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Oncology / Organ Transplant > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

Lung cancer accounts for ___% of all cancer diagnosis in the U.S.

A

15%

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2
Q

Lung cancer prevalence peaks between the ages of ___ and ___.

A

55-65

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3
Q

Lung carcinomas arise from ____.

A

Normal bronchial epithelial cells

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4
Q

2 Types of Lung Cancer

A

NSCLC

SCLC

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5
Q

___% of lung cancer in the U.S. is attributed to tobacco use.

A

80%

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6
Q

____% of smokers develop lung cancer

A

Less than 20% of smokers actually develop lung cancer

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7
Q

Other compounds that lead to lung cancer

A

benzene

asbestos

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8
Q

80% of lung cancer puts have this type:

A

NSCLC

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9
Q

Major cell types in NSCLC

A

Squamous Cell carcinoma
Adenocarcinoma
Large Cell Carcinoma

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10
Q

Type of Lung Cancer that grows faster

A

SCLC grows faster than NSCLC

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11
Q

Type of NSCLC that is more prevalent in males

A

SCC

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12
Q

Type of NSCLC that has a STRONG DOSE-RESPONSE to tobacco

A

SCC

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13
Q

Common metastatic sites for SCC

A 
Hilar and Mediastinal Lymph Nodes
Liver
Adrenal Glands
Kidneys
Bones
GI Tract
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14
Q

Most common type of lung cancer

A

Adenocarcinoma

-accounts for half of all lung cancers

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15
Q

Most common NSCLC subtype in non-smokers

A

Adenocarcinoma

-accounts for half of all lung cancers

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16
Q

___ is a worse prognosis than SCC

A

Adenocarcinoma

-more likely to metastasize at early stage and spread to distant sites

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17
Q

Adenocarcinoma metastatic sites

A 
Contralateral Lung
Liver
Bone
Adrenal Glands
Kidneys
CNS***
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18
Q

LCC

A 
Large Cell Carcinoma
Undifferentiated Epithelial tumors
-often dvx of exclusion
-large and bulky tumors
-assoc with similar poor prognosis as adenocarcinomas
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19
Q

___% of all lung cancers are SCLC

A

15%

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20
Q

SCLC

A

Very aggressive
-60-70% of pts present with disseminated dz
-occur in
major bronchi and
periphery of lung
May express neuroendocrine differentiation leading to paraneoplastic syndromes

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21
Q

SCLC major meta sites

A 
Lymph Nodes
Opposite Lung
Liver
Adrenal Glands
Bone /and marrow
CNS
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22
Q

Paraneoplastic Syndromes

A

S/S that occur at sites away from primary tumor or its metastases.

  • Not assoc with direct tumor involvement
  • Caused by prod. of biologically active subs or antibodies
  • Occur more frequently with lung cancer than any other cancer.
    • More freq with SCLC than NSCLC
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23
Q

NLST

A

National Lung Screening Trial

  • compared LOW-dose CT (LDCT) to CXR with high risk pts.
  • ages 55-74 and 30 pack year smokers
  • 3 scans each 1 yr apart
  • those with LDCT had 20% less chance of death
24
Q

ASCO screening guidelines for lung cancer

A

Pts. who meet:

  1. 55-74 yr old
  2. Fairly good health
  3. at least 30 pack year hx
  4. smoked within last 15 yrs
25
Q

Beta-carotene

A

study found that older pts who smoked and took beta-carotene were more likely to develop and die from lung cancer

26
Q

Metastasis status at time of LC dgx

A

Over 50% distant metas
25% regional
15% localized

27
Q

Most common initial s/s of LC

A

Cough
Dyspnea
CP or discomfort
Many pts also have co-morbidities: COPD, CVD, etc.
-may be assoc with paraneoplastic syndromes

28
Q

Examples of paraneoplastic syndromes

A 
Wt loss
Cushing's syndrome
Hypercalcemia
SIADH
Pulm hypertrophic osteoarth
Clubbing
Anemia
Eaton-Lambert's
Hypercoagulable state
29
Q

Staging for NSCLC

A

TNM

30
Q

Staging for SCLC

A

VA LC Study Group method

  • Limited dz (LD) - single hemothorax
  • Extensive dz (ED) - 60-70% of pts
    • evenly bone, then liver, marrow, CNS
31
Q

If untreated, most LC pts die ___

A

Within 1 year of dgx

32
Q

Role of surgery in LC

A

Used in stages I-III NSCLC vs. radiation in SCLC

33
Q

Role of radiation in NSCLC

A

Stages I and II ONLY with POSITIVE margins
All pts with N2 dz
Palliative tx

34
Q

Systemic Tx in NSCLC

A

adjuvant and in unresectable/metastatic for palliation

35
Q

Chemo options for NSCLC

A 
Cisplatin or Carboplatin
 PLUS one of:
Gemcitabine
Paclitaxel
Docetaxel
Vinorelbine
Pemetrexed

1st Line Tx for advanced NSCLC
ECOG 0-2
ECOG 3+ best supportive care

36
Q

2nd and 3rd Line Tx of NSCLC

A 
Offered to pts with ECOG 0-2 who experience dz progression after 1st line chemo
MONOTHERAPY with:
 -pemetrexed
 -erlotinib
 -docetaxel
If ECOG 3+, supportive care
37
Q

1st Line Tx for NSCLC

A 
Surgery for Stages I-III or single meta
Then, radiation with pos. margins ONLY
ECOG 0-2
Chemo DOC: Cisplatin or Carboplatin
 PLUS
Gemcitabine
Paclitaxel
Docetaxel
Vinorelbine
Pemetrexed

ECOG 3+, supportive care

38
Q

EGFR inhibitors

A

Must have EGFR (+) aka HER-1

  • Afatinib
  • Cetuximab
  • Erlotinib
39
Q

Pts most likely to respond to EGFR inhibitors

A

Pts who never smoked
Women (think HER)
Asians
Adenocarcinoma Histology

40
Q

Mutations commonly seen in NSCLC

A 
EGFR (w/ or w/o KRAS) aka HER-1
 =erlotinib, cetuximb, afatinib
VEGF
 =bevacizumab (added to CbP)
   IF: Non-squamous cell 
        No bleeding/anticoag
        No CNS metas
ALK
 =crizotinib
41
Q

ADEs of EGFR inhibitors

A

Acneiform Rash

Diarrhea

42
Q

VEGF inhibitors

A

Bevacizumab

43
Q

Bevacizumab

A

VEGF inhibitor
-also used in colorectal cancer
Combined w/carboplatin and paclitaxel (CbP)
**Watch for bleeding, anticoag, CNS meta
**Not in SCC

44
Q

ALK Inhibitors

A

Crizotinib
ALK mutations seen more in non-smokers
and adenocarcinoma (where there are fewer)

45
Q

Crizotinib

A 
ALK Inhibitor
 -used more in non-smokers
 -used more in adenocarcinomas
ADEs:
 -vision disorder
 -Pneumonitis
46
Q

ADEs of crizotinib

A

Vision Disorder and Pneumonitis

47
Q

Tx of SCLC (General)

A

Chemo +/- radiation

(not surgery in early stages like NSCLC)

48
Q

Favorable prognostic factors for SCLC

A

Female
Early Stage
Less than 5% unintentional wt loss

49
Q

DOC for SCLC Limited Dz (LD)

A

EC - Etoposide/Cisplatin
May sub carboplatin
Then, PCI if complete response

50
Q

PCI

A

Prophylactic Cranial Irradiation (PCI)
-Offered to LD/ED SCLC pts who have
complete response
-Reduces brain mets and incr 3-yr survival

51
Q

Tx of SCLC Extensive Dz (ED)

A

EC remains the DOC
(etoposide/cisplatin)
alt: cisplatin + irinotecan
If response, PCI

52
Q

Tx of Recurrent dz in SCLC

A

If less than 3 mo:
-supportive care/clinical trial
If over 3 mo:
-TOPOTECAN (only use)

53
Q

Topotecan

A 
Used in recurrent SCLC 
IF occurred in over 3 months
-Improves symptoms, 
   NOT 
  response rate, survival, time to progression
54
Q

Evaluation of Tx Response in NSCLC

A 
Evaluate tumor response after 2-3 cycles AND
 every other cycle after that
Continue 4-6 cycles with response
After completed tx:
 -PE
 -CXR q3-4 mo x2 yr
     -then q6 mo x 3 yr
         -then annually
55
Q

Evaluation of Tx Response in SCLC

A 
Evaluate tumor response after 2-3 cycles
Continue 4-6 cycles with response
Offer PCI if response
After completed tx:
 -F/U visits q 3mo x3 yr
     -then q4-6 mo x 2 yr
         -then annually

Oncology / Organ Transplant (12 decks)

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