lung cancer JH Flashcards

1
Q

what are the risk factors for lung cancer?

A

cigarette smoking
passive smoking
other occupational/ environmental hazards- radiation/ air polution
genetic predisposition
previous malignancies
general risk factors- old age, obesity, poor diet, physical inactivity, alcohol

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2
Q

how more common is lung cancer death in smokers?

A

15x

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3
Q

what type of lung cancer is smoking strongly linked with?

A

small cell lung cancer and squamous cell carcinoma

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4
Q

what are the different types of smoking cessation available?

A

12 week programme
NRT
champix
CO readings

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5
Q

what should you inform patients of in the smoking cessation following diagnosis?

A

smoking increases risk of pulmoary complications after surgery
advise to stop ASAP and tell why important
offer NRT/ champix
do not postpone surgery for lung cancer to allow patients to stop smoking

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6
Q

what are the signs and symptoms of lung cancer?

A
  • cough that won’t go away
  • A change in a cough you have had for a long time :
    – More painful
    – Sounds different
    – Bringing up coloured mucus of phlegm
  • Shortness of breath
  • Haemoptysis
  • Pain in chest or shoulder
  • Loss of appetite/weight
  • Fatigue
  • Ongoing chest infection
  • Reduced breath sounds over lobe, inspiratory crackles over a lobe, unilateral wheeze
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7
Q

what are the 3 different patholohys of lung cancer?

A

non-small-cell lung cancer- 80%
small cell lung cancer
mesothelioma

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8
Q

what are the different types of NSCLC

A

– Adenocarcinoma 40%
– Squamous cell carcinoma 30%
– Large cell lung cancer 10%

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9
Q

what is the pathology of NSCLC

A

grows at a slower rate

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10
Q

what is the pathology of SCLC?

A
  • Most aggressive
  • Has almost always metastasised by the time of diagnosis
  • chemo sensitive
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11
Q

what is the pathology of mesothelioma?

A
  • Alsoaggressive
  • 70-80% caused by asbestos exposure
  • Linked with heavy industry
  • Not common in certain areas and therefore specialist opinion may be sought
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12
Q

how do you treat NSCLC?

A
  • Surgery
    – Treatment of choice in stage I-II
  • Radical radiotherapy
    – Continuous Hyperfractionated Accelerated Radiotherapy
    (CHART)
  • Radical chemoradiotherapy
  • Neoadjuvant chemoradiotherapy+ surgery
  • Palliative chemotherapy
  • Symptomatic support+radiotherapy
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13
Q

what are the different types of surgery options available?

A

– Surgery alone
– Surgery + radiotherapy
– Surgery + chemotherapy

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14
Q

what is the benefit of chemo before or after sugrery?

A

before- neo-adjuvant- shrink cancer making it easier to remove
after- can help lower the risk of cancer coming back

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15
Q

what is the benefit of giving chemo before, after or alongside radiotherapy?

A

can sometimes help to get rid of early NSCLC in people who cant have surgery

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16
Q

what does the EGFr gene control?

A

controls growth and proliferation

17
Q

what are targeted therapies of the EGFR gene?

A

tyrosine kinase inhibitors
Erlotinib (Tarceva), Gefitinib (Iressa)and Afatinib (Giotrif

18
Q

what are some adverse effects of tyrosine kinase inhibitors?

A

acneiform rash, dry skin or itching

19
Q

what can EGFR inhibitors cause?

A

keratitis and ulcerative keratitis

20
Q

who is pallative chemo offered to?

A

stage 3b or 4 cancer

21
Q

what are examples of combination chemo for pallative care?

A

include docetaxel or gemcitabine with
either carboplatin or cisplatin

22
Q

what kind of cancer is small cell lung cancer ?

A

highly malignant tumour

23
Q

how is SCLC treated in limited stage disease?

A

cancer is contained in a single area that can be treated
chemotherapy is followed by radiotherapy or radiotherapy
very few cases of surgery

24
Q

how is extensive disease stage treated in SCLC?

A

treatment aims to control cancer for as long as possible and help with symptoms

25
Q

what is first line chemotherapy for limited stage disease in SCLC?

A

– Carboplatin/cisplatin+etoposide
– Four to six cycles should be given unless progressive disease or unacceptable toxicity
– Give concurrent chemoradiotherapy to patients if they present with disease that can be targeted by radiotherapy
– Sequential radiotherapy for patients who are unfit for concurrent chemoradiotherapy but who respond to chemotherapy

26
Q

what is second line therapy for SCLC?

A

–a platinum based regumen as above
CAV
topotecan capsules

27
Q

what physcical changes may the patient have living with lung cancer?

A

coping with breathlessness
tiredness

28
Q

what psychological changes are there living with lung cancer?

A

-shock and worry
fear and anxiety
smokers guilt
grief
depression
isolation and loneliness

29
Q

what are palliative care issues ?

A

endobronchial obstruction
superior vena cava obstruction
plural effusion
breathlessness
cough
brain metastases
hypercalcaemia