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M104 Symposia > M104 Lung Cancer Symposia > Flashcards

M104 Lung Cancer Symposia Flashcards

1
Q

What percentage of all cancers consist of lung cancer?

A

20%

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2
Q

What is the leading cause of cancer deaths?

A

lung cancer

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3
Q

What proportion of patients with lung cancer have never smoked?

A

1 in 8

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4
Q

What are the survival rates like for lung cancer and why?

A

Poor survival rates due to patients only presenting in advanced stages

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5
Q

What are the symptoms for cancer like?

A

they are similar to normal smoking symptoms

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6
Q

What are the causes of lung cancer?

A

smoking (70% of cases) or smoke inhalation

radiotherapy / exposure to radiation

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7
Q

What are the symptoms of lung cancer?

A 
Smoker of more than 20 years
Cough, Wheeze, hoarseness
Haemoptysis
Dyspnoea
chest pain
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8
Q

What are the systemic and metastatic presenting symptoms of lung cancer?

A

Weight loss, Fatigue
Pain from sites
Commonly metastasise to CNS, bone and skin

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9
Q

What are the two types of paraneoplastic syndromes associated with lung cancer?

A

Hyponatraemia- small cell carcinoma

Hypercalcaemia- squamous cell carcenoma

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10
Q

What are paraneoplastic syndromes caused by?

A

an abnormal immune system response to a neoplasm.

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11
Q

What’s another term for tumour?

A

neoplasm

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12
Q

What is hyponatraemia caused by in lung cancer?

A

a small cell carcinoma

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13
Q

What is hypercalcaemia caused by in lung cancer?

A

a squamous cell carcinoma

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14
Q

What is performed early on for suspected lung cancer?

A

CXR

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15
Q

What are the signs of lung cancer on examination?

A 
Clubbing
Cachexia
Supraclavicular / cervical lymphadenopathy
Stridor / vocal cord palsy
Pleural effusion
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16
Q

What are the sub types of lung cancer?

A 
Non small cell (85% of cases)
Squamous (20%)
Adenocarcinoma (40%)
Large cell
Undifferentiated- 18%
Small cell- 13%
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17
Q

What group of people is Adenocarcinoma more common in?

A

non-smokers

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18
Q

What investigations are performed for suspected lung cancer?

A

CT, PE scanning
Bronchoscopy, Biopsy
Endobronchial ultrasound

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19
Q

What is done to determine further treatment for lung cancer?

A

determine the malignant cell type and stage of the cancer

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20
Q

What are the criteria of TNM staging? (TIL)

A

Tumour size
Involvement of local structures
Lymph / blood metastasis

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21
Q

How is non small cell lung cancer managed?

A

the cancer is resectable - can be surgically removed

but treatments involving radiation may be more appropriate

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22
Q

What group of people might it be appropriate to perform surgery on for NSC lung cancer?

A

for stage 1 and 2 patients

usually involves lobectomy

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23
Q

What percentage of NSC lung tumours are removed via surgery?

A

20%

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24
Q

What are treatments involving radiation?

A

high dose radial therapy

chemotherapy

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25
Q

When are treatments involving radiation used?

A

for stage 1 and 2 patients who aren’t fit enough for surgery

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26
Q

What is the effect of palliative radio/chemotherapy?

A

good for symptom relief but not expected to cure

often improve QoL, and often lengthens life but only weeks to months

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27
Q

What is the main treatment for Small cell lung cancer?

A

chemotherapy

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28
Q

What are the effects of chemotherapy for the treatment of Small cell lung cancer?

A

is effective, is good for symptom control and can induce remission
it prolongs survival by months
there is a 15% 5 year survival rate

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29
Q

What are the differential diagnosis of a lung mass?

A 
Neoplastic or not
Benign or malgnant
Primary or secondary
Site of origin
Histological subtype
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30
Q

What are the pathological diagnosis of a lung mass?

A

Histopathology - growth pattern and margin
Small cell- 10-15%
Non small cell- 85%

31
Q

What are the features of Small cell lung cancer?

A

Little cytosplasm
Azzopardi effect
Small dark cells

32
Q

What is Small cell lung cancer otherwise known as?

A

oat cell lung cancer

33
Q

What type of disease is Small cell lung cancer?

A

a widespread bulky disease

34
Q

What is Squamous cell carcinoma caused by?

A

cigarette smoke promotes squamous metaplasia

35
Q

What is the second most common form of skin cancer?

A

Squamous cell carcinoma

36
Q

What is Squamous cell carcinoma characterized by?

A

the abnormal, accelerated growth of squamous cells

37
Q

Are Adenocarcinomas malignant?

A

they are often benign but with malignant cells lining the alveolar spaces

38
Q

Are Adenocarcinomas malignant?

A

they are often benign but with malignant cells lining the alveolar spaces

39
Q

Where are Adenocarcinomas located? What type of tissue do they contain?

A

peripheral and contains fibrous tissue

40
Q

How are SCCs and ACs differentiated from eachother?

A

by looking for specific proteins such as TTF1 which is expressed in adenocarcinoma

41
Q

How are AC’s divided into categories?

A

depending on key driver mutations

42
Q

What are the three types of AC’s / the two types of key driver mutations?

A

EGFR mutation (oncogene)
ALK fusion proteins EML4-ALK
PD1/PD-L1- pembrolizumab

43
Q

What substance targets the EGFR mutation?

A

tyrosine kinase inhibiting agents

44
Q

What substance targets ALK fusion proteins?

A

ALK Tki

45
Q

What is the role of pembrolizumab?

A

to produce an ATBY which results in tumour cells being destroyed

46
Q

What is another term for oncogene?

A

EGFR mutation

47
Q

What is another term for ALK fusion proteins?

A

EML4-ALK

48
Q

What is another term for pembrolizumab?

A

PD1/PD-L1

49
Q

What are the different patterns of spread for lung cancer?

A

Local and direct
Lymphatic
Systemic spread

50
Q

What does the lung cancer spread when it is

local and direct?

A

intrapulmonary metastasis - to the adjacent lung

the pleural cavity

51
Q

What does the lymphatic pattern of spread for lung cancer involve?

A

to the nodes or within the lungs

52
Q

Where does lung cancer spread when it is systemic? (LABB)

A

liver, adrenal, bone, brain

53
Q

How is a diagnosis made for lung cancer?

A 
MDT effort
clinical features through imaging
determining whether the cancer is Small cell or non
determining the subtype within NSC
determining the proteins involved
54
Q

When does radiation pneumonitis most commonly develop?

A

1 to 3 months after treatment is over

but it can happen up to 6 months after treatment

55
Q

What type of disease is radiation pneumonitis?

A

a metastatic disease

56
Q

What is radiation pneumonitis caused by?

A

radiation therapy to the chest

57
Q

What is the main physiological problem associated with radiation pneumonitis?

A

inflammation of the lungs

58
Q

What is the survival period of radiation pneumonitis without treatment?

A

2-4 months

59
Q

What is the survival period of radiation pneumonitis without treatment?

A

2-4 months

60
Q

How is radiation pneumonitis treated?

A

with palliative chemo which works to relieves symptoms

61
Q

What is the survival period of radiation pneumonitis with palliative chemo?

A

12-24 months

62
Q

What drugs are used to treat lung cancer?

A

Afatinib & Osimertinib
crizotinib, alectinib- target ALK
Immunotherapy
New CTLA4 inhibitors

63
Q

What family of medications does Afatinib and Osimertinib come under?

A

the tyrosine kinase inhibitor family of medications

64
Q

What is Afatinib and Osimertinib used to treat?

A

cases of NSCLC with EGFR gene mutations

65
Q

What are the three immunotherapy drugs used to treat lung cancers? (PAN)

A

pembrolizumab, atezolizumab, nivolumab

66
Q

How does pembrolizumab work?

A

targets and blocks the PD-1 surface protein on T-cells

this triggers the T-cells to find and kill cancer cell

67
Q

What surface protein is targeted by pembrolizumab?

A

PD-1

68
Q

What type of substance is atezolizumab?

A

a monoclonal antibody

69
Q

What substance binds to atezolizumab?

A

the programmed death-ligand-1

70
Q

How does atezolizumab work?

A

in its capacity as a monab, it binds to PD-L1, thereby reactivating the immune response to tumour cells

71
Q

What type of substance is nivolumab?

A

a human immunoglobulin G4 (IgG4) monoclonal antibody

72
Q

How does nivolumab work?

A

it blocks the interaction between PD-1, PD-L1 and PD-L2
thereby releases PD-1 pathway-mediated inhibition of the immune response, including the anti-tumor immune response, resulting in decreased tumor growth

73
Q

When is the decision made regarding palliative care for a patient with lung cancer?

A

terminal patients

it is often mixed alongside ongoing treatment

74
Q

What are three reasons why palliative care is utilized for patients with lung cancer?

A

it will make them comfortable and have the best QoL
it can help patient and their families
less depression and longer survival

M104 Symposia (11 decks)

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