Onc.2 Lung Ca

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#1 cause of cancer death in the world (and canada?

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lung

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mortality?

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80%

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relationship of smoking and lung cancer?

other causes? 4

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90% of cases due to smoking

other 10%

1. radon gas

2. workplace exposure (asbestos, argon, arsenic)

3. second hand smoke

4. RT

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Lung cancer screening?

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NOT currently done in canada

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Def'n of a SPN + features that suggest benign or malignant cause

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workup and management of SPN

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1. CT

2. needle biopsy/PET in selected cases

3. surgical removal unless clearly benign

note: if cancer, proceed to lobectomy

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Paraneoplastic syndromes in NSCLC? 3

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1. clubbing and hypertrophic pulmonary osteoarthropathy (adeno > SCLC)

2. hpyercalcemia from PTH-rp (squamous cell)

3. gynecomastia (HCG (large cell))

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paraneoplastic syndromes in SCLC 3

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1. cushings from ectopic ACTH

2. Neuro: Eaton lambert, neuropathy, cerebellar degeneration

3. hyponatremia from SIADH (euvolemic hyponatremia)

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Suspected lung cancer.. need to get some tissue

central vs peripheral sampling

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major distinction to make: in Lung Ca

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SCLC vs. NSCLC

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SCLC:

1. extent of spread at diagnosis

2. paraneoplastic syndromes..

3. tx modalities?

4. resistance issues

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SCLC: how is limited disease defined?

extensive disease?

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limited: tumor in one lung, mediastinum and LNs that can be radiated to an adequate dose to control the cancer with an ACCEPTABLE risk of toxicity

extensive disease: has spread beyond one lung, the mediastinum, and local LNs

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Tx of SCLC:

limited disease? 3

Extensive disease? 2

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survival: benefits of treatment

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Histologic types of lung Ca

1. SC

2. NSC

3. other

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Small cell (10-15%)

Non-small cell (85-90%):

Squamous cell

Adenocarcinoma

Large cell

Bronchoalveolar ..... etc.

Other - metastases, carcinoid, lymphoma etc..

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How to stage the lung Ca patient ? which indications are indicated

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TNM staging for NSCLC

I through IV

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treatments corresponding to stages of NSCLC

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concept: resectable vs. Operable

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outcomes for early stage therapy

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role of adjuvant therapy in resected disease?

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no benefit from adjuvant radiation

adjuvant chemo: 5-15% survival benefit 5 y overall survival

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tx for locally advanced NSCLC (no mets, but extensive tumor invasion or mediastinal adenopathy)

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Combination chemoradiotherapy

5yOS is about 10-15% , median survival 17 mo.

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complications of pancoast tumors? 2

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1. frequent vertebral invasion

2. neurovascular invasion (shoulder/arm pain, horner's, arm weakness and mm atrophy

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tx pancoast tumors

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tx of early stage disease

outcomes/cure rates

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RT for early stage disease

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radical radiothterapy in 30-33 daily treatments (fractions)

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Tx of locally advanced NSCLC (stage III)

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RT and concurrent chemotherapy.

RT over 6-7 weeks 30-33 daily treatments

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limiting factors for dose of deliverable radiation in Stage III NSCLC

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Solitary brain met

when is tx surgical?

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when is NSCLC incurable

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>99% of stage IV

and most stage III

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Indications for palliative RT in NSCLC

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localized, symptomatic lesions

Lung, brain, bone

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Palliative Chemotx in NSCLC

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d

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Note: EGFR receptor inhibs in specific types of NSCLC

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note: dramatic response to EGFR TKI therapy

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