Flashcards in Lung Cancer Deck (19)
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)
What are some clinical features of lung cancer?
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
Pancoast tumour complications
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
Common metastatic sites of lung cancer?
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
When is PET scanning used for lung cancer?
In operable patients to detect unseen metastases and evaluate mediastinum (often upstages disease)
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
Treatment for stage 1 NSCLC?
Surgical resection - ideally lobectomy
No role for adjuvant chemo
If not operable candidate - radical RT
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
Treatment for stage 3 NSCLC?
When should you test for a targetable mutation?
Non-squamous lung cancer
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
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
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
Who is EGFR mutation more common in?
Occurs in 10% of Caucasian population
What are drugs used for EGFR mutation?
Tyrosine kinase inhibitors compete for ATP for binding to tyrosine kinase domain
What are some side effects of EGFR inhibitors?
Rare: hepatitis, pneumonitis
Resistance develops in all patients, 50% due to a point mutation in t790M
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