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Heme/Onc > Lung Cancer > Flashcards

Lung Cancer Flashcards

(54 cards)

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1
Q

What are the risk factors for lung cancer?

A

Tobacco smoking and exposure
Age: rare in less than 40 yo
Genetics
Occupational/ Environmental exposures

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2
Q

What are the genetic mutations responsible for lung cancer?

A 
p53
KRAS
EGFR
MYC
c-KIT
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3
Q

What are occupational/ environmental exposures?

A 
Radiation therapy
Second-hand smoke
Asbetos
Radon
Metals
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4
Q

Smoking causes what type of lung cancer?

A

SCLC

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5
Q

The doubling time/growth rate is rapid in which type of lung cancer?

A

SCLC

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6
Q

What is the general treatment type for SCLC?

A

Chemotherapy

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7
Q

Which type of lung cancer is paraneoplastic syndromes common?

A

SCLC

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8
Q

What are the staging criteria for SCLC?

A

Limited

Extensive

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9
Q

What are paraneoplastic syndromes?

A

Appear unrelated to cancer but are sx of the cancer

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10
Q

What is the screening for lung cancer?

A

Evaluation of individual risk assessment

Low dose spinal CT in high risk patients who are potential candidates for treatment

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11
Q

What are considered high risk patients for lung cancer?

A

Age 55-74: smoking at least 30 packs/yr, or smoking cessation within 15 years
Age 50+: 20-29 pack/yr, with one additional RF

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12
Q

What are pulmonary and thoracic s/sx?

A 
Cough
Dyspnea
Chest pain
Sputum production
Hemoptysis
Pleural effusion
Hoarseness
Superior vena cava syndrome
Dysphagia
Wt loss
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13
Q

What are sx of metastatic involvement?

A 
Neurologic: paralysis, neurologic deficits, spinal cord compression
Bone pain
Liver dysfunction
Adrenal dysfunction
Lymphadenopathy
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14
Q

What are paraneoplastic syndromes?

A 
Hypercalcemia
Cushing syndrome
Vasopressin --> SIADH
Immune mediated
Eaton-Lambert syndrome
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15
Q

How do we diagnose lung cancer?

A

Hx, PE, Lab testing
PFT
Radiography
Biopsy

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16
Q

What type of biopsies are used to test for lung cancer?

A 
TBNA
Thoracentesis
Mediastinoscopy
VATS and open surgical biopsy
EBUS - guided forceps biopsy
EUS - guided biopsy
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17
Q

What is limited stage SCLC?

A

Lung cancer that can be safely treated with definitive radiation doses

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18
Q

What is extensive stage SCLC?

A

Stage IV

Tumor/nodal volume too large to fit in a tolerable radiation plan

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19
Q

What are poor prognostic factors for SCLC?

A

ECOG > 3
Wt loss
Markers associated with bulky disease

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20
Q

What is the goal of limited stage SCLC?

A

Cure

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21
Q

What is treatment for limited stage SCLC with good performance status?

A

Radiation concurrently w/chemotherapy

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22
Q

What is the treatment for limited stage SCLC with poor performance status?

Study These Flashcards
A

Chemo +/- radiation

23
Q

What is the goal of extensive stage SCLC?

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A

Include palliation, prolong life (very rarely curable)

24
Q

What is the treatment of extensive stage SCLC with good performance status?

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A

Chemo +/- radiation to sx metastatic sites

25
What is the treatment of extensive stage SCLC with poor performance status?
Supportive care
26
When is prophylactic cranial irradiation used?
If complete/partial response attained | If still good performance status and minimal comorbidities
27
What are the preferred drugs of choice for SCLC?
Cisplatin and Etoposide (w/radiation) | Carboplatin and Etoposide
28
What do we do with the therapy if a patient with SCLC has a relapse w/in 6 months with ECOG 0-2?
+/- ipilimumab | Topotecan, Irinotecan, Temozolomide, Paclitaxel, CAV, gemxitibine, docetaxel, etopodisde, vinorelbine, nivolumab
29
What do we do if a patient has a relapse of SCLC after 6 months?
Retry original regimen
30
What are types of supportive care for SCLC?
``` Pain management N/V MGFs Radiation therapy toxicities Paraneoplastic syndrome tx ```
31
Which stages of NSCLC are resectable?
I, II, III
32
What are treatment options for stages I, I, and III NSCLC?
Srugery +/- adjuvant radiation (if positive margins) | Adjuvant chemotherapy/ chemoradiation
33
If the cancer is unresectable in stage IIB or IIIA, what are treatment options?
Chemoradiation
34
What are the drugs that are used in EGFR mutation positive NSCLC patients?
Erlotinib Afatinib Gefitinib
35
What are the drugs used in ALK mutation positive NSCLC patients?
Alectinib Crizotinib Ceritinib
36
What is the drug used for PD-L1 expression positive NSCLC patients?
Pembrolizumab
37
What drugs are used for adenocarcinoma with negative NSCLC mutations?
Doublet chemo +/- bevacizumab
38
What drugs are used for squamous cell NSCLC?
Doublet chemotherapy
39
What drugs are used with early stage adjuvant chemotherapy for NSCLC?
Cisplatin plus one of the following | Vinorelbine, etoposide, vinblastine, gemcitabine, paclitaxel, pemetrexed
40
Which histology is pemetrexed used with?
Non-squamous cell
41
Why would carboplatin be used in place of cisplatin for NSCLC?
Decrease toxicity
42
What is considered advanced/metastatic disease?
Stage IV or IIIB with pericardial effusions or supraclavicular lymph node involvement
43
If a patient has advanced metastatic NSCLC disease with an EGFR mutation, what medication can be initiated?
Erlotinib Afatinib Gefitinib
44
If a patient has advanced metastatic NSCLC disease with an ALK mutation, what medication can be initiated?
Alectinib Crizotinib Ceritinib
45
If a patient has advanced metastatic NSCLC disease with a PD-L1 expression, what medication can be initiated?
Pembrolizumab
46
If a patient has advanced metastatic NSCLC disease with no mutations (adenocarcinoma), what medication can be initiated?
Doublet chemotherapy +/- bevacizumab
47
If a patient has advanced metastatic NSCLC disease with squamous cell histology, what medication can be initiated?
Doublet chemotherapy
48
What is the maintenance therapy for NSCLC advanced/metastatic disease if there is no disease progression and they were on doublet + bevacizumab?
Bevacizumab
49
What is the maintenance therapy for NSCLC advanced/metastatic disease if there is no disease progression and they were on cisplatin/pemetrexed?
Pemetrexed
50
What is the maintenance therapy for NSCLC advanced/metastatic disease if there is no disease progression and they were on Bevacizumab/pemetrexed with cisplatin or carboplatin?
Bevacizumab + pemetrexed
51
If the patient has advanced/metastatic NSCLC and their initial therapy was platinum based doublet, what drug can be used as a switch agent?
Pemetrexed
52
What drugs are affected by EGFR mutations?
Erlotinib Afatinib Gefitinib
53
What drugs are affected by KRAS mutations?
Erlotinib | Afatinib
54
What drugs are affected by EML4-ALK mutations?
Alectinib Crizotinib Ceritinib

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