Non-operative Management of Lung Cancer COPY Flashcards
What are the histological subtypes of lung cancer?
- Non-small cell lung cancer
- Small cell lung cancer
What forms of NSCLC are there?
- Squamous
- Adenocarcinoma
- Large cell undifferentiated
- NOS
What is the proliferation rate of NSCLC?
Doubles every 129 days
What must be considered in the treatment of lung cancer?
- Tumour type
- Stage
- ECOG performance status
- Patient wishes
- Options
- Aims of therapy
What treatment options are there?
- Surgery
- Radiotherapy
- Chemotherapy
- Combination
- Targeted therapy
- Supportive care only
What is the aim of NSCLC adjuvant therapy?
Postoperative in order to increase the chance of cure
What demonstrates a significant survival advantage for stage III NSCLC?
Neoadjuvant chemotherapy
What is essential in stage III NSCLC radical RT?
Pulmonary function tests
What is the average number of cycles of chemo in the UK?
4
What improves survival in stage III and IV NSCLC by a further 3 to 5 months?
Maintenance chemotherapy with Pemetrexed
What may the presenting symptom in bone metastasis?
Pathological fracture
When does bone pain from metastases usually occur?
Any site but often worse at night
What mutations have been identified which lead to adenocarcinoma?
- EGFR mutation
- ALK translocation
- BRAF mutation
- ROS alteration
Who are targeted drugs suitable for?
Patients unfit for chemotherapy
What does nivolumab BMS do?
Blocks the binding of PD-1 to PD-L1 and PD-L2 which potentiates the activity of T-lymphocytes by preventing them from being inactivated
What is the proliferation rate of SCLC?
Doubles every 29 days
How does SCLC present?
- Presentation is identical to NSCLC
- Secretory syndromes present
- SIADH, ACTH
What are the treatment options for SCLC LD?
- Chemotherapy
- Combination of drugs
- Early thoracic RT
- Prophylactic cranial radiation
What proves to have no advantage in SCLC LD?
- High dose chemo
- Alternating chemo
- Maintenance chemo
- Chemo on demand
- Maintenance interferon, MMPI, targeted therapies
What are the treatment options for SCLC ED?
- 4 cycles combination chemo
- Consolidation thoracic RT
- PCI
- Single fraction RT to palliate if unfit for chemo
- RT and steroids if brain metastasis
