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Respiratory > Non-operative Management of Lung Cancer > Flashcards

Non-operative Management of Lung Cancer 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?

A

20%

21
Q

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

A

About 27%

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
Q

NSCLC: What are the features of Bone pain from mets?

A

Occurs in any site

Often worse at night

Potential for pathological fracture

Need for palliative radiotherapy

26
Q

NSCLC: What is pemetrexed used for?

A

Maintainance chemotherapy

27
Q

What can drugs target in NSCLC?

A

Driver mutation in ADENOCARCINOMA

28
Q

NSCLC: Give examples of Driver mutations for NSCLC

A

EGFR mutation

BRAF mutation

ALK translocation

ROS alteration

29
Q

NSCLC: Who are targetted drugs used by?

A

Patients who are unfit for chemotherapy

30
Q

NSCLC: What is the concept for Tyrosine Kinase Inhibitors?

A

Blocks Tyrosine Kinase

Membrane receptor protein - stops the formation of a protein that causes tumour growth

31
Q

What drugs are Tyrosine Kinase Inhibitors?

A

Erlotinib, gefitinib, afatinib

32
Q

What is Tarceva?

A

Tyrosine Kinase inhibitor used to treat EGFR mutations

33
Q

What is the function of Nivolumab?

A

Blocks binding of PD-1 to PD-L1 and PD-L2

Potentiates activity of lymphocytes by preventing them from being activated

34
Q

What is different between the presentation of small cell lung cancer and NSCLC?

A

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
Q

What are the two classifications of Small cell lung cancer severity?

A

Limited Disease - Staged to one hemithorax

Extensive disease - more advanced disease

36
Q

How do you treat SCLC of limited disease?

A

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
Q

What treatment has no effect in SCLC?

A

High Dose chemo

Alternating Chemo

Maintainance Chemo

Chemo ‘on demand’

Maintainance interferon

38
Q

What is response rate of limited disease treatment?

A

90%

Complete remission is 60%

39
Q

What is median survival of limited disease SCLC with and without treatment?

A

With - 16 months

Without - 8 months

40
Q

What is the rate of two year survival with SCLC in limited disease?

A

25%

41
Q

What is the treatment for SCLC in extensive disease?

A

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
Q

What is percutaneous coronary intervention

A

Non-surgical

Used to treat narrowing (stenosis) of coronary arteries

43
Q

What is the percentage of patients that are diagnosed too late to cure?

A

80%

Respiratory (30 decks)

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