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BRS YEAR 2 > Resp - Lung Cancer > Flashcards

Resp - Lung Cancer Flashcards

1
Q

How common is Lung cancer

A

3rd most common cancer in UK but leasing cause of cancer death

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2
Q

How many deaths does lung cancer cause a year

A

35,000 UK

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3
Q

How many new cases are diagnosed a year

A

48,000 UK

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4
Q

What are the most common causes of cancer mortality

A

Lung
Prostate/breast
Bowel

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5
Q

When did lung cancer start to become prevalent

A

1930s after smoking became popular

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6
Q

What are the main risk factor groups for lung cancer

A

Age (75-90)
Male
Lower socioeconomic status
Smoking duration and intensity

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7
Q

How do cigarettes correlate with lung cancer

A

Cigarettes cause 1.5m million lung cancer deaths/year . 10-15% of lung cancer patients are non smokers, but 15% of these are passive smokers

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8
Q

What can be other risk factors for lung cancer

A 
Asbestos
Radon (mining)
Indoor cooking fumes 
Chronic lung disease (COPD, fibrosis)
Immunotherapy 
Familial/genetic
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9
Q

What are the different types of lung cancer

A

SCC
LCLC
SCLC
Adenocarcinoma

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10
Q

Squamous Cell Carcinoma

A

30%
From bronchial epithelium
Centrally located

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11
Q

Adenocarcinoma

A

From the mucus producing glandular tissue
More peripherally located
40% - most common since 1980s

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12
Q

Large Cell Lung Cancer

A

15%

Heterogenous group, undifferentiated

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13
Q

Small Cell Lung Cancer

A

15%
From pulmonary neuroendocrine cells
Highly malignant

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14
Q

What are NSCLC

A

Every lung cancer apart from small cell lung cancer

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15
Q

What are the early stages of lung cancer development

A

Normal epithelium
Hyperplasia
Squamous metaplasia

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16
Q

What is the significance of squamous metaplasia

A

Reversible change in which one adult cell type is replaced by another cell type - this stage can be revered therefore is included in early stage of development

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17
Q

What is the intermediate stage of lung cancer

A

Dysplasia

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18
Q

What is the significance of dysplasia

A

Abnormal pattern of growth in which some of the cellular and architectural features of malignancy are present - pre-invasive stage but basement membrane is intact

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19
Q

What is the late stage of lung cancer development

A

Carcinoma in situ

Invasive carcinoma

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20
Q

Why is knowing about oncogenes helpful

A

Can help with directed treatment

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21
Q

What are the main oncogenes relevant to lung cancer

A

EGFR
ALK
ROS1
BRAF

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22
Q

What is Epidermal growth factor receptor tyrosine kinase

A

Seen in 15-30% of adenocarcinomas, more commonly in people who have never smoke, women and Asians

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23
Q

What is anaplastic lymphoma kinase tyrosine kinaae

A

Seen in 2-7% of NSCLC, more in younger patients and those who have never smoked

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24
Q

What is C-ROS Oncogene 1 receptor tyrosine kinase

A

Seen in 1-2% of NSCLC, more in younger patients and those who have never smoked

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25
What is BRAF
Downstream cell cycle signalling mediator - seen in 1-3% of NSCLC especially in smokers
26
How can lung cancer present
``` Cough Weight loss Breathlessness Fatigue Chest pain Haemoptysis Frequently asymptomatic ```
27
What are the signs of advanced metastatic disease
- Neurological e.g. focal weakness, seizures, spinal cord compression - Bone pain - Paraneoplastic syndromes: - Clubbing, hyperkalemia, hyponatremia, Cushing's
28
What are the signs of lung cancer
Clubbing Cachexia Superior vena cava obstruction (Pemberton's sign) Horner's syndrome
29
What is the strategy for diagnosing lung cancer
Establish most likely diagnosis Establish features for investigation and treatment Confirm diagnosis e.g. systemic treatment requires specific type of cancer Confirm staging
30
What scans can we use for lung cancer
CXR CT PET
31
When is PET useful
Find occult metastasis
32
How should we determine what biopsy method to choose
Accessibility, availability and impact on staging
33
When is a bronchoscopy used
Central airway tumour | Staging not important
34
When is EBUS (TBNA) used
Endobronchial US and transbronchial needle aspiration of the mediastinal lymph nodes. Used to stage mediastinum and achieve a tissue diagnosis
35
When is CT guided lung biopsy used
Used to access peripheral lung tumours
36
What staging do we use for lung cancer
TNM T1-4 N0-3 M0-1c
37
Aside from TNM, what else can we use to stage
Early Locally advanced Metastatic
38
What are the determinants for lung cancer treatment
``` Patient fitness Patient preference Cancer histology Cancer stage Health service factors ```
39
What is patient fitness 0
Asymptomatic
40
What is patient fitness 1
Symptomatic but completely ambulatory
41
What is patient fitness 2
Symptomatic, <50% in bed during day
42
What is patient fitness 3
Symptomatic, >50% in bed but not bed bound
43
What is patient fitness 4
Bedbound
44
What is patient fitness 5
Death
45
When can radical treatment be used
Stage 0-2
46
What is the standard care for early stage disease
Surgery - usually lobectomy and lymphadenectomy
47
When can we do a sub lobar resection
If the cancer is in stage 1 (≤3cm)
48
When is radical radiotherapy used
Alternative to surgery used for early stage disease, particularly if there's a comorbidity present
49
What do we usually opt for in radical radiotherapy
stereotactic ablative body radiotherapy (SABR) which uses multiple convergent beams from high precision targeting
50
What types of systemic treatment can be given
Oncogene directed Immunotherapy Cytotoxic chemotherapy
51
When is oncogene directed treatment used
1st line for metastatic NSCLC with mutation
52
What targets EGFR
erlotinib, gefitinib, afatinib, dacomitinib, osimertinib
53
What targets ALK
crizotinib, ceritinib, alectinib, brigatinib, lorlatinib
54
What targets ROS-1
crizotinib. entrectinib
55
What are the limitations with oncogene directed treatment
Improvement in progression free survival but not necessarily overall survival when compared to chemotherapy Drugs are usually well tolerated but can cause rash, diarrhoea and pneumonitis
56
When is immunotherapy used
First line for NSCLC with no mutation and PDL1 ≥ 50%
57
What is the significance if targeting PDL1
Tumour cells use PDL1 to avoid T cells identifying them as harmful therefore evade immune cells. However Anti-PSL1 can prevent T cells from binding to the tumour cells to recognise it therefore the tumour cell is destroyed
58
What drugs do we use for immunotherapy
Pembrolizumab Atezolizumab Nivolumab
59
What is the outcome for immunotherapy
Improvements in both progression free and overall survival rates
60
What are the side affects for immunotherapy
Generally well tolerated but can cause immune side effects of the thyroid, skin, bowel, lung and liver in 10-15% of patients
61
When is cytotoxic chemotherapy used
First line for NSCLC with no mutation and PDL1 ≤50%. Used in combination with immunotherapy (pembrolizumab)
62
What drugs are used for cytotoxic chemotherapy
Carboplatin Cisplatin Paclitaxel Pemetrexed These are platinum based regimes that target rapidly dividing cells
63
What are the side effects of cytotoxic chemotherapy
Often cause fatigue, nausea, bone marrow suppression and nephrotoxicity. No substantial improvements in quality of life
64
When is palliative care offered
Offered to all patients with advanced stage disease
65
What is offered in palliative care
``` Symptom control Psychological support Education Practical/ financial support Planning for end of life ```
66
What are the outcomes of palliative care
Improved survival and symptomatic benefit with improved quality of life and lower depression scores when there is the use of lung cancer specialist nurses
67
What is the general prognosis with lung cancer
Only 10% live longer than 10 years
68
How does prognosis alter with stage
The more advanced the lung cancer, the lower 5 year survival rate

BRS YEAR 2 (37 decks)

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