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Respiratory System & CVS Physiology Year 1 > Non operative management of cancer > Flashcards

Non operative management of cancer Flashcards

1
Q

What tests are used for tissue diagnosis?

A

Biopsy

  • Bronchoscopy
  • CT guided
  • US guided
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2
Q

What percentage of diagnosises are non small cell lung cancer?

A

85%

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3
Q

What percentage of diagnoses are small cell lung cancer?

A

15%

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4
Q

What is discussed in the MDT meeting for each new cancer diagnosis?

A

Staging, Tumour type, patient history and wishes, patient fitness

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5
Q

What therapeutic options are discussed in an MDT meeting?

A
  • Curative or palliative
  • Radiotherapy
  • Surgery
  • Chemotherapy
  • Immunotherapy
  • Combination of the above?
  • Targeted therapies
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6
Q

How is the ECOG performance staus scaled?

A 
0 = asymptomatic; well
1 = symptomatic; able to do light work 
2 = has to rest but for < 50% of the day
3 = has to rest for >50% of the day
4 = bedbound

5 = dead

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7
Q

What is the doubling time for non-small cell lung cancer?

A

129 days

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8
Q

What is the staging technique for NSCLC?

A

TNM

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9
Q

What FEV1 is required for lobectomy?

A

> 1

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10
Q

What FEV1 is necessary for pneumonectomy?

A

FEV1 > 2

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11
Q

What is the role of chemotherapy post operatively?

A

To increase the chance of cure/reduce risk of recurrence

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12
Q

What does adjuvant mean?

A

It means after a definitive process.

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13
Q

What does neoadjuvant therapy mean?

A

Before a definitive procedure

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14
Q

What is radical radiotherapy used for?

A

Non small cell lung cancer

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15
Q

How long does the planning process in radical radiotherapy last for?

A

Two weeks

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16
Q

What are the side effects of radical radiotherapy?

A

Acute: lethargy, oesophagitis, SOB due to pneumonitis

Long term: pulmonary fibrosis, oesophageal stricture, cardiac

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17
Q

What does the addition of chemotherapy to radiotherapy?

A

It increases the toxicity.

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18
Q

What are the symptoms of concurrent chemoradiotherapy?

A

Nausea, GI upset, marrow suppression and risk of life-threatening infection, Venous thrombotic embolism disease, neuropathies.

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19
Q

Which types of people are eligible for immunotherapy?

A

People with the stage of non-small cell lung cancer and who have had chemoradiotherapy.

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20
Q

What size of tumors are SABR (Stereotactic Ablative Radiotherapy) used to treat?

A

Up to 4cm and they must be >2cm away from airways and proximal bronchial tree.

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21
Q

What stages of the disease aren’t curable by palliative treatment?

A

Stage IV - distant metastases

Stage III - very locally advanced disease

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22
Q

What are the options for palliative treatment?

A

Chemotherapy, Immunotherapy, TKI, Palliative radiotherapy, a combination of the above.

23
Q

How is palliative chemotherapy given?

A

It is given as a doublet regime.

24
Q

Why can’t you give more than three or four cycles of chemotherapy?

A

Because of the side effects

25
Q

How is ongoing response measured?

A

Regular CT scans

26
Q

what are cancer cells good at?

A

They are good at masking themselves from the immune system.

27
Q

How does immunotherapy work?

A

It works by upregulating immune system and unmasking cancers.

28
Q

What are TKIs?

A

Tyrosine Kinase Inhibitors

29
Q

Who are TKIs used for?

A

Patients who have a targetable mutation and people who are unfit for chemotherapy.

30
Q

What symptoms are palliative radiotherapy used to manage?

A

Bone metastasis, Cord compression, Haemoptysis

31
Q

When is a higher dose of palliative treatment used?

A

If disease too large to encompass radically has a survival advantage.

32
Q

What is the doubling time for small cell lung cancer?

A

29 days

33
Q

What symptoms are more common in small cell lung cancer?

A

Secretory syndromes

34
Q

How is small cell lung cancer treated?

A

It is treated with chemotherapy and a combination of drugs

35
Q

What does SCLC not get any advantage from?

A

High dose chemo, Alternating chemo, Maintenance chemo, Chemo ‘on demand’, maintenance interferon, MMPI, targeted therapies.

36
Q

What is the median survival of SCLC with no treatment?

A

8 months

37
Q

What is the median survival of SCLC with treatment?

A

16 months

38
Q

What are the outcomes in limited disease?

A
  • Response rate 90%, Complete remission 60%, 2-year survival 25%.
39
Q

What are the outcomes in extensive disease?

A

Response rate 80%, Complete response 30%, Median survival with no treatment is 8 weeks, Median survival with treatment is 8 months.

40
Q

What are the main symptoms of chemotherapy?

A

Marrow suppression, Nausea, Vomiting, GI upset, Mucositis, Fatigue, Lethargy, Neuropathy, Increased risk of MI/stroke, Renal Impairment, Hair loss, Nail changes.

41
Q

What are the side effects of radiotherapy?

A

Lethargy, Risk to surrounding organs, Pneumonitis, Dysphagia, Fibrosis, Stricture, Increased risk MI, 2nd malignancies

42
Q

What are the side effects of immunotherapy?

A

Colitis, pneumonitis, dermatitis, endocrinopathies

43
Q

Where do you normally find squamous and adenocarcinoma cancers?

A

Squamous - usually more central (usually male, usually smokers)

Adenocarcinoma - more peripheral, usualy in woman

44
Q

Is adjuvant therapy helpful in stage 1 and 2 non-small cell lung cancer?

A

Detrimental - but some possible benefits if mediastinal nodes (N2 or involved margins)

45
Q

What is treatment for stage 4 NSCLC?

A

Incurable

Palliation essential

RT to primary tumour to releive symptoms (~70% symptom benefit)

(—Chemo gives equal symptomatic benefit AND survival advantage)

—Median survival now >12 months with chemo alone

46
Q

What is the average number of cycles of chemo for stage 3 NSCLC?

A

3 as good as 6 cycles of chemo (4 is average in UK)

47
Q

NSCLC: What should be considered in the case of Painful bone metastases and Brain mets?

A

Painful bone mets - radiotherapy

Brain mets – resection

48
Q

NSCLC: What are the features of Bone pain from mets?

A

Occurs in any site

Often worse at night

Potential for pathological fracture

Need for palliative radiotherapy

49
Q

NSCLC: What is pemetrexed used for?

A

Maintainance chemotherapy

50
Q

What is the function of Nivolumab?

A

Blocks the binding of PD-1 to PD-L1 and PD-L2

This potentiates the activity of lymphocytes by preventing them from being activated

51
Q

What is different between the presentation of small cell lung cancer and NSCLC?

A

Presentation identical but secretory syndromes are present.

e.g SIADH (The syndrome of inappropriate antidiuretic hormone (ADH) secretion)

Low sodium - confusion

ACTH (Adrenocorticotropic hormone - Its principal effects are increased production and release of cortisol by the cortex of the adrenal gland) - causing Cushings - hypersecretion of ACTH by the pituitary gland

52
Q

What are the two classifications of Small cell lung cancer severity?

A

Limited Disease - Staged to one hemithorax

Extensive disease - more advanced disease

53
Q

How do you treat SCLC of limited disease?

A

Chemotherapy

Combination of drugs including cisplastin and etoposide

Early thoracic radiotherapy is better

Prophylactic cranial radiation

Only resect about 1 lung cancer per year for those with small cell lung cancer – SURGERY IS NOT THE TREATMENT, chemotherapy dominated treatmen

54
Q

What is the treatment for SCLC in extensive disease?

A

4 cycles of combination chemotherapy

Percutaneous coronary intervention (PCI) recommended - non-surgical procedure used to treat narrowing (stenosis) of the coronary arteries of the heart found in coronary artery disease

Single fraction RT to palliate if not fit for chemo

If brain Mets - RT and steroids

Respiratory System & CVS Physiology Year 1 (58 decks)

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