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Cancer CE & VP > VP L3 Lung cancer > Flashcards

VP L3 Lung cancer Flashcards

1
Q

Mortality rate of lung cancer

A

80% die within one year of diagnosis

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2
Q

Smoking is associated with …..% of LC cases

A

90

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3
Q

Risk factors other than being a smoker (5)

A 
passive smoking
asbestos 
radon gas
previous lung disease
family history
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4
Q

2 types of lung cancer

Which is most common?

A

Small cell lung cancer (20%)

Non small cell lung cancer (80%)

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5
Q

Describe the cells in SCLC v NSCLC

A

small and uniform

vs

several types (squamous cell, adenocarcinoma, large cell)

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6
Q

What is the role of surgery/chemo/radio in SCLC v NSCLC

A

SCLC - surgery has a limited role. Responds well to chemo and radio therapy.

NSCLC - sugery more often used, limited response to chemo

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7
Q

What is the role of surgery/chemo/radio in SCLC v NSCLC

A

SCLC - surgery has a limited role. Responds well to chemo and radio therapy.

NSCLC - sugery more often used, limited response to chemo

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8
Q

Clinical presentation of lung cancer

A 
Persistent cough
SOB/weezing
Haemoptysis
Chest, shoulder or back pain
Weight loss
Fatigue
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9
Q

Often diagnosed by

A

X-ray
>50% of patients metastatic at presentation

often initially confused with COPD

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10
Q

Diagnostic tests

A

Chest Xray
Broncoscopy and biopsy
Sputum cytology
CT scan (to assess suitability for surgery/find metstasis)
Lung function tests to establish baseline

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11
Q

Stages of lung cancer outline (2)

A

Limited stage disease – cancer is confined to one side of the chest & involved lymph nodes can be treated with radiotherapy
Extensive stage disease – cancer has metastasised to distant organs

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12
Q

Dont bother learning stages but

A

Stage I & II – primary tumour in 1 lung lobe with
lymph node involvement confined to hilar nodes
Stage IIIa – locally advanced with involvement of
mediastinal lymph nodes
Stage IIIb – locally advanced with pleural
effusion & involvement of contralateral media-
stinal lymph nodes
Stage IV – metastases to other organs

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13
Q

Treatment options for LC

A 
Surgery
Radio therapy
Chemo
Novel therapies
Best supportive care
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14
Q

SCLC often has a good/poor responce to chemo

A

Good initial response then

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15
Q

SCLC often has a good/poor responce to chemo

A

Good initial response then relapse.

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16
Q

SCLC - if a patient is at least 6 months stable disease what do you treat them with in relapse?

A

The same agent

(If

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17
Q

What is usually 1st line regimen for SCLC

(drugs and cycle length and no of cycles(

A

Carboplatin + etoposide

21 days for 4 cycles

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18
Q

What is usually 2nd line regimen for SCLC

A

CAV

cyclophosphamide, doxorubicin, vincristine

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19
Q

Is SCLC senstive to radio therapy?

What is the problem?

When is it given?

A

Yes sensitive but the dose is limited as the thorax contains many sensitive vital organs

In combo with chemo in limited stage OR plalliatively

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20
Q

Why use radiotherapy palliatively? (SCLC)

A

To control symptoms such as bone pain, & large airway narrowing

21
Q

When is surgery used?

A

NSCLC stages I and II (maybe IIIa if shrunk by chemo first)

22
Q

Types of surgery (2)

A

Lobectomy

Pneumonectomy - removal of the whole lung, often has complications.

23
Q

What complicates chemo in NSCLC

A

pt often have co morbidities

24
Q

Stages I & II NSCLC what chemo is used

Stages III & IV?

A

I & II - cisplatin based regimen
(use as adjutant to surgery/chemo)

III & IV - combo cisplatin and permetrexed

25
Q

Why use chemo with surgery (2)

A

Less extensive surgery may be needed

Eradicates micro-metastases at start of treatment

26
Q

Why use chemo with surgery (2)

A

Less extensive surgery may be needed

Eradicates micro-metastases at start of treatment

27
Q

Cisplatin and vinorelbine s/e

A 
nausea & vomiting
bone marrow suppression
mucositis
constipation
alopecia
peripheral neuropathy
nephrotoxicity & ototoxicity
28
Q

Cisplatin and vinorelbine - why must people have inpatient stay for this

A

hydration

29
Q

Cisplatin and vinorelbine cycle length and bonus details

A

Cisplatin 80mg/m2 IV infusion day 1
Vinorelbine 30mg/m2 IV stat day 1 & 8
Given every 21 days for max. 4 courses

30
Q

Cisplatin and vinorelbine cycle length and bonus details

A

Cisplatin 80mg/m2 IV infusion day 1
Vinorelbine 30mg/m2 IV stat day 1 & 8
Given every 21 days for max. 4 courses

31
Q

Things to check before Cisplatin and vinorelbine regimen

A

FBC, body surface area and dose.

Renal function - GFR must be >55ml/min
recalculate before each cycle

32
Q

What 2 things should be prescibed with the Cisplatin and vinorelbine regieme?

A
  1. Antiemetics

2. pre and post hydration with cisplatin (3L before and after) - ensure urine output of 6-8 hours after cisplatin admin)

33
Q

What 2 things should be prescibed with the Cisplatin and vinorelbine regieme?

A
  1. Antiemetics

2. pre and post hydration with cisplatin (3L before and after) - ensure urine output of 6-8 hours after cisplatin admin)

34
Q

When might a patietn need addtional diuressis with Cisplatin and vinorelbine

A

inadequate urine output or wight gain (fluid retention)

35
Q

What should we monitor patients for during Cisplatin and vinorelbine regiemen

A

Cisplatin-induced wasting of electrolytes - Mg, Ca & K.

Supplements may be needed

36
Q

What sort of molecule is vinorelbine

A

Vinorelbine – vinca alkaloid, must be diluted to 50mls with NaCl 0.9%

37
Q

What sort of molecule is gefitinib?

What does it target?

A

Gefitinib is a selective inhibitor of epidermal growth factor receptor tyrosine kinase (EGFR-TK) which blocks the signal pathways involved in cell proliferation.
By blocking EGFR-TK, gefitinib helps to slow the growth and spread of the cancer.

38
Q

How is gefitanib administered

A

Oral agent – 250mg daily

39
Q

When is gefitanib recommended?

A

option for the first-line treatment of people with locally advanced or metastatic (stage III or IV) non-small-cell lung cancer (NSCLC) if:
• they test positive for the epidermal growth factor receptor tyrosine kinase (EGFR-TK) mutation and
• the manufacturer provides gefitinib at the fixed price agreed under the patient access scheme.

40
Q

What mutation must be carried to have Gefitanib?

A

Only for patients with EGFR-TK mutation – worse outcome if gefitinib is given to EGFR-TK negative patients

41
Q

Erlotinib is a novel therapy targeting

A

Erlotinib targets & inhibits the tyrosine kinase region of EGF receptor

42
Q

Erlotinib is licensed 1st line for ….

or second line for…..

A

Licensed for 1st line treatment of locally advanced or metastatic NSCLC or 2nd line after failure of previous chemotherapy

43
Q

How is erlotinib administered

A

orally 150mg daily

44
Q

Limitations of evidence behind erlotinib

A

No trials comparing this erlotinib and docetaxel (another option 2nd line)

45
Q

Erlotinib is also called

A

Tarceva

46
Q

s/e erlotinib

A

acne-like rash (75%)

diarrhoea (55%)

47
Q

What is treatment of choice for early stage (stage I-III) NSCLC pts who are not suitable for surgery –

A

Radiotherapy - given with curative intent daily over 3-4 weeks

48
Q

When do we use radical (high dose) radio therapy

A

Only small % of pts are suitable for this as tumour must be

Cancer CE & VP (15 decks)

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