Non-operative Management of Lung Cancer Flashcards
What type of lung cancer makes up 85% of lung cancer?
Non-small cell cancer
What are the types of non-small cell lung cancer?
Squamous (30%)
Adenocarcinoma (55%)
Large cell undifferentiated
What type of cancer makes up about 15% of ung cancers?
Small cell cancer - extremely aggressive - doubles in size every 29 days
Where do you normally find squamous and adenocarcinoma cancers?
Squamous - usually more central (usually male, usually smokers)
Adenocarcinoma - more peripheral, usualy in woman
What does stage 4 mean?
Distant metastases
What is the percentage of non-small cell cancer is operable?
maximum of 25%
What are all the therapeutic options for cancer?
Surgery
Radiotherapy (radical/curative or palliative)
Chemotherapy
Combination
Targetted therapies
What determines the therapeutic options?
Tumour type, stage, ECOG performance status, patient wishes and options, aims of therapy (curative or palliative)
NSCLC: What are the scores available for the ECOG performance status measurement?
What is the average 5 year survival for non-small cell lung cancer?
Around 40%
What is meant by adjuvant therapy?
When the cancer has appeared to all have been removed – but it is post operative treatment to ensure all cancer has been removed
Is adjuvant therapy helpful in stage 1 and 2 non-small cell lung cancer?
Detrimental - but some possible benefits if mediastinal nodes (N2 or involved margins)
NSCLC: When does preoperative chemotherapy demonstrate significant survival advantage?
Stage 3 Non small cell lung cancer
What percent of Non small cell lung cancer patients have adbvanced disease?
80% of all patients
What is the dose for stage 3 Non small cell lung cancer radiotherapy?
What is the survival rate for stage 3 non small cel lung cancer?
20%
What is survival of stage 3 non small cell cancer for patients treated with ChemoRT?
About 27%
What is treatment for stage 4 NSCLC?
Incurable
Palliation essential
RT to primary tumour to releive symptoms (~70% symptom benefit)
(Chemo gives equal symptomatic benefit AND survival advantage)
Median survival now >12 months with chemo alone
What is the average number of cycles of chemo for stage 3 NSCLC?
3 as good as 6 cycles of chemo (4 is average in UK)
NSCLC: What should be considered in the case of Painful bone metastases and Brain mets?
Painful bone mets - radiotherapy
Brain mets – resection
NSCLC: What are the features of Bone pain from mets?
Occurs in any site
Often worse at night
Potential for pathological fracture
Need for palliative radiotherapy
NSCLC: What is pemetrexed used for?
Maintainance chemotherapy
What can drugs target in NSCLC?
Drugs that can target the driver mutation in ADENOCARCINOMA
NSCLC: Give examples of Driver mutations for NSCLC
EGFR mutation
ALK translocation
BRAF mutation
ROS alteration
NSCLC: Who are targetted drugs used by?
Patients who are unfit for chemotherapy
NSCLC: What is the concept for Tyrosine Kinase Inhibitors?
Blocks Tyrosine Kinase which is a membrane receptor protein - This stops the formation of a protein causing the tumour to grow
What drugs are Tyrosine Kinase Inhibitors?
Erlotinib, gefitinib, afatinib
Whar us Tarceva?
Tyrosine Kinase inhibitor used to treat EGFR mutations
What is the function of Nivolumab?
Blocks the binding of PD-1 to PD-L1 and PD-L2
This potentiates the activity of lymphocytes by preventing them from being activated
What percentage of lung cancer patients have small cell lung cancer?
Roughly 15%
What is different between the presentation of small cell lung cancer and NSCLC?
Presentation identical but secretory syndromes are present.
e.g SIADH (The syndrome of inappropriate antidiuretic hormone (ADH) secretion)
Low sodium - confusion
ACTH (Adrenocorticotropic hormone - Its principal effects are increased production and release of cortisol by the cortex of the adrenal gland) - causing Cushings - hypersecretion of ACTH by the pituitary gland
What are the two classifications of Small cell lung cancer severity?
Limited Disease - Staged to one hemithorax
Extensive disease - more advanced disease
How do you treat SCLC of limited disease?
Chemotherapy
Combination of drugs including cisplastin and etoposide
Early thoracic radiotherapy is better
Prophylactic cranial radiation
Only resect about 1 lung cancer per year for those with small cell lung cancer – SURGERY IS NOT THE TREATMENT, chemotherapy dominated treatment
In SCLC is there any benefit from any of the following?
High Dose chemo?
Alternating Chemo?
Maintainance Chemo?
Chemo ‘on demand’?
Maintainance interferon?
NO
What is response rate of limited disease treatment?
90%
Complete remission is 60%
What is median survival of limited disease SCLC with and without treatment?
With - 8 months
Without - 16 months
What is the rate of two year survival with SCLC in limited disease?
25%
What is the treatment for SCLC in extensive disease?
4 cycles of combination chemotherapy
Percutaneous coronary intervention (PCI) recommended - non-surgical procedure used to treat narrowing (stenosis) of the coronary arteries of the heart found in coronary artery disease
Single fraction RT to palliate if not fit for chemo
If brain Mets - RT and steroids
What is the percentage of patients that are diagnosed too late to cure?
80%
