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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
Q

What is BRAF

A

Downstream cell cycle signalling mediator - seen in 1-3% of NSCLC especially in smokers

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26
Q

How can lung cancer present

A 
Cough 
Weight loss
Breathlessness
Fatigue 
Chest pain 
Haemoptysis 
Frequently asymptomatic
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27
Q

What are the signs of advanced metastatic disease

A
  • Neurological e.g. focal weakness, seizures, spinal cord compression
  • Bone pain
  • Paraneoplastic syndromes:
    - Clubbing, hyperkalemia, hyponatremia, Cushing’s
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28
Q

What are the signs of lung cancer

A

Clubbing
Cachexia
Superior vena cava obstruction (Pemberton’s sign)
Horner’s syndrome

29
Q

What is the strategy for diagnosing lung cancer

A

Establish most likely diagnosis
Establish features for investigation and treatment
Confirm diagnosis e.g. systemic treatment requires specific type of cancer
Confirm staging

30
Q

What scans can we use for lung cancer

31
Q

When is PET useful

A

Find occult metastasis

32
Q

How should we determine what biopsy method to choose

A

Accessibility, availability and impact on staging

33
Q

When is a bronchoscopy used

A

Central airway tumour

Staging not important

34
Q

When is EBUS (TBNA) used

A

Endobronchial US and transbronchial needle aspiration of the mediastinal lymph nodes. Used to stage mediastinum and achieve a tissue diagnosis

35
Q

When is CT guided lung biopsy used

A

Used to access peripheral lung tumours

36
Q

What staging do we use for lung cancer

A

TNM
T1-4
N0-3
M0-1c

37
Q

Aside from TNM, what else can we use to stage

A

Early
Locally advanced
Metastatic

38
Q

What are the determinants for lung cancer treatment

A 
Patient fitness
Patient preference
Cancer histology
Cancer stage
Health service factors
39
Q

What is patient fitness 0

A

Asymptomatic

40
Q

What is patient fitness 1

A

Symptomatic but completely ambulatory

41
Q

What is patient fitness 2

A

Symptomatic, <50% in bed during day

42
Q

What is patient fitness 3

A

Symptomatic, >50% in bed but not bed bound

43
Q

What is patient fitness 4

44
Q

What is patient fitness 5

45
Q

When can radical treatment be used

46
Q

What is the standard care for early stage disease

A

Surgery - usually lobectomy and lymphadenectomy

47
Q

When can we do a sub lobar resection

A

If the cancer is in stage 1 (≤3cm)

48
Q

When is radical radiotherapy used

A

Alternative to surgery used for early stage disease, particularly if there’s a comorbidity present

49
Q

What do we usually opt for in radical radiotherapy

A

stereotactic ablative body radiotherapy (SABR) which uses multiple convergent beams from high precision targeting

50
Q

What types of systemic treatment can be given

A

Oncogene directed
Immunotherapy
Cytotoxic chemotherapy

51
Q

When is oncogene directed treatment used

A

1st line for metastatic NSCLC with mutation

52
Q

What targets EGFR

A

erlotinib, gefitinib, afatinib, dacomitinib, osimertinib

53
Q

What targets ALK

A

crizotinib, ceritinib, alectinib, brigatinib, lorlatinib

54
Q

What targets ROS-1

A

crizotinib. entrectinib

55
Q

What are the limitations with oncogene directed treatment

A

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
Q

When is immunotherapy used

A

First line for NSCLC with no mutation and PDL1 ≥ 50%

57
Q

What is the significance if targeting PDL1

A

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
Q

What drugs do we use for immunotherapy

A

Pembrolizumab
Atezolizumab
Nivolumab

59
Q

What is the outcome for immunotherapy

A

Improvements in both progression free and overall survival rates

60
Q

What are the side affects for immunotherapy

A

Generally well tolerated but can cause immune side effects of the thyroid, skin, bowel, lung and liver in 10-15% of patients

61
Q

When is cytotoxic chemotherapy used

A

First line for NSCLC with no mutation and PDL1 ≤50%. Used in combination with immunotherapy (pembrolizumab)

62
Q

What drugs are used for cytotoxic chemotherapy

A

Carboplatin
Cisplatin
Paclitaxel
Pemetrexed

These are platinum based regimes that target rapidly dividing cells

63
Q

What are the side effects of cytotoxic chemotherapy

A

Often cause fatigue, nausea, bone marrow suppression and nephrotoxicity. No substantial improvements in quality of life

64
Q

When is palliative care offered

A

Offered to all patients with advanced stage disease

65
Q

What is offered in palliative care

A 
Symptom control
Psychological support
Education
Practical/ financial support
Planning for end of life
66
Q

What are the outcomes of palliative care

A

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
Q

What is the general prognosis with lung cancer

A

Only 10% live longer than 10 years

68
Q

How does prognosis alter with stage

A

The more advanced the lung cancer, the lower 5 year survival rate

BRS YEAR 2 (37 decks)

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