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1st year systems ADAM > Non-operative Management of Lung Cancer COPY > Flashcards

Non-operative Management of Lung Cancer COPY Flashcards

1
Q

What type of lung cancer makes up 85% of lung cancer?

A

Non-small cell cancer

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2
Q

What are the types of non-small cell lung cancer?

A

Squamous (30%)

Adenocarcinoma (55%)

Large cell undifferentiated

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3
Q

What type of cancer makes up about 15% of lung cancers?

A

Small cell cancer:

  • extremely aggressive
  • doubles in size every 29 days
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4
Q

Where do you normally find squamous and adenocarcinoma cancers?

A

Squamous - more central (usually male, usually smokers)

Adenocarcinoma - more peripheral, (usually in woman)

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5
Q

What does stage 4 mean?

A

Distant metastases

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6
Q

What percentage of non-small cell cancer is operable?

A

maximum of 25%

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7
Q

What are all the therapeutic options for cancer?

A

Surgery

Radiotherapy (radical/curative or palliative)

Chemotherapy

Combination

Targetted therapies

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8
Q

What determines the therapeutic options?

A
  • Tumour type
  • stage
  • ECOG performance status
  • patient wishes and options
  • aims of therapy (curative or palliative)
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9
Q

What are the side effects to chemotherapy

A

Risk of Neutropenic sepsis

marrow suppression -> urgent admission, IV fluids + broad spectrum Abx

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10
Q

When would a patient not be able to use radiotherapy

A

If FEV1<1

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11
Q

What are the side effects of radiotherapy

A

Short term:

  • lethargy
  • oesophagitis
  • SOB due to pneumonitis

Long term:

  • pulmonary fibrosis
  • oesophageal stricture
  • cardiac

*concurrently/subsequently to chemotherapy but ↑side effects

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12
Q

What are the comorbidities of palliative radiotherapy in advanced disease (stage¾)

A

bone metastasis

cord compression

haemoptysis

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13
Q

NSCLC: What are the scores available for the ECOG performance status measurement?

A

0= fully active

1= symptoms, able to do light work

2= has to rest <50%, unable to work

3= has to rest >50%, limited self-care

4= bed/chair bound

5= dead

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14
Q

What is the average 5 year survival for non-small cell lung cancer?

A

Around 40%

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15
Q

What is meant by adjuvant therapy?

A

post operative ↑chance of cure ↓risk of recurrence

Cancer appears to have been removed

Ensures all cancer has been removed

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16
Q

Is adjuvant therapy helpful in stage 1 and 2 non-small cell lung cancer?

A

Detrimental

Some possible benefits if mediastinal nodes (N2 or involved margins)

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17
Q

NSCLC: When does preoperative chemotherapy demonstrate significant survival advantage?

A

Stage 3 Non small cell lung cancer

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18
Q

What percent of Non small cell lung cancer patients have advanced disease?

A

80% of all patients

19
Q

What is the dose for stage 3 Non small cell lung cancer radiotherapy?

A

Dose 55Gy+

20
Q

What is the survival rate for stage 3 non small cel lung cancer?

21
Q

What is survival of stage 3 non small cell cancer for patients treated with ChemoRT?

22
Q

What is treatment for stage 4 NSCLC?

A

Incurable

Palliation essential

RT to primary tumour to relieve symptoms (~70% symptom benefit)

(Chemo gives equal symptomatic benefit AND survival advantage)

Median survival >12 months with chemo alone

23
Q

What is the average number of cycles of chemo for stage 3 NSCLC?

A

3 as good as 6 cycles of chemo

4 is average in UK

24
Q

NSCLC: What should be considered in the case of Painful bone metastases and Brain mets?

A

Painful bone mets - radiotherapy

Brain mets – resection

25
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
26
NSCLC: What is pemetrexed used for?
Maintainance chemotherapy
27
What can drugs target in NSCLC?
Driver mutation in ADENOCARCINOMA
28
NSCLC: Give examples of Driver mutations for NSCLC
EGFR mutation BRAF mutation ALK translocation ROS alteration
29
NSCLC: Who are targetted drugs used by?
Patients who are unfit for chemotherapy
30
NSCLC: What is the concept for Tyrosine Kinase Inhibitors?
Blocks Tyrosine Kinase Membrane receptor protein - stops the formation of a protein that causes tumour growth
31
What drugs are Tyrosine Kinase Inhibitors?
Erlotinib, gefitinib, afatinib
32
What is Tarceva?
Tyrosine Kinase inhibitor used to treat EGFR mutations
33
What is the function of Nivolumab?
Blocks binding of PD-1 to PD-L1 and PD-L2 Potentiates activity of lymphocytes by preventing them from being activated
34
What is different between the presentation of small cell lung cancer and NSCLC?
Presentation identical secretory syndromes are present in SCLC - e.g SIADH Low sodium - confusion ACTH - increases production and release of cortisol by cortex of adrenal gland ACTH causes Cushings - hyper-secretion of ACTH by pituitary gland ACTH (Adrenocorticotropic hormone) SIADH (syndrome of inappropriate antidiuretic hormone (ADH) secretion)
35
What are the two classifications of Small cell lung cancer severity?
Limited Disease - Staged to one hemithorax Extensive disease - more advanced disease
36
How do you treat SCLC of limited disease?
Chemotherapy Combination of drugs - 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*
37
What treatment has no effect in SCLC?
High Dose chemo Alternating Chemo Maintainance Chemo Chemo 'on demand' Maintainance interferon
38
What is response rate of limited disease treatment?
90% Complete remission is 60%
39
What is median survival of limited disease SCLC with and without treatment?
With - 16 months Without - 8 months
40
What is the rate of two year survival with SCLC in limited disease?
25%
41
What is the treatment for SCLC in extensive disease?
4 cycles of combination chemotherapy Percutaneous coronary intervention (PCI) Single fraction RT to palliate if not fit for chemo If brain Mets - RT and steroids
42
What is percutaneous coronary intervention
Non-surgical Used to treat narrowing (stenosis) of coronary arteries
43
What is the percentage of patients that are diagnosed too late to cure?
80%

1st year systems ADAM (52 decks)

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