Lung Malignancy

Question 1

Why are small cell bronchial carcinomas preferentially treated with chemotherapy instead of surgery?

Answer 1

Small cell carcinomas are more rapidly dividing, so surgery doesn’t have the same benefits as chemotherapy

Question 2

What is the first choice of treatment for non small cell carcinomas?

Answer 2

Surgery (if the tumor is operable)

Then radical radiotherapy (20 days of radiation)

Question 3

What are the requirements to decide if a non-small cell lung cancer is operable?

Answer 3

1. Patient must be assessed fit enough:
   - Respiratory fitness (often smokers, often have COPD and other respiratory comorbidities)

-Cardiovascular fitness (may have IHD or arteriopathy)

2. The tumour must be respectable:
   - Where the spread is; wide or minimal
   - Location of the tumour, If it’s removal is safe
   (e. g. if it is penetrating outside of the lung it is inoperable)
   - Often requires an FDG PET scan in order to find any metastases: cannot remove one tumour, must remove them all

Question 4

What are common reasons for a non-small cell lung tumour being inoperable?

Answer 4

Distant metastases

Mediastinal spread - recurrent laryngeal nerve palsy or phrenic nerve palsy

Poor pulmonary function

Frequent angina

HF

Psychological issues

Question 5

What are the palliative treatments for non small cell lung cancer?

Answer 5

Symptomatic - painkillers, effusion drain

Radiotherapy - brachytherapy or external beam

Chemotherapy

Question 6

How do we treat the hypercalcaemia that occurs in 10% of lung cancer patients?

Answer 6

Furosemide (to endure calciuresis)

If the Hypercalcemia is severe - bisphosphonates

Question 7

What is the management of asbestosis?

Answer 7

Symptomatic treatment only, lesions are irreversible

Question 8

What is the management of mesothelioma?

Answer 8

Chemotherapy with pemetrexed and cisplatin

Intrapleural drainage

Pleurodesis (pleural space obliteration by fusion of the pleura)