Lung Cancer Treatment Flashcards
What are the 5 steps in treating lung cancer?
Giving the diagnosis Surgery Radiotherapy Chemotherapy Supportive care
What are the steps of giving a diagnosis?
Prepare the ground Bring a relative Make sure they understand Prepare for obvious questions Tell their GP Arrange follow up
What are the survival rates of lung cancer in scotland?
median= 5.8 months
1 year survival = 30%
What are the clinical options of small cell carcinoma?
At time of presentation, usually spread beyone primary site- can't operate 12% of lung cancers Rapidly progressive Early metastases Good initial response to chemotherapy
What are the clinical options of non small cell carcinoma?
Can be potentially cured with surgery or radical chemotherapy
Paliative chemotherapy
Most of lung cancers are non-small cell
What is the survival rate of non small cell?
7.7 months
39% survive a year
What is the survival of small cell?
5.9 months
24% survive a year
what is the survival of unknown lung cancers?
4.9 months
26% survive a year
What do you consider when thinking of lung cancer surgery?
Can it be cut out?
Is it localised?
Will the patient survive the operation?
What willthe residual lung function be?
After surgery, what are the survival rates?
42.7 months
81% survive a year
what tests need to be taken before surgery?
Bronchoscopy Mediastinoscopy/EBUS CT scan of brain CT scan of thorax PET scan
what would you look for in a pre-op bronchosopy?
Vocal cord palsy
proximal to carina
cell type
what would you look for in a pre-op Mediastinoscopy/EBUS?
Lymph nodes
what would you look for in a pre-op CT of brain?
Metastases
what would you look for in a pre-op thorax CT?
Tumour size
lymph nodes
metastases
local invasion
what would you look for in a pre-op PET scan?
Metastases
What are some surgeries for lung cancer?
Pneumonectomy/lobectomy
Thoracotomy
Minimal access VATS
What is a thoracotomy?
A long incision around the length of the sixth rib to gain access to lung
what is VATS?
Video assisted thoracic surgery- key hole
What do you need to know before chemotherapy?
What cell type the cancer is- Bronchoscopy
Tumour size, local iinvasion, nodes, metastases- CT
Performance status ECOG score
what performance status are considered for chemo?
0, 1 or 2
What does chemotherapy involve?
Longer survival Better response in small cell cancer Major side effects IV infusions every 3-4 weeks outpatient visits Imaging
what does chemotherapy target?
whole body
Rapidly dividing cells
What are some chemotherapy side effects?
Nausia Tiredness Bone marrow suppression Hair loss Pulmonary fibrosis
What are common genetic mutation targets?
EGFR
ALK1
what are some targets for immune therapy?
PD-L1
What is radiotherapy?
ionising beams, targeted against a localised point
What are the main uses of radiotherapy?
Curative
Paliative
What are the side effects of radiotherapy?
Collateral damage- spinal cord/ oesophagus/ adjacent lung tissue
what is a common side effect of radiotherapy for lung cancer?
Temporary oesophagitis
What is SABR?
Stereotactic ablative radiotherapy
lots of small beams- higher radiation on tumour, less on surrounding tissues
what is required for SABR?
4D scanning
What are some types of endobronchial therapy?
Stent inserion for stridor
Photodynamic therapy
Laser therapies
What determines the treatment of lung cancer?
Cell type
Extent of the disease
Co-morbidity
THE PATIENT’S WISHES
What are some big factors stopping someone being able to receive treatment?
COPD
emphysema
ischaemic heart disease
What are the main things to tackle with palliative care?
Pain Breathlessness Cough Anxiety Poor mobility
What are the main causes of lung cancer?
Tobacco smoking
Asbestos
Radon
