Term
| risk factors for lung cancer |
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Definition
tobacco (10 x RR)
asbestos (5 x RR)
radon/ionizing radiation
occupational exposure
diet: low beta carotene and vitamin E linked to cancer; protective effect from fruits and vegetables
genetic predisposition |
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Term
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Definition
responsible for about 85% of lung cancer cases
dose-response relationship: amount, duration, tar/nicotine content
risk gradually decreases WHEN STOP SMOKING!!
risk will never get back to baseline though |
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Term
| second hand smoke and lung cancer |
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Definition
second hand smoke contains > 40 known or suspected carcinogenic substances
3,000 non-smoking adults die each year of lung cancer from second hand smoke
passive smokers 1.5 x risk of developing lung cancer as non-smokers |
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Term
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Definition
small cell lung cancer (SCLC):
15-20%, most aggressive
non-small cell lung cancer (NSCLC):
adenocarcinoma - 40%, most common type in US, most common type in non-smokers
squamous cell - 30%, slowest growing, strong relation to smoking
large cell - 15%, anaplastic tumor, decreasing incidence |
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Term
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Definition
chest x-ray:
more sensitive for adenocarcinoma
sputum cytology:
more sensitive for squamous cell
spiral CT:
new technology, more sensitive in general
summary: detect lung cancer at earlier stage, but no decrease in mortality |
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Term
| National Lung Cancer Screening Trail |
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Definition
n ~ 53,500
current or former heavy smokers aged 55-74 (> 30 pack year history)
low dose helical CT vs. chest x ray
baseline, year 1, year 2
354 deaths in CT group, 442 in x-ray group
absolute risk reduction was 0.4% |
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Term
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Definition
tobacco avoidance
smoking cessation
chemoprevention:
reversal of pre-malignancy
role for vitamin E??
nothing has been proven effective |
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Term
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Definition
dyspnea
cough
pain
loss of appetite
haemoptysis |
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Term
| clinical evaluation of lung cancer |
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Definition
physical exam
bronchoscopy - precise tumor location, specimen
fine needle aspirate - cytology
chest x-ray - detect position, size, number of tumors
CT scare - detect chest wall invasion, mediastinal nodes, distant mets
PET scan - lymph node staging
lab tests
mediastinoscopy - visualize and sample nodes |
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Term
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Definition
sputum cytology
bronchoscopy
percutaneous needle biopsy
fine needle aspirate (FNA)
open lung biopsy
have to have a biopsy for diagnosis |
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Term
| non small cell lung cancer (NSCLC) positive prognostic factors |
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Definition
early stage disease
good performance status - can take care of themselves without limitations
no significant weight loss
female gender |
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Term
| non small cell lung cancer staging at presentation |
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Definition
70% are in stage III or IV
curative potential is determined by if the cancer is operable
stage III-b and up are inoperable |
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Term
| non small cell lung cancer - metastatic spread |
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Definition
most common sites of metastasis:
bone
bone marrow
brain
liver
lymph nodes
adrenal glands (very common for lung cancer) |
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Term
| NSCLC treatment - surgery |
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Definition
lobectomy
segmentectomy
wedge resection |
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Term
| NSCLC treatment - radiation |
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Definition
single agent:
palliation - control local disease and reduce disease related symptoms
combination therapy:
adjuvant (postoperative) - eliminate unknown residual disease in surgical margins
neoadjuvant (preoperative) |
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Term
| NSCLC treatment - combination chemotherapy |
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Definition
carboplatin + paclitaxel
cisplatin + paclitaxel
cisplatin + gemcitabine
cisplatin + docetaxel
MEDIAN 1 YEAR SURVIVAL NOT DIFFERENT
toxicities are different |
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Term
| NSCLC treatment - single agent chemotherapy |
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Definition
used in salvage treatment or for patients with metastatic disease that can't handle big chemo
don't use the same agent for two different courses
if got carbo/paclitaxel first time, don't give paclitaxel the second time
paclitaxel
docetaxel
gemcitabine
erlotinib
vinorelbine |
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Term
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Definition
STAGE 1:
surgery is treatment of choice
clinical trails to evaluate role of chemotherapy
STAGE II:
surgery
chemotherapy
radiation
STAGE IIIA:
neoadjuvant chemotherapy + radiation
THEN
surgery
STAGE IIIB:
chemotherapy + radiation
surgery generally not possible
STAGE IV:
patients who are bed ridden, cannot take care of themselves DO NOT benefit from therapy (only treat those with GOOD PERFORMANCE STATUS)
chemotherapy with bevacizumab:
young, relatively good health-combotherapy + bevacizumab
DO NOT GIVE BEVACIZUMAB TO PATIENTS WITH SQUAMOUS CELL CANCER OF THE LUNG
radiation for symptom palliation
surgery for palliation (adrenal mets, brain mets)
clinical trials
RECURRENT NSCLC:
single agent chemotherapy with bevacizumab (if haven't already received, and if not squamous cell cancer)
erlotinib (reserved for people that have failed 2 types of chemo) |
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Term
| initial chemotherapy regimen for NSCLC |
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Definition
MUST USE PLATINUM CONTAINING REGIMEN (cisplatin or carboplatin, CARBOPLATIN better tolerated)
can combine with various agents (paclitaxel, docetaxel, gemcitabine, vinorelbine) however CARBOPLATIN/PACLITAXEL is considered standard
add bevacizumab in patients with metastasis IF NOT SQUAMOUS CELL IN ORIGIN |
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Term
| recurrent NSCLC chemotherapy |
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Definition
only treat good performance status
1st relapse: use chemotherapy + bevacizumab (if haven't had bevacizumab before); single agent chemotherapy
2nd relapse: use biologic therapy (erlotinib) |
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Term
| chemotherapy regimen for NSCLC |
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Definition
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Term
| carboplatin/paclitaxel major counseling points |
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Definition
ADRs:
quick: hypersensitivity (especially important in patients taking paclitaxel - must be given slowly; often are premedicated with corticosteroid +/- benadryl)
short term: N/V, myelosuppression, mucositis, alopecia, neuropathies (taxanes act on spindle fibers = neuropathies), nephrotoxicity (from carboplatin - STAY HYDRATED)
long term: hepatoxicity |
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Term
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Definition
dose = AUC x (CrCl +25)
IBW female = 45.5 + 2.3 (Ht in inches - 60)
IBW male = 50 + 2.3(Ht in inches - 60)
CrCl = [(140-age)(IBW)]/[SCr x 72] multiply by 0.85 if patient is a women |
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Term
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Definition
prolonged survival from 4.7 to 6.7 months
ADRs:
rash (effects EGFR pathway)
N/V/D
VTEs
hepatotoxicity |
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Term
| NSCLC maintenance therapy (stage IIIb/IV) |
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Definition
pemetrexed IV every 3 weeks until disease progression
median overall survival 13.4 vs 10.6 months
progression free survival 4 vs 2 months
NON SQUAMOUS ONLY
erlotinib also studied, but not approved |
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Term
| small cell lung cancer (SCLC) |
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Definition
strongest association with cigarette smoking
most aggressive clinical course if untreated
highly sensitive to XRT (radiation) and chemotherapy |
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Term
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Definition
LIMITED:
tumor confined to one lung and/or lymph nodes of one lung
EXTENSIVE:
tumor not confined
crossed into the other lung or has distant metastasis |
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Term
| SCLC paraneoplastic syndromes |
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Definition
hyponatremia of malignancy
Cushing's syndrome
hypercalcemia
superior vena cava syndrome (tumor spreads so fast it can cut off the vena cava) |
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Term
| SCLC positive prognostic factors |
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Definition
good performance status
limited stage disease
female gender
normal lactic dehydrogenase (LDH) |
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Term
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Definition
response rate 80-90% with chemotherapy
complete response in 50-60%
median survival 18-20 months
2 year survival is 40%
5 year survival rate is 15-25%
SCLC will often metastasize to the brain |
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Term
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Definition
surgery is very seldom possible b/c patients frequently have multiple tumors
CHEMOTHERAPY
RADIATION
concurrent thoracic XRT + chemo improves survival
prophylactic cranial XRT for patients with complete response
if they have a good response to chemo and radiation to the chest (got rid of everything in the chest) THEN you do prophylactic cranial radiation (likes to hide in the brain)
if they do not have a complete response then DO NOT radiate the brain; have to get rid of the lung cancer first (have to take care of what we know is there before worrying about what might be there) |
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Term
| limited SCLC chemotherapy |
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Definition
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Term
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Definition
surgery has minimal to no role
CHEMOTHERAPY
combination chemotherapy is standard therapy
radiation is palliative for symptomatic sites (including brain) |
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Term
| extensive SCLC chemotherapy |
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Definition
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Term
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Definition
initial response rate is 60-80%
median survival with treatment is 8-10 months
2 year survival is < 10% |
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Term
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Definition
generally relapse after initial treatment
up to 50% chance of second response
single agent
combination therapy may increase survival, also increases toxicity |
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Term
| etoposide and cisplatin major counseling points |
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Definition
ADRs:
QUICK:
hypersensitivity
hypotension - etoposide has a diluent in it that causes hypotension; has to be given slowly
SHORT TERM:
N/V (including delayed) - cisplatin
myelosuppression
mucositis
alopecia
neuropathies
nephrotoxicity
ototoxicity - cisplatin causes high frequency hearing loss |
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