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BRS 1b > 5.7 Lung Cancer > Flashcards

5.7 Lung Cancer Flashcards

(60 cards)

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1
Q

What is the leading cause of cancer death in men and women?

A

Lung

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2
Q

What does a typical lung cancer patient look like? (4)

A

age peak 75-90
more men than women
lower socioeconomic status
smoking history (when stopped, duration, intensity)

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3
Q

What % of patients with lung cancer have never smoked?

A

10-15%

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4
Q

What are other aetiological factors that could increase the risk of lung cancer? (7)

A

passive smoking
asbestos exposure 2x risk (plumbers, ship-builders etc)
radon (silver/uranium miners)
indoor cooking fumes (wood burning, frying fats)
chronic lung disease (COPD, fibrosis)
immunodeficiency
genetic

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5
Q

What are the four classes of lung cancer?

A
  1. Squamous cell carcinoma
  2. Adenocarcinoma
  3. Large cell
  4. Small cell

(1-3 sometimes known as non-small cell)

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6
Q

What % of cases of lung cancer are squamous cell carcinoma?

A

~30%

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7
Q

What % of cases of lung cancer are adenocarcinoma?

A

~40% - Most common

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8
Q

What % of cases of lung cancer are large cell lung cancer?

A

~15%

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9
Q

What % of cases of lung cancer are small cell lung cancer?

A

~15%

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10
Q

What is squamous cell carcinoma?

A
  • previously most common

- originating from bronchial epithelium; centrally located

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11
Q

What is adenocarcinoma?

A

originating from mucus-producing glandular tissue; more peripherally located

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12
Q

Why was adenocarcinoma the most common type of lung cancer from the 1980’s onwards?

A

low tar cigarettes, inhaled more deeply/retained longer

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13
Q

What is large cell lung cancer?

A

heterogenous group, undifferentiated

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14
Q

What is small cell lung cancer?

A

originates from pulmonary neuroendocrine cells

highly malignant

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15
Q

Why is small cell lung cancer grouped separately?

A

because it often presents very differently; much more aggressive than other types

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16
Q

What is metaplasia?

A

reversible change in which one adult cell type replaced by another adult cell type; adaptive

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17
Q

What is dysplasia?

A

abnormal pattern of growth in which some of the cellular and architecture features of malignancy are present; pre-invasive stage with intact basement membrane

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18
Q

What are the 6 stages in model of lung cancer development?

A 
normal epithelium
hyperplasia
squamous metaplasia
dysplasia
carcinoma in situ
invasive carcinoma
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19
Q

Why is dysplasia an important turning point in cancer development?

A

turning point from reversible to irreversible

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20
Q

What are the 4 important oncogenes in lung cancer?

A

EGFR tyrosine kinase
ALK tyrosine kinase
ROS1 receptor tyrosine kinase
BRAF

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21
Q

Why is it important to know the oncogenes that could play a role in lung cancer?

A

Targeting these proteins can have therapeutic benefit

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22
Q

What are the 6 key symptoms of lung cancer?

A 
cough
weight loss
breathlessness
fatigue
chest pain
haemoptysis (coughing up blood) --> rare
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23
Q

Why can it be hard to diagnose lung cancer?

A
  • frequently asymptomatic, lots of space for tumour to grow before symptoms develop
  • patients often have pre-existing lung conditions –> similar symptoms
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24
Q

What are the features of advanced lung cancer/ metastatic disease?

A

neurological features: focal weakness, seizures, headaches, spinal cord compression (weakness in arms and legs)
bone pain
paraneoplastic syndromes: clubbing, hypercalcemia, hyponatremia, Cushing’s
Horner’s syndrome
Superior vena cava obstruction (Pemberton’s sign)

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25
What is Horner's syndrome?
Apical lung tumour compresses thoracic outlet, affects sympathetic supply to face - ptosis - myosis (constriction of pupil)
26
What is Pemberton's sign?
Superior VC obstruction | causes facial swelling and redness when they lift arms up
27
What is the diagnostic strategy for lung cancer? (4)
establish most likely diagnosis establish fitness for investigation and treatment confirm diagnosis confirm staging
28
Why do we establish fitness fir investigation and treatment?
Average patient very old with many comorbidities
29
How do we confirm staging?
Staging CT (chest and abdomen)
30
When is x ray used in the investigation of lung cancer?
Early, to confirm diagnosis (staging done by CT)
31
When is a PET scan used in the investigation of lung cancer?
To exclude occult metastases (lymph node involvement) --> look for bright scan
32
Why do we do CT of chest and abdomen when investigating lung cancer?
To look for mets (esp liver)
33
What's the ultimate way we mage a diagnosis and confirm type of cancer?
biopsy
34
How do we choose what type of biopsy to confirm type of cancer?
choose method based on accessibility, availability and impact on staging
35
When do we do bronchoscopy?
for tumours of central airway | where tissue staging not important
36
When do we use endobronchial ultrasound and transbronchial-needle aspiration of mediastinal lymph nodes?
to stage mediastinum +/- achieve tissue diagnosis
37
When do we use CT-guided lung biopsy
to access peripheral lung tumours
38
What are the three options for biopsy for lung cancer?
bronchoscopy endobronchial ultrasound and transbronchial needle aspiration CT- guided lung biopsy
39
What is the criteria for lung cancer staging?
TNM
40
What does T stand for in lung cancer staging (TNM)?
T1-4: tumour size and loaction
41
What does N stand for in lung cancer staging (TNM)?
N0-3: lymph node involvement - mediastinum and beyond
42
What does M stand for in lung cancer staging (TNM)?
M0-1c: metastases + number
43
How do we determine treatment? (4)
patient fitness cancer history cancer stage patient preference
44
What are the 5 levels of patient fitness according to WHO?
0-Asymptomatic 1- Symptomatic but completely ambulatory 2- Symptomatic <50% in bed during the day 3- Symptomatic >50% in bed but not bedbound 4- Bedbound 5- Death
45
What level of patient fitness, according to the WHO patient fitness level, should radical treatment be restricted to?
0-2
46
When is surgical resection the standard of care for lung disease?
Early stage disease keyhole lobectomy + lymphadectomy usual approach sublobar resection if stage 1 (<3cm)
47
What is an alternative to surgery for early stage lung cancer?
radical radiotherapy stereotactic ablative body radiotherapy (SABR) - high precision, other structures less affected
48
When is radical radiotherapy used instead of surgery in early stage lung cancer?
if patient has many comorbitities
49
What are the 3 systemic treatment options for lung cancer?
1. oncogene-directed 2. immunotherapy 3. cytotoxic chemotherapy
50
When is oncogene directed drugs used?
metastatic NSCLC with mutation
51
When are immunotherapy drugs typically used for treatment of lung cancer?
metastatic NSCLC with no mutation and PDL1 expression>50%
52
When are chemotherapy drugs typically used for treatment of lung cancer?
first line for metastatic NSCLC with no mutation and PDL1> 50% and used in combination with immunotherapy
53
Why do we get frequent side effects with chemo?
very non specific, many other cells affected
54
When should palliative and supportive care be offered for lung cancer?
advanced stage disease - look to improve QoL - educate about disease - lower depression scores
55
What are the treatment options for early stage disease? (2)
surgery radiotherapy --> both with curative intent
56
What are the treatment options for locally advanced disease (involving thoracic lymph nodes)? (2)
surgery + adjuvant chemotherapy | radiotherapy + chemotherapy +/- immunotherapy
57
What are the treatment options for metastatic disease? (4)
with targetable mutation (e.g. EFGR,ALK,ROS-1): tyrosine kinase inhibitor no mutation, PDL-1 positive: immunotherapy alone no mutation, PDL-1 negative: chemo + immunotherapy palliative care
58
What are the benefits of immunotherapy?
generally well tolerated | immune related side effects in 10-15%
59
How does immunotherapy work?
blocks PD-L1, allows T cell killing of tumour cell
60
What is the prognosis of lung cancer?
only 10% live > 10 years | survival decreases with worse staging

BRS 1b (25 decks)

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