Non-operative Management of Lung Cancer COPY 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 lung cancers?
Small cell cancer:
- extremely aggressive
- doubles in size every 29 days
Where do you normally find squamous and adenocarcinoma cancers?
Squamous - more central (usually male, usually smokers)
Adenocarcinoma - more peripheral, (usually in woman)
What does stage 4 mean?
Distant metastases
What 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)
What are the side effects to chemotherapy
Risk of Neutropenic sepsis
marrow suppression -> urgent admission, IV fluids + broad spectrum Abx
When would a patient not be able to use radiotherapy
If FEV1<1
What are the side effects of radiotherapy
Short term:
- lethargy
- oesophagitis
- SOB due to pneumonitis
Long term:
- pulmonary fibrosis
- oesophageal stricture
- cardiac
*concurrently/subsequently to chemotherapy but ↑side effects
What are the comorbidities of palliative radiotherapy in advanced disease (stage¾)
bone metastasis
cord compression
haemoptysis
NSCLC: What are the scores available for the ECOG performance status measurement?
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
What is the average 5 year survival for non-small cell lung cancer?
Around 40%
What is meant by adjuvant therapy?
post operative ↑chance of cure ↓risk of recurrence
Cancer appears to have been removed
Ensures all cancer has been removed
Is adjuvant therapy helpful in stage 1 and 2 non-small cell lung cancer?
Detrimental
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 advanced disease?
80% of all patients
What is the dose for stage 3 Non small cell lung cancer radiotherapy?
Dose 55Gy+
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 relieve symptoms (~70% symptom benefit)
(Chemo gives equal symptomatic benefit AND survival advantage)
Median survival >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?
Driver mutation in ADENOCARCINOMA
NSCLC: Give examples of Driver mutations for NSCLC
EGFR mutation
BRAF mutation
ALK translocation
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
Membrane receptor protein - stops the formation of a protein that causes tumour growth
What drugs are Tyrosine Kinase Inhibitors?
Erlotinib, gefitinib, afatinib
What is Tarceva?
Tyrosine Kinase inhibitor used to treat EGFR mutations
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
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)
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 - 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
What treatment has no effect in SCLC?
High Dose chemo
Alternating Chemo
Maintainance Chemo
Chemo ‘on demand’
Maintainance interferon
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 - 16 months
Without - 8 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)
Single fraction RT to palliate if not fit for chemo
If brain Mets - RT and steroids
What is percutaneous coronary intervention
Non-surgical
Used to treat narrowing (stenosis) of coronary arteries
What is the percentage of patients that are diagnosed too late to cure?
80%
