Oncology - Lung and Prostate Cancer Flashcards
what is the lifetime risk of cancer
1 in 2
What are the 4 types of cancer treatment
- surgery
- chemotherapy
- radiotherapy
- immunotherapy
3 types of curative cancer treatment
- neoadjuvant
- radical
- adjuvant
radical treatment
curative on its own or as part of a curative regime
a definitive treatment
neoadjuvant treatment
using chemo/radio/immuno to shrink and then surgery to remove
most common side effect of lung cancer
hypercalcaemia
general trend of lung cancer in males and females
reducing in men
rising in women
average 1 year survival rate for lung cancer
31%
average 5 year survival rate for lung cancer
9%
very low
2 types of lung cancer
non-small cell
small cell
types of non-small cell lung cancer and %
non small cell - 81%
adenocarcinoma 38%
squamous call carcinoma 20%
large cell 5%
other 18%
prevalence of small cell lung cancer
13%
EGFR mutation cancers most common in
females
never-smokers
ALK mutation cancers prevalence and drug treatment
5% of lung cancers
alectinib
target for immunotherapy for lung cancer
PDL-1
local symptoms of lung cancer
Cough
Breathing Problems, SOB, stridor
Change in phlegm
Lung infection
haemoptysis
Hoarseness, Hiccups
Wt loss
Chest Pain and tightness
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
Investigations for lung cancer
Biopsy (cannot treat with chemo without biopsy)
- bronchoscopy/EBUS
- maybe CT guided
lung cancer staging
TNM
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
treatment for stage 3 NSCLC
Radical chemoradiotherapy
Radical radiotherapy alone
treatment for stage IV NSCLC
palliative intent chemo only
what are the 3 surgical options for lung cancer
lobectomy
pneumonectomy
wedge removal
can you offer surgery for SCLC
NO
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
- CHECK heart and blood pressure
- fluids - 1litre over 2hrs
- 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
5
which lobe is the only one which can be palpated
posterior (with a DRE)
how many pathological zones are on the prostate
4
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
- watch and wait
- surgery
- radiotherapy
- neoadjuvant or hormone therapy
what are the 2 radiotherapy options for prostate cancer
- prostate brachytherapy (insert small radioactive pellets)
- 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
