Lung Cancer Treatment

Question 1

What is the ECOG performance status (0-5) stand for

Answer 1

0= fully active 
1= symptoms but ambulatory 
2= ‘up & about’ > 50%, unable to work 
3=’up and about’ < 50%, limited self-care 
4= bed/chair bound 
5= dead

Question 2

What is neoadjuvant therapy?

Answer 2

Treatment given as first step to shrink tumour before the main treatment (e.g. chemotherapy, radiotherapy, hormone therapy)

Question 3

What is adjuvant therapy

Answer 3

Additional treatment given after primary treatment to lower risk of cancer coming back

Question 4

What investigations will be done pre-operatively?

Answer 4

Echo
ECG
ETT
Coronary angio
Spirometry
Diffusion studies 
LN sampling

Question 5

What are some preoperative complications?

Answer 5

• ARDS (acute respiratory distress syndrome)
• Bronchopneumonia
• MI
• PTE
• Pneumothorax
• Intrathoracic bleeding

Question 6

What are some post-operative complications?

Answer 6

• Thoracotomy wound pain
• Empyema
• Bronchopleural fistula after pneumectomy
• AF, MI
• Post op respiratory insufficiency
• Constipation

Question 7

Which surgeries are carried out in lung cancers?

Answer 7

• Wedge resection:
  
  • localised portion of diseased lung is removed
• lobectomy
  
  • removal of a lobe of the lung
• pneumonotomy
  
  • entire lung removed

Question 8

Is surgery in lung cancer curative or palliative?

Answer 8

Curative

Question 9

Which criteria may make a patient non-eligible for surgery?

Answer 9

• CVS pathology, diabetes, murmurs
• Resp: barrel chest, COPD, smoking, asthma, recent URTI, on oxygen, previous thoracotomy, ICD, pulmonary Hypertension
• Psych
• Cirrhosis-> impaired liver cannot remove fat soluble debris post op
• Rheumatoid arthritis
• pleural/pericardial effusion

Question 10

Is chemotherapy curative/palliative?

Answer 10

Adjuvant (post op) palliative

Question 11

What is chemotherapy used in combination with?

Answer 11

RT for both NSCLC & SCLC

Question 12

What is the median survival of palliative chemotherapy for lung cancer?

Answer 12

> 1 year

Question 13

What are risks of chemotherapy?

Answer 13

Risk of Neutropenic sepsis-marrow suppression —-> urgent admission, IV fluids + broad spectrum Abx

Question 14

Is radiotherapy curative or palliative for lung cancer?

Answer 14

Curative + palliative

Question 15

What is radical radiotherapy treatment?

Answer 15

as much of prescribed dose as possible- minimum dose to surroundings
Not eligible if FEV1<1

Question 16

What are short and long term side effects of radiotherapy?

Answer 16

Short term: lethargy, oesophagitis, SOB due to pneumonitis

Long term: pulmonary fibrosis, oesophageal stricture, cardiac

Question 17

What is palliative radiotherapy used for?

Answer 17

Palliative: comorbidities/ advanced disease (stage 3/4)

• bone metastasis
• cord compression
• haemoptysis
• High dose palliative if too large for radical= survival advantage

Question 18

Is immunotherapy curative or palliative?

Answer 18

Palliative

Question 19

What is immunotherapy? Why use it?

Answer 19

PDL1 inhibitor- Nivolumab
Patient not as fit as for chemo
1st line if PDL1 score> 50%

Side effects -> anything -itis (give steroids)

Question 20

Are tyrosine kinase inhibitors curative or palliative?

Answer 20

Palliative for adenocarcinoma with driver mutation

Suitable if unfit for chemo