4- treatment of lung cancer

Question 1

what are some important aspects of giving cancer diagnosis?

Answer 1

1. prepare the ground
2. bring a relative
3. make sure they understand
4. prepare for obvious questions
   →what can you do about it?
   →how long have i got?
5. tell their GP
6. range follow up

Question 2

what is prognosis for lung cancer like?

Answer 2

not good - biggest cancer killer by far

specific prognosis depends on lots of things like where you live, stage etc

Question 3

what are some differences between small cell and non-small cell carcinomas?

Answer 3

small cell (12% of lung cancers) = more rapidly progressive, usually found when already spread so rarely suitable for surgery but it is susceptible to chemotherapy (unfortunately doesn’t usually go away)
non-small cell = squamous + adenocarcinoma. curative options are surgical or radical radiotherapy but often treatment is palliative chemotherapy and new targeted treatment (only 10% is curative treatment)

Question 4

what are treatment options for lung cancer?

Answer 4

• surgery →depends if spread, also have to think if they can cope afterwards. operating is good if they can do it. quicker is better as more spread = less survival
• radiotherapy (x-ray treatment)
• chemotherapy (drug therapy)
• palliative care

Question 5

what is type of surgery for lung cancer treatment? and what are some new developments?

Answer 5

= usually take away whole lobe the tumour is on, not just tumour itself. gold standard when works

• usually do minimally invasive surgery with VAT, video assisted thoracoscopic surgery (keyhole surgery) = quicker recovery
  →have to talk through perioperative mortality and post-operative mortality

= new developments have been only 1 incision and robots doing surgery (surgeons control robots with hands and feet)

Question 6

what are some important things to do for assessing if surgery an option?

Answer 6

have to check their fitness for surgery, if they’ll be able to cope with recovery etc

• also have to check if metastases anywhere else like CT scan if brain + thorax or PET scan. also bronchoscopy to check distance to carina

Question 7

what is chemotherapy?

Answer 7

= drug treatment, also called systemic anti-cancer therapy (SACT)

• whole body treatment (sometimes doesn’t work as well on brain)

Question 8

what do you do to check what chemotherapy drug to use?

Answer 8

need to take sample of the tumour

Question 9

what is important to assess before starting chemo?

Answer 9

• CT scan →tumour size, local invasion, nodes, metastases
• check their performance status = how fit they are, from 0-5 (0 completely normal and 4 is bedbound, 5 is dead) so you want 1-2

= rarely curative but does prolong life. person needs to be able to cope with side effects and relentless treatment (blood tests, CT scans etc)

Question 10

what are some examples of new drug treatments for lung cancer?

Answer 10

• tissue sample, take gene sample from the tumour and identify what genetic mutations there are. there are certain genetic mutations that we have specific drugs for (don’t completely eradicate but do massively shrink so they’re liveable with) = game changing
• immune therapy = marker on tumour cell surface, if tumour expressing this marker then can use immune system against marker

Question 11

what is radiotherapy?

Answer 11

• focused radiation to destroy tissue
• it’s external beam for lung cancer (sometimes can be internal)
• radical treatment = intending to cure
• can go up and down to hospital every day but home every night
• well tolerated but less good evidence, more likely to have recurrent disease

Question 12

when does radiotherapy cause problems?

Answer 12

can destroy too much (spinal cord, adjacent lung tissue etc). you need to know exactly where it is as only treats at specific location

Question 13

what is SABR?

Answer 13

stereoactive ablative radiotherapy = uses more beams each beam less powerful (so less collateral damage), they get 4D scan as breathing moves tumour so need to be scanned in how they breathe and make sure breathe in specific pattern

Question 14

what is endobronchial therapy?

Answer 14

= not common, give drug that activated by light - you give drug then you expose light over tumour and then over next day or 2 tumour will die but doesn’t work for big deep tumours. mostly just for palliative (only cures carcinoma in situ which is very rarely found as so early)

→guide light down with stent insertion to open airways (not curative)

Question 15

what 3 questions can you use to determine treatment?

Answer 15

1. what is it? cell type
2. where is it? extent of disease
3. how are you? their fitness

= patients wishes important but make sure they are completely informed

assess co-morbidity: COPD (FEV1<1 litre), ischaemic heart disease

Question 16

what is palliative care for lung cancer?

Answer 16

massive umbrella term. can be morphine, can be radiotherapy, can be anti-depressants →it’s what is infecting your quality of life right now?

• palliative radiotherapy = just a couple of times to improve pain