Cancers of the Lung, Heart and Vasculature Flashcards

Question

In what order are the imaging and other tests conducted and why?

Answer 1

First, chest x-ray, to see if anything is wrong - i.e. tumour, pleural effusion Next, staging CT of chest and abdomen to confirm the findings seen on the chest x-ray and to look for spread of tumour i.e. into the mediastinum or abdomen Then, PET scan as it is most useful to exclude occult metastases Lastly, biopsy to confirm the diagnosis of lung cancer and to work out the histological subtype

Answer 2

Ingestion of radioactively labelled glucose Taken up by all parts of the body metabolising Tumours metabolise at a greater rate = radioactive glucose shows up brighter on the scan

Answer 3

Bronchoscopy - fibro-optic tube passed down the bronchi, suitable for tumours in the central airway and where tissue staging is not important Endobronchial ultrasound and trans bronchial needle - aspiration of mediastinal lumph nodes (ABUS [TBNA]), used to stage mediastinum and achive tissue diagnosis CT guided lung biopsy - to access peripheral lung tumours Choose method based on accessibility, availability, and impact on staging

Answer 4

The TNM system: T1-4: tumour size and location N0-3: lymph node involvement – mediastinum + beyond M0-1c: metastases + number TNM can be simplified to stages 1 to 4

Answer 5

Surgical Radiological Pharmacological Supportive ``` Patient fitness Cancer histology Cancer stage Patient preference Health service factors ```

Answer 6

0 = Asymptomatic (Fully active, able to carry on all predisease activities without restriction) 1 = Symptomatic but completely ambulatory (Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature. For example, light housework, office work) 2 = Symptomatic, <50% in bed during the day (Ambulatory and capable of all self care but unable to carry out any work activities. Up and about more than 50% of waking hours) 3 = Symptomatic, >50% in bed, but not bedbound (Capable of only limited self-care, confined to bed or chair 50% or more of waking hours) 4 = Bedbound (Completely disabled. Cannot carry on any self-care. Totally confined to bed or chair) 5 = Death

Answer 7

0-2 Other co-morbidities and lung function

Answer 8

Surgical resection is standard of care for early stage disease Wedge resection - tumour and small area of surrounding healthy tissue removed Sublobar resection if stage 1 (≤3 𝑐𝑚) - larger portion of the lobe is removed containing the tumour Lobectomy + lymphadenectomy usual approach - entire lobe containing the tumour and lymph nodes affected are removed Pneumonectomy - entire lung removed

Answer 9

Open thoracotomy - cranking open the ribs at the side of the chest to remove part of the lung Video-assisted thoracoscopic surgery (VATS) - more commonly used nowadays, keyhole surgery

Answer 10

Less post-op pain Lower risk of post-op infections Fewer days spent post-op in hospital Resection is still just as good performed via VATS vs open thoracotomy

Answer 11

Alternative to surgery for early stage disease - used if not fit enough for surgery (particularly comorbidity) or refuse surgery Stereotactic ablative body radiotherapy (SABR): - Involves a lot of 3D planning due to high precision of target - Technique of choice - High-precision targeting, multiple convergent beams

Answer 12

First line for metastatic NSCLC with specific mutation - the drugs are usually protein kinase inhibitors EGFR: erlotinib, gefitinib, afatinib, dacomitinib, and osimertinib ALK: crizotinib, ceritinib, alectinib, brigatinib, lorlatinib ROS-1: crizotinib, entrectinib

Answer 13

Drugs are better than standard chemo therapy in terms of progression free survival and side effects (but not necessarily overall survival) These are palliative treatments - to help control the disease and improve symptoms rather than cure the disease e.g. erlotinib PFS 13 vs 5 months, OS 23 vs 27 months compared to chemo (OPTIMAL trial) PFS = progression free survival, OS = overall survival

Answer 14

Generally well-tolerated (tablets) | Rash, diarrhoea, and (uncommonly) pneumonitis

Answer 15

New, progressive field, radical approach Harnesses own immune system to attack cancer cells

Answer 16

First line for metastatic NSCLC with no mutation (and PDL1 >50%) Pembrolizumab, atezolizumab, nivolumab

Answer 17

Improvements in progression-free survival and overall survival vs standard chemotherapy: e.g. pembrolizumab PFS 10 vs 6 months, OS 30 vs 14 months (KEYNOTE-024 trial) Generally well-tolerated Immune-related side-effects in 10-15% (thyroid, skin, bowel, lung, liver)

Answer 18

First line for metastatic NSCLC with no mutation and PDL1 ≤50% (in combination with immunotherapy) Target any rapidly dividing cells Platiunum-based regimens, e.g. carboplatin, cisplatin, paclitaxel, pemetrexed

Answer 19

Modest improvements in overall survival vs best supportive care: e.g. 29% vs 20% one year survival in clinical trials

Answer 20

Frequent: fatigue, nausea, bone marrow suppression, nephrotoxicity Quality of life poorly evaluated in trials; no evidence for improvement

Answer 21

Palliative care | Supportive care

Answer 22

Should be offered as standard to all patients with advanced stage disease Offers symptom control, psychological support, education, practical and financial support, planning for end of life Lung cancer specialist nurse, other nurses

Answer 23

Improve QoL Lower depression scores Mean survival can increase

Answer 24

Surgery or radiotherapy with curative intent

Answer 25

Surgery + adjuvant chemotherapy | Radiotherapy + chemotherapy +/- immunotherapy

Answer 26

With targetable mutation (e.g. EFGR, ALK, ROS-1): tyrosine kinase inhibitor No mutation, PDL-1 positive: immunotherapy No mutation, PDL-1 negative: ‘standard’ chemotherapy Palliative care, alone or with the above

Cancers of the Lung, Heart and Vasculature Flashcards

(50 cards)