Flashcards in CANCER- LUNG CANCER Deck (34):
Smoking is a big cause of lung cancer, it causes over ____% of cases.
Period of time smoking / number of cigarettes smoked a day- which is more important?
Stopping smoking immediately reduces the risk of lung cancer: after ____ years the risk is the same as that of a non smoker
Smoking Causes over 90% of lung cancers
Period of time smoking is more important in causing it
Stopping smoking: after 15 years risk is the same as a non smoker
What are the risk factors of lung cancer??
Asbestos exposure (plumbers etc)
Radon gas exposure
Previous lung disease
Family history (but not as strong link as breast cancer)
Which is more common, Small cell lung cancer (SCLC) or Non small cell lung cancer (NSCLC)?
Non small cell lung cancer = 80% of all cases
In terms of their pathology, what's the different between NSCLC and SCLC??
SCLC consists of small cells that are uniform
NSCLC consists of several different types of cells, may be squamous cell, adenocarcinoma, large cells
SCLC is usually Metastatic at diagnosis (I.e usually already spread)
In terms of their treatments, what's the different between NSCLC and SCLC??
Surgery is more often used with NSCLC, it has limited use in SCLC.
SCLC responds well to chemotherapy and radiotherapy, whereas NSCLC is less responsive to this
Where can NSCLC metastasise to??
Brain liver and bones
But remember it's SCLC that's usually metastasised at diagnosis
What are the symptoms of lung cancer??
Note: There are no symptoms in the early stages and symptoms appear later due to tumour causing pressure, pain or obstruction.
Persistent chronic cou
Haemoptysis (coughing up blood)
Chest, shoulder or back pain
How do we usually diagnose lung cancer?
Chest x ray- early diagnosis usually found on routine chest x rays (I.e. Patient doesn't think they have cancer at this point as no symptoms in early stages)
Bronchoscopy and biopsy (tube placed down into trachea to take a biopsy)
Sputum cytology- testing peoples flem
CT scan: can be used to look for metastases
Limited stage disease : cancer confined in one side of chest. Involved Lymph nodes can be treated with radiotherapy.
Extensive stage disease: cancer has metastised to distant organs.
Which type of lung cancer are these stages of ?
Either limited stage disease or extensive stage disease
How is NSCLC staged?
By stages I- IV
Or can use TNM system seen in breast cancer
What is the usual treatment pathway for SCLC?
Good initial response to chemotherapy but a lot of patients relapse
If they have at least 6 months with the cancer being stable they will be retreated with the same chemo regimen again as we know that has worked for them.
If relapse happens In under 6 months then look to second line chemo or "best supportive care" used when patients unfit/ unsuitable for other therapies.
What are the first line drugs in chemotherapy for SCLC??
Carboplatin plus etoposide
Radiation can be used in SCLC.
The radiation dose is limited as the thorax contains many sensitive vital organs.
When is radiation usually used in SCLC??
Used in combination with chemotherapy in limited (early) stage SCLC. Better than using chemotherapy alone.
Can be used palliatively to control symptoms such as bone pain and large airway narrowing in advanced disease.
Radiation is Usually used post surgery as an adjuvant to eradicate any cells not removed in surgery.
Also used In patients not suitable for surgery.
When can surgery be used in treatment of NSCLC??
Only in NSCLC
For stages I and II disease
(Occasionally in stage IIIa disease when tumour is shrunk by chemotherapy first)
Surgery for NSCLC involves either an lobectomy or a pneumonectomy. What are these??
Lobectomy: most common, remove the affected lobe of the lung
Pneumonectomy: remove the entire lung. High rate of mortality, long term debility. Only for patients who have good pre-op performance
Chemotherapy can be used as an adjuvant therapy post surgery (in stage 1 and 2 NSCLC) to eradicate any cells that weren't removed in surgery. This involves using a ______ based chemotherapy regimen.
We can also use chemo in stage 3 and 4 NSCLC to improve survival and symptoms. What combo of chemo drugs does this involve using?
Using cisplatin based chemo in stage 1 and 2
Use cisplatin in combo with pemetrexed in ADENOCARCINOMA in stage 3 and 4 disease.
Chemotherapy can also be used as a neo-adjuvant (before surgery) to shrink the tumour in NSCLC.
This means less extensive surgery is needed
Eradicates any small metastases at the start of treatment.
Not sure whether neo-adjuvant (before surgery) or adjuvant (after surgery) is superior.
How common is lung cancer??
Second most common cancer in the UK (following breast cancer)
Most common cancer world wide
Incidence peaks between 75 and 85 years old
An example chemotherapy regimen for NSCLC involves CISPLATIN (IV infusion) And VINORELBINE (IV stat)
This requires an inpatient stay in hospital as they will need rehydration. Why do they require this??
Cisplatin is nephrotoxic
They'll do a lot of weeing
So need to stay in hospital to get fluids pumped in
NB: vinorelbine is a vinca alkaloid
What are the side effects of the cisplatin and vinorelbine Chemotherapy regimen used in NSLC?
Nausea and vomiting
Bone marrow suppression
Mucositis (pain and inflammation of the mucous membrane lining the digestive tract)
Peripheral neuropathy (tingly fingers and toes: comes from vinorelbine as it's a vinca alkaloid)
Ototoxicity (hearing loss and tinnitus)
What are the pharmaceutical care issues with the chemotherapy regimen cisplatin + vinorelbine used in NSCLC?
Need to check Full Blood Count
Need to check renal function before treatment as eGFR must be over 55. Cisplatin is nephrotoxic so doses need to be reduced.
Ensure that anti-emetics have been prescribed
Ensure that pre and post HYDRATION has been prescribed- before and after cisplatin; 3L of IV fluids
Measure urine output as it needs to be over 100ml per hour during and for 6 -8 hours post cisplatin administration. If it's not then patient may need diuresis.
In the chemotherapy treatment of NSCLC, We need to monitor patients for cisplatin induced wasting of ______. Patients May need supplements.
Cisplatin induced Wasting of electrolytes
Why must Vinorelbine be diluted ? (Used in chemotherapy for NSCLC)
Because in the past it's been injected into the spine and vinca alkaloids are lethal if done, if it's 50mls then they won't attempt this so mistake won't be made again!!
What is the name of the oral agent that is a targeted therapy for NSCLC?
How does Gefitinib work??
It's a selective inhibitor of the EGF receptor Tyrosine Kinase!!
This means it blocks the signal pathway involved in cell proliferation.
If you remember back to Christine's stuff, the EGFR has a tyrosine kinase domain that undergoes and conformational change and receptor dimerisation when the EGF binds.
This dimerisation stimulates kinase active and activating signal transduction pathways and downstream signalling proteins.
So stopping this results in less signalling, less cell proliferation, slower growth of the cancer
Gefitinib is recommended by NICE as an option for first line treatment in patients with locally advanced or metastatic NSCLC. But only if they test positive for what?? And what is the other criteria that must be met?
Positive For EGFR tyrosine kinase MUTATION.
Also only if the manufacturer provides Gefitinib at the fixed price agreed under the patient access scheme (where it's paid for at end of third month, but doctors won't stop treatment before the third month so everyone ends up paying!)
What is erolitinib ?
A new therapy used for NSCLC
It's licensed first line for locally advanced metastatic NSCLC or 2nd line after failure of previous chemo
It's also oral
How does eroltinib work?
It's targets and inhibits the tyrosine kinase region of the EGF receptor. (Just like Gefitinib!)
This blocks signalling pathways and cell division and proliferation
So we know eroltinib and Gefitinib are both EGFR-TK inhibitors. Eroltinib is the newer version, what's the difference?
Eroltinib (newer agent) Suggested to be more efficacious.
Eroltinib is the only agent licensed for treatment of locally advanced or metastatic NSCLC after failure of at least one prior chemotherapy regimen.
What can erolitinib now be used as an alternative to SECOND line? Why?
NICE now approves eroltinib as an alternative to docetaxel SECOND line in treatment of NSCLC for locally advanced or metastatic NSCLC.
This is because Roche (drug company) agreed to provide eroltinib at the same price as docetaxel, so now either treatment can be used.
What are the side effects of EROLTINIB??
Acne like skin rash (good sign as it shows patients are responding to the treatment)
Eroltinib is generally well tolerated.
When can radiotherapy be used for NSCLC in terms of measurements of the tumour?
Tumour must be under 3cm
Radiation dose given to tumour and 2cm around it
It's the treatment of choice for early stage NSCLC (stages 1-3) in patients who are not suitable for surgery.
How do we work out the number of pack years a patient has smoked?
Number of pack years= number of packs per day X number of years smoking
where 1 pack = 20 cigarettes