lung cancer JH Flashcards
% 10yr survival for lung cancer
10%
% of lung cancers that are preventable
79%
biggest RF for lung cancer
cigarette smoking
RF for lung cancer
- smoking, passive smoking
- asbestos
- ionising radiation
- occupation RF
- air pollution
- genetic predisposition
- previous malignancies
- old age
- obesity
- poor diet
- physical inactivity
- alcohol
what has the most effect on lung cancer risk with smoking
duration of smoking
started at a younger age
most common lung cancers associated with smoking
small cell lung cancer
SCC - squamous cell carcinoma
2 12 week programmes for smoking cessation in community pharmacy
NRT - patches, gum, inhalers, nasal spray
Champix - start 1-2 weeks before stopping
smoking after lung cancer surgery
can increase risk of pulmonary complications
sings/Sx of lung cancer
- cough that won’t go away
- change in cough had for long time - more painful sounds different, bringing up coloured mucus/phlegm
- SOB
- haemoptysis
- pain in chest/shoulder
- loss of appetite/weight
- fatigue
- ongoing chest infection
- reduced breath sounds over lobe, inspiratory crackles over a lobe, unilateral wheeze
most common lung cancer in UK
NSCLC - non small cell lung cancer
types of lung cancer
NSCLC 80%
SCLC 15%
mesothelioma 5%
types of NSCLC
- adenocarcinoma
- squamous cell carcinoma
- large cell lung cancer
appearance of SCLC
SCLC cells appear closely packed together with large nuclei
growth of NSCLC
grows at slower rate
features of SCLC
- most aggressive
- has nearly always metastasised at diagnosis
- chemo sensitive
features of mesothelioma
- aggressive
- most caused by asbestos exposure
- linked with heavy industry
- not common in certain areas, might need specialist opinion
Tx options for NSCLC
- surgery
- radical radiotherapy
- radical chemotherapy
- neoadjuvant chemotherapy + surgery
- palliative chemotherapy
type of radical radiotherapy used for NSCLC
CHART
continuous hyperfractionated accelerated radiotherapy
When is surgery Tx choice in NSCLC?
in stage I-II
When can chemo be used in NSCLC?
before or after surgery
before, after of with radiotherapy Tx
What is chemo before surgery called?
neo adjuvant chemotherapy
common chemo drugs used for NSCLC
cisplatin
carbopatin
with 1+ other drug
What mutation can occur in lung cancer?
EGFR
mutation in epidermal growth factor receptor gene
What does EGFR control?
cell proliferation and growth
targeted therapies for EGFR mutation
TKIs (EGFR inhibitors)
Erlotinib
Gefitinib
Afatinib
adverse effects of TKIs (2)
skin disorders
- acneiform rash
- dry skin
- itching
diarrhoea
Tx for skin disorders with TKIs
steroids
topical/oral ABX
topical retinol
serious s/e with EGFR inhibitors
- serious cases of keratitis and ulcerative keratitis (inflammation of cornea)
- rarely can result in corneal perforation and blindness
- present with Sx of keratitis, refer to opthalmology specialist
stage when palliative chemo is used in lung cancer
stage 3B or 4
high risk of what with SCLC
brain metastases
staging for SCLC
- limited stage disease
- cancer contained in single area that can be treated
- chemotherapy then radiotherapy/chemoradiotherapy
- few get surgery - extensive stage disease
- cancer spread beyond single area that can be treated
- advanced disease
- Tx aims to control cancer for as long as possible and help with Sx -> palliative Tx
1st line Tx in SCLC in limited stage disease
chemotherapy
chemo drugs for SCLC
carboplatin/cisplatin + etoposide
4-6 cycles
