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