Lung cancer Flashcards
(23 cards)
What are the risk factors?
- smoking (85%)
- occupation: asbestos exposure, uranium mining, ship building, petroleum refining
what areas of the lung most commonly give rise to tumours?
- large and medium sized bronchi (rarely lung parenchyma)
what type of cells is small cell lung cancer derived from?
- small cell (18%) derived from neuro-endocrine cells within the lung
Name the cell types of non-small cell lung cancer?
- Non small cell make up 82% of lung cancer:
- SCC
- Adenocarcinoma
- large cell carcinoma
- non-small cell lung cancer
What mutation is adenocarcinoma most commonly associated with?
- activating mutations in EGFR
how may the patient present?
- cough
- dyspnoea
- haemoptysis
- chest pain
- recurrent chest infection
what cancer subtypes produce what paraneoplastic syndromes?
- squamous cell carcinoma hypercalcaemia (PTHrP)
- Small Cell lung cancer
SIADH - Small Cell lung cancer, Carcinoid tumours
Increased ACTH
What investigations would you do? and how reliable are they?
- CXR (95% of tumours visible)
- Sputum cytology (80% have malignant cells in sputum)
- Bronchoscopy: allows visualisation of bronchial tree and tumour biopsy
- CT chest and abdomen:
extent of local and distant disease - PET scan
What non-specific tumour markers can be used?
Tumour markers: neuron specific enolase (NSE) and LDH
What kind of factors may be taken into account for assessing treatment options?
- performance status (refer to notes)
- COPD, vascular disease, general debility
How is the tumour staged?
Tumour:
> T1 3cm or less, not invading a main bronchus
> T2 <7cm
>T3 local invasion of particular structures irrespective of tumour size
> T4: organ invasion (inoperable) mediastinum, heart, great vessels
Nodes:
> N1: ipsilateral bronchopulmonary and hilar nodes
> N2: ipsilateral mediastinal nodes (operable)
> N3: contralateral nodes (inoperable)
At what stage does it automatically become inoperable?
Stage 3b, most patients will have occult mets at presentation
How is SCLC staged?
Limited- confined to one hemithorax, local extension confined to ipsilateral side
Extensive- disease at sites beyond the definition of limited disease (2/3)
How is SCLC managed?
- limited- radical radio/ chemotherapy
- extensive- chemotherapy
How well do small cell lung cancers respond to chemotherapy?
- SCLC is one of the most chemosensitive tumours and responds within days
- 90% will respond to combination chemotherapy
- most patients will relapse with disease that is chemo-resistant and die from rapidly progressive disease
When is radiotherapy indicated in SCLC? (3 times)
- Treatment of primary tumour: highly radiosensitive, used in combination with chemo
- Prophylactic cranial irradiation: brain mets are frequent and cause significant morbidity. Reduces frequency of brain mets and improved survival
- Palliative: radiotherapy may be used to palliate the symptoms of advanced SCLC.
What is the scope for surgery?
- 90% of patients do not undergo surgery.
- tumours <3cm confined to broncho-pulmonary and hilar nodes
what is the prognosis of SCLC?
- 2-4 months without treatment
- approx a year with chemotherapy
- limited disease, good performance status, favourable biochemistry have a 10-15% chance of long term survival
What is the surgical indications in NSCLC?
- Stage 1 and 2 (80% 5yr survival)
- mediastinal involvement is inoperable
What are the indications for radiotherapy?
- patients not suitable for surgery
- following surgery
- CHART radiotherapy (high dose) results in improved survival
- complications e.g. SVCO, SCC
What are the indications for chemotherapy?
- Palliative, shrinks the tumour together with radical radiotherapy
- Adjuvant chemo to surgery
What kind of targeted therapy can be used?
- Tyrosine kinase inhibitors (erlotinib/ gefitinib)
- benificial in palliative NSCLC
- Can be used in first line in patients who have activating mutations of EGFR.
What is the prognosis?
Stage 1- 50% 5yr survival
Stage 2 - 40%
Stage 3a- 25%
Stage 3b- <5%
