Oncology - Lung and Prostate Cancer Flashcards by Elen Price

what is the lifetime risk of cancer

1 in 2

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What are the 4 types of cancer treatment

surgery
chemotherapy
radiotherapy
immunotherapy

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3 types of curative cancer treatment

neoadjuvant
radical
adjuvant

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radical treatment

curative on its own or as part of a curative regime

a definitive treatment

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neoadjuvant treatment

using chemo/radio/immuno to shrink and then surgery to remove

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most common side effect of lung cancer

hypercalcaemia

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general trend of lung cancer in males and females

reducing in men
rising in women

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average 1 year survival rate for lung cancer

31%

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average 5 year survival rate for lung cancer

9%
very low

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2 types of lung cancer

non-small cell
small cell

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types of non-small cell lung cancer and %

non small cell - 81%

adenocarcinoma 38%
squamous call carcinoma 20%
large cell 5%
other 18%

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prevalence of small cell lung cancer

13%

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EGFR mutation cancers most common in

females
never-smokers

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ALK mutation cancers prevalence and drug treatment

5% of lung cancers
alectinib

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target for immunotherapy for lung cancer

PDL-1

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local symptoms of lung cancer

Cough
Breathing Problems, SOB, stridor
Change in phlegm
Lung infection
haemoptysis
Hoarseness, Hiccups
Wt loss
Chest Pain and tightness

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metastatic symptoms of lung cancer

BONE PAIN - persistent pain needs to be investigated
Headaches,
Neurologic findings
Abdominal pain,
Enlarged liver
Anorexia
Cachexia
jaundice
Weight loss

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Investigations for lung cancer

Biopsy (cannot treat with chemo without biopsy)
- bronchoscopy/EBUS
- maybe CT guided

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lung cancer staging

TNM

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treatment or stage 1-2 NSCLC

SURGERY if possible
+/- adjuvant chemotherapy (to improve the results of RT and also surgery) +/- radiotherapy if still localised but cannot be resected)
If unfit: stereotactic radiotherapy

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treatment for stage 3 NSCLC

Radical chemoradiotherapy
Radical radiotherapy alone

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treatment for stage IV NSCLC

palliative intent chemo only

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what are the 3 surgical options for lung cancer

lobectomy
pneumonectomy
wedge removal

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can you offer surgery for SCLC

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what is this

pneumonectomy trachea deviated and stoma bubble surgical clips

what is this

pneumothorax and then pleural effusion due to a mass

67yr female Known metastatic breast cancer. Bone, lymph nodes, liver Only on hormone treatment Presenting to A&E – unwell, fatigue, constipation. Family – Pt more forgetful and confused than usual what is your first possible diagnosis and main concerns

hypercalcaemia also ensure you MUST check for urine and/or chest infection CT head - for brain mets

what is the hypercalcaemia symptoms

Bones, stones, groans, moans bone pain, renal stones, body pain and confusion

managment of hypercalcaemia

1. CHECK heart and blood pressure 2. fluids - 1litre over 2hrs 3. bisphosphonates - 60-90mg pamidronate IV over 2 hrs

what are the signs and symptoms of superior vena cava obstruction

SOB Facial swelling, arm swelling, upper venous engorgement

treatment of superior vena cava obstruction

Steroids: frequently prescribed but no evidence to support their use dexamethasone 8mg B.D. Chemotherapy: used for SCLC with good response rate Radiotherapy: High response rates for Squamous cell Lung cancer~60%. Stent: 95% response rate. Rapid relief of symptoms but doesn’t treat the cause. If there is a clot anticoagulation treatment

what is the most common cancer in men

prostate

what is the overall most common cancer in both men and women

lung

at what age is prostate cancer most common

70-75

where is prostate cancer most common

europe, north america, australia

what are the 2 tissue types which make up the prostate

70% glandular tissue 30% fibromuscular stroma

how many lobes are there in the prostate

which lobe is the only one which can be palpated

posterior (with a DRE)

how many pathological zones are on the prostate

which pathological zone is most common for prostate cancer

70% in peripheral zone

what are the 2 germline mutations common in prostate cancer

BRCA1 and BRCA2

what is the lifetime risk of prostate cancer in men

1 in 8

what are some of the risk factors of prostate cancer

age (over 50) FHx black diet BRCA1 and BRCA2 mutations

what is the most common pathology of prostate cancer

90% adenocarcinoma

where does prostate cancer metastasis to

bone, liver, lung

what lymph nodes does prostate cancer first spread to

pelvic - or para-aortic

what are local signs and symptoms of prostate cancer

LUTS Haematuria perineal pain

what are signs and symptoms of metastatic prostate cancer

Lymph nodes: Lower body oedema Bone: Pain Nerve / cord compression Anaemia Hypercalcaemia Liver: Jaundice Ascites

what initial investigations should be undertaken for suspected prostate cancer

PSA and DRE CT scan if PSA over 40

what is the scoring system for prostate cancer

gleason

what are the 5 levels of gleason scoring (a score of microscopic appearance of biopsy spec)

1=Well-differentiated 2-3=Moderately differentiated 4=Poorly differentiated 5=Undifferentiated

how is gleason score calculated

first by grade of most dominant cell type then add the grade of the highest grade of cells seen 3.g. of 4 biopsies most common cell type is stage 3 highest grade seen is stage 4 therefore 3+4 stage

what is this

Left peripheral zone tumour T2 / ?early T3a

what is this

Locally advanced invading pelvic sidewall T4

what are the 5 stages of the WHO general health and function status

0=Fit and active 1=Well, but no strenuous activity 2=Self-caring, >50% of the day 3=Self-caring, <50% of the day 4=bedbound 5=Dead

what are the 2 approaches for prostate biopsy

trans-perineal - most common TRUS biopsy

what are the options for early prostate cancer

1. watch and wait 2. surgery 3. radiotherapy 4. neoadjuvant or hormone therapy

what are the 2 radiotherapy options for prostate cancer

1. prostate brachytherapy (insert small radioactive pellets) 2. external radiotherapy beam

what hormone therapy can be offered to prostate cancer patients

androgen deprivation therapy

what are the 2 main types of hormone therapy offered for prostate cancer

LHRH analogues and Androgen receptor antagonists

give and example of an LHRH analogue and the most important side effect of the drug

Goserelin (Zoladex) causes an initial tumour flare

2 examples of Androgen receptor antagonists

Bicalutamide (Casodex) Enzalutamide (Xtandi)

what are common side effects of androgen deprevation therapy

Hot flushes Reduced libido Erectile dysfunction Gynaecomastia (growth of breast tissue) Osteopaenia (loss of bone density) Sarcopaenia (loss of muscle mass) Insulin resistance Weight gain Mood swings Fatigue

what is the management of spinal cord compression

Dexamethasone 16mg per day PPI (for gastroprotection) Urgent MRI of while spine to determine exact location

what anti epileptic drug is used for seizures due to brain metastasis

Levetiracetam (keppra)

What antiemetic should be absolutely avoided in a patient with bowel obstruction and bowel cancer

metoclopramide