
tyrosine kinase inhibitors
Erlotinib (Tarceva), Gefitinib (Iressa)and Afatinib (Giotrif
what are some adverse effects of tyrosine kinase inhibitors?
acneiform rash, dry skin or itching
what can EGFR inhibitors cause?
keratitis and ulcerative keratitis
who is pallative chemo offered to?
stage 3b or 4 cancer
what are examples of combination chemo for pallative care?
include docetaxel or gemcitabine with
either carboplatin or cisplatin
what kind of cancer is small cell lung cancer ?
highly malignant tumour
how is SCLC treated in limited stage disease?
cancer is contained in a single area that can be treated
chemotherapy is followed by radiotherapy or radiotherapy
very few cases of surgery
how is extensive disease stage treated in SCLC?
treatment aims to control cancer for as long as possible and help with symptoms
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
what is second line therapy for SCLC?
–a platinum based regumen as above
CAV
topotecan capsules
what physcical changes may the patient have living with lung cancer?
coping with breathlessness
tiredness
what psychological changes are there living with lung cancer?
-shock and worry
fear and anxiety
smokers guilt
grief
depression
isolation and loneliness
what are palliative care issues ?
endobronchial obstruction
superior vena cava obstruction
plural effusion
breathlessness
cough
brain metastases
hypercalcaemia
