Wk 14: Lung cancer in practice Flashcards
What are the risk factors of lung cancer?
- Smoking/passive
- Asbestos
- Ionising radiation
- Air pollution
- Genetic
- Previous malignancies
- Old age
- Poor diet
- Physical inactivity
Which types of lung is strongly linked to smoking?
- Small cell lung cancer
- Squamous cell carcinoma
What are examples of smoking cessation strategies?
12 wk programme:
- NRT
- Champix (1-2 wks before stopping)
- CO readings
What are the problems associated with lung cancer screening?
- Lack of sensitive tests
- X-ray exposes patient to radiation
- Costs too high
What are the signs of lung cancer?
- Cough won’t go away
- Coloured mucus
- SOB
- Haemoptysis
- Pain in chest/shoulder
- Loss of appetite
- Ongoing chest infection
- Red breath sounds, crackles + unilateral wheeze
What are the types of lung cancer?
- Non small cell lung cancer (most common)
- Small cell lung cancer
- Mesothelioma
What are the types of non small cell lung cancer?
- Adenocarcinoma
- Squamous cell carcinoma
- Large cell lung cancer
What is the rate at which non-small cell lung cancer grows at?
Slow rate
What rate does small cell lung cancer grow at?
- Most aggressive
- Metastasised by time of diagnosis (high risk of brain metastisis)
- Located: central airway
- Tumours smaller
What rate does mesothelioma grow at?
- Aggressive
- Caused by asbestos exposure (industry linked)
- Specialist needed
What is the treatment of non small cell lung cancer?
- Surgery: stage I-II
- Radical radiotherapy: continuous hyperfractionated accelerated radiotherapy (CHART)
- Radical chemoradiotherapy
- Neoadjuvant chemoradiotherapy + surgery
- Palliative chemotherapy
Describe the chemotherapy regime for non small cell lung cancer
- Before surgery: easier to remove
- Early stage, after surgery: lower risk of remission
- Before/after radiotherapy: get rid of early stage who can’t get surgery
- Combine radio + chemo: fit
What drugs are used for chemotherapy in non small cell lung cancer?
Cisplatin or carboplatin w/:
- Gemcitabine
- Etoposide
- Docetaxel
What is included during diagnosis in terms of cancer related receptors?
Mutation in epidermal growth factor receptor (EGFR)
What is used to treat epidermal growth factor receptors?
- Erlotinib (tarceva)
- Gefitinib (Iressa)
- Afatinib (Giotrif)
What are the adverse effects of EGFR treatment?
- Acneiform rash, dry skin or itching
- Use steroids, topical/oral antibiotics or topical retinol
What is the MHRA advice on EGFR inhibitors?
- Risk of keratitis + ulcerative keratitis
- Causes: corneal perforation + blindness
- Worsening: refer to opthamologist
- Treatment discontinued if ulcerative keratitis
What is palliative chemotherapy?
- Stage 3B/4 cancer
- Docetaxel/gemcitabine w/ carboplatin/cisplatin
- Radiotherapy if persistent symptomatic disease
What is limited stage disease of SCLC?
- Cancer contained single area
- Chemo followed by radio or chemoradio
What is extensive stage disease of SCLC?
Cancer spread (advanced)
What is the first line chemotherapy for limited stage disease in SCLC?
- Carboplatin/cisplatin + etoposide
- 4-6 cycles
- Concurrent chemo radio if respond to radio
- Sequential radio if unfit for concurrent but respond to chemo
What is the second line chemotherapy for SCLC?
- Carboplatin/cisplatin
- CAV (cyclophosphamide, doxorubicin, vincristine)
- Topotecan capsules
What are the changes for people living with lung cancer?
- Coping w/ breathlessness
- Tiredness
- Smoker guilt
- Fear
What are the issues of palliative care?
- Endobronchial obstruction
- Superior vena cava obstruction
- Breathlessness
- Cough
- Brain metastases
- Hypercalcaemia
