bronchial Carcinoma Treatment

Question 1

giving diagnosis

Answer 1

prepare ground
bring relative
make sure they understand
prepare for obvious questions
tell GP
arrange follow up

Question 2

small cell

Answer 2

rapidly progressive disease
early metastases
rarely suitable for surgery
good initial response to chemotherapy

Question 3

non small cell

Answer 3

squamous + adeno carcinomas
curative options = surgery or radical radiotherapy
palliative chemo + new targeted treatments

Question 4

surgery questions

Answer 4

can we cut it out
is disease localised
will patient survive operation
what will residual function be

Question 5

bronchoscophy

Answer 5

vocal cord palsy
proximity to carina
cell type

Question 6

mediastinoscopy/ EBUS

Answer 6

lymph nodes

Question 7

CT scan of brain

Answer 7

metastases

Question 8

CT scan of thorax

Answer 8

tumour size
lymph nodes
metastases
local invasion

Question 9

PET scan

Answer 9

positron emission tomogrphy

metastases

Question 10

Lung cancer surgery

Answer 10

pneumonectomy or lobectomy

• thoracotomy
• minimal access VATS

curative objects

peri-operative mortality

post-operative morbidity

Question 11

chemotherapy staging

Answer 11

bronchoscopy or other tissue sampling
-small cell/non-small cell

CT scan

• tumour size
• local invasion
• nodes
• metastases

performance status = ECOG score

Question 12

cytotoxic chemotherapy

Answer 12

rarely curative
longer survival
better response small cell
major side effects
intravenous infusion every 3-4 weeks
outpatient visits
whole body treatment
targets rapidly dividing cells
blood brain barrier - prophylactic cranial irradiation

Question 13

chemotherapy side effects

Answer 13

nausea + vomiting
tiredness
bone marrow suppression 
-opportunistic infection
-anemia
hair loss
pulmonary fibrosis

Question 14

radiotherapy

Answer 14

ionising radiation

• usually X rays
• external beam

radical
-curative intent

palliative

• delaying tactic
• useful for metastases

well tolerated

Question 15

radiotherapy disadvantages

Answer 15

macimum cumulative dose

collateral damage

• spinal cord
• oesophagus
• adjacent lung tissue

only goes where beam pointed
- no good for subclinical metastases

Question 16

common radiotherapy side effect

Answer 16

oesophagitis

Question 17

SABR

Answer 17

more beams
beam = less powerful
=less collateral damage
total dose = higher + more effective

Question 18

endobronchial therapy

Answer 18

stent insertion for stridor
photodynamic therapy
other laser therapy

Question 19

lung cancer treatment determined by

Answer 19

cell type
extent of disease
co-morbidity
patient’s wishes

Question 20

examples of co-morbidities

Answer 20

smoking related diseases
COPD; FEV1 < 1 litre
ischaemic heart disease

Question 21

palliative care

Answer 21

pain
breathlessness
cough
anxiety
poor morbidity