VP Lung Cancer Flashcards
_____ most common UK cancer and most common worldwide
Second
Aetiology:
- Smoking is the biggest cause (around __% of cases)
- Period of time smoking is __ important than number of cigarettes smoked
- Around 1/6 lifelong smokers ___ of lung cancer
- Stop smoking and immediately reduce risk and after __years the risk of developing as the same as a non smoker
90%
More
Die
15 years
Risk factors:
- Smoking
- ____ smoking
- History of previous lung disease
- _____ exposure
- _____ gas exposure
Passive
Asbestos
Radon gas exposure
Pathology SCLC:
- Around ___% of cases
- ___, ___ cells
- ____ tumour
- Surgery has a ____ role
- Usually ____ when diagnosed
- Responds ____ to chemo and radiation
NSCLC:
- Around __% of cases
- Several types: squamous cell, ______ and large cell
- Surgery if caught early
- Metastasises to ___, ____ and bones
- ____ responsive to chemo
15% Small, uniformed Aggressive Limited Metastatic Well
85%
Adenocarcinoma
Brain, liver and bones
Less responsive to chemo
Clinical presentation:
- No symptoms at early stage but then: _____, _____-____, ____, ____ and _____ pain
- Symptoms are usually due to tumour ____/_____.
- Smokers cough, persistent, ___, ____ and dyspnoea
- _____ - coughing up blood - significant symptom
- Over __% have metastatic disease at presentation
- Early disease often confused with ___ (similar symps)
- Early disease often diagnosed during routine chest _-__
Fatigue, weight loss, back, neck and shoulder pain Pressure/obstruction wheezing/SOB Haemoptysis 50% COPD X-RAY
Diagnostic tests:
- Chest _-___
- B_______ (stick tube into lung and remove lump to _____)
- Sputum _____ (often cancer cells in sputum)
- __ scan (assess suitability for surgery and assess sites of common metastases e.g. _____)
- Lung _____ tests to establish baseline condition
Chest X-RAY Bronchoscopy - so can biopsy tumour Sputum cytology CT scan and sites of common metastases e.g. liver Lung function tests
Staging of cancer:
- description of extent of cancer ____
- ___ of tumour
- How deeply it _____
- Whether it invaded adjacent or _____ organs
- How many ____ ____ it spread to (if any)
- Treatment usually determined by staging
- ___ staging is also used
Spread Size Penetrated Distant Lymph nodes
TNM
SCLC:
1) Limited stage disease (__%)
- Cancer confined to one side of ____ and involves ____ ____
- Can be treated using _____
2) _____ stage disease (__%)
- Cancer ______ to distant organs
30%
Chest
Lymph nodes
Radiotherapy
Extensive
70%
Metastasised
Treatment of SCLC:
Limited stage:
5% - _____ then ____ chemo
Others - _______ and _____
Extensive stage:
________ chemotherapy
Surgery then adjuvant chemo
Radiotherapy and chemotherapy
Palliative chemotherapy
Treatment of NSCLC: (4 options)
1) Surgery (cure)
2) Radiotherapy (cure)
3) Radiofrequency abalation (if not fit enough for surgery)
4) 1st line chemo/targeted Tx for advanced or metastatic NSCLC - then maintenance chemo and then 2nd line chemo/targeted treatment
Surgery in NSCLC:
- Only NSCLC stage _ or _ - disease might be _a when tumour shrunk by chemo first
- ____ - most common - removal of entire ____ of lung affected by tumour
- ______ - remove entire lung - high _____ rates and long term debility only if good ___ performance status pre op
- Major complications occur in 30% undergoing surgery for LC
1 or 2 3a Lobectomy Lobe Pneumonectomy Mortality WHO
Adjuvant chemotherapy in NSCLC:
- Given post ____ to eradicate cells that were not removed - use a ______ based chemo regimen
- Offered to those with good ___ performance status
Surgery
Cisplatin
WHO
Treatment of advanced/metastatic NSCLC:
- With stage - NSCLC and good ___ performance status
- Encourage smoking _____ (can interact with some drugs)
- Treatment depends on specific tumour subtype ______ either _______ or _____ ___ carcinoma
- Also depends on biomarkers/mutations e.g. ____ mutation or ___ (anapaestic lymphoma kinase) gene _____.
3-4 WHO Cessation Histology Adenocarcinoma or squamous cell carcinoma EGFR mutation or ALK gene translocation
Treatment example of NSCLC adenocarcinoma with ALK translocation:
C_____ = treatment of choice
- Oral ___ receptor inhibitor
- Taken continuously until ____ _____/toxicity
Side effects: (6)
Crizotinib
ALK (anaplastic lymphoma kinase)
Disease progression
Visual problems (photophobia, blurred vision, diplopida)
Nausea and vom, diarrhoea
Oedema (face and general)
Neuropathy
Neutropenia
Interstitial lung disease (inflam disease of interstitium in lungs - important for supporting alveoli - if thickens then gas xchange poor and coughing occurs. Hard to treat so monitor for signs and phone after 1 week and quiz on any side effects. If coughing and SOB then get back in to monitor)
Treatment example of adenocarcinoma without ___ or EGFR mutation:
____/____ chemotherapy for 4-6 cycles
Both _____ and _____ on day one (IV infusions)
__ day cycles
Then maintenance _____ until disease progression/toxicity
- Median overall survival __ months (11 w/o pemetrexed maintenance dose)
Side effects: (8)
ALK (anaplastic lymphoma kinase) Cisplatin/pemetrexed Cisplatin/pemetrexed 28 day cycles Pemetrexed 14 months
Nausea and vomiting Diarrhoea Stomatitis Alopecia Peripheral neuropathy (cisplatin) Ototoxicity Nephrotoxicity (monitor renal function) Myelosuppression
