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Flashcards in Lung Cancer Deck (19):
1

What are the types and freq of types of lung cancer?

Non small cell lung cancer (85%)
- adenocarcinoma (40%, typically peripheral)
- squamous (25%, typically central)
- large cell (10%, typically peripheral)

Small cell lung cancer (15%, typically central)

2

What are some clinical features of lung cancer?

Cough, haemoptysis
Chest pain, sob
Hoarseness due to laryngeal nerve involvement (most freq on left side due to longer course of nerve)
HPOA (clubbing, joint swelling, periositis) = more common in adeno
SVCO
Pancoast tumour complications

3

What is a pancoast tumour?

Apical mass (usually squamous) which causes pain in shoulder/arm, hornets syndrome, wasting of small muscles of hand, bony destruction of ribs

4

Common metastatic sites of lung cancer?

Liver
Adrenal gland
Bone
Brain

5

What are some examples of paraneolpastic syndromes seen in lung cancer?

Hypercalcaemia (most commonly squamous due to PTHrP)
SIADH (SCLC causes 75% of cancer related SIADH)
Neurological - lambert-eaton myasthenia syndrome, cerebellar ataxia

6

When is PET scanning used for lung cancer?

In operable patients to detect unseen metastases and evaluate mediastinum (often upstages disease)

7

Basic staging for NSCLC lung cancer?

Stage 1 - solitary tumour
Stage 2 - regional lymph node involvement (hilar) or tumour invading local structures
Stage 3 - mediastinal lymph node involvement
Stage 4 - distant mets

8

Treatment for stage 1 NSCLC?

Surgical resection - ideally lobectomy
No role for adjuvant chemo
If not operable candidate - radical RT

9

Treatment for stage 2 NSCLC?

Surgical resection and adjuvant chemotherapy (platinum doublet - best is cisplatin/vinorelbine

If unresectable or poor operative candidate treat with radical chemo-rad

10

Treatment for stage 3 NSCLC?

Concurrent chemoradiation

11

When should you test for a targetable mutation?

Advanced disease
Non-squamous lung cancer

12

What is treatment of stage 4 NSCLC without targetable mutation?

Platinum doublet chemotherapy - 4 cycles
Pemetrexed best in non-squamous
Gemcitabine best in squamous

Role for maintainance pemetrexed in adenocarcincoma

13

What is an eGFR mutation?

Mutation causes a constantly active tyrosine kinase receptor leading to increased signalling
Mutation in EGFR caused by a deletion in exon 19

14

What are some risk factors for lung cancer?

Smoking - dose related
Environmental exposure - asbestos, radon, heavy metals
Radiation treatment - typically mantle RT for lymphoma or RT for breast cancer

15

Who is EGFR mutation more common in?

Non smokers
Younger patients
Asian
Females
Adenocarcinomas

Occurs in 10% of Caucasian population

16

What are drugs used for EGFR mutation?

Tyrosine kinase inhibitors compete for ATP for binding to tyrosine kinase domain
Erlotinib
Gefitinib

17

What are some side effects of EGFR inhibitors?

Mucosal toxicities
Skin rash
Diarrhoea
Rare: hepatitis, pneumonitis
Resistance develops in all patients, 50% due to a point mutation in t790M

18

What is ALK?

Anaplastic lymphoma kinase is a transmembrane receptor tyrosine kinase - mutation caused by breakpoint leads to aberrant signalling
Found in 5%
Higher in younger, non smokers and adenocarcinomas

19

What is the drug used on ELK mutated lung cancer?

Crizotinib - dual ALK and MET tyrosine kinase inhibitor