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Respiratory block > Non-operative Management of Lung Cancer > Flashcards

Non-operative Management of Lung Cancer Flashcards

1
Q

What is the most cancer worldwide ?

A

Lung cancer

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2
Q

What type of cancer makes up 85% of lung cancer ?

A

Non-small cell lung cancer:

- adenocarcinoma
- squamous carcinoma
- large cell carcinoma
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3
Q

What type of cancer makes up 15% of lung cancers ?

A

Small cell lung cancer

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4
Q

What is the ECOG performance status ?

A 
0- asymptomatic, well 
1- symptomatic, able to do light work
2- has to rest for <50% of the day
3- has to rest >50% of the day
4- bedbound
5- dead
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5
Q

What is the doubling time for NSCLC ?

A

129 days

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6
Q

How is NSCLC staged ?

A

Using TNM

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7
Q

What does stage IV mean ?

A

Distant metastasis

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8
Q

What % of NSCLC is operable ?

A

Maximum of 25%

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9
Q

What are all the therapeutic options for cancer ?

A 
Surgery
Adjuvant therapy
Neo-adjuvant therapy 
Radiotherapy 
Chemotherapy 
Combination 
Targeted therapies
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10
Q

What determines the therapeutic options ?

A 
Tumour type
Stage
ECOG performance status
Patient wishes and options
Aims of therapy (curative or palliative)
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11
Q

What is the average 5 year survival for non-small cell lung cancer ?

A

Overall 40%

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12
Q

When is surgery only offered ?

A

Only offered as a curative treatment

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13
Q

What is necessary for surgery ?

A

Good lung function necessary:
- FEV1 >1 for lobectomy
- FEV1 >2 for pneumectomy
Lymph node sampling essential

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14
Q

What is adjuvant therapy ?

A

When the cancer has appeared to all have been removed – but it is post operative treatment to ensure all cancer has been removed
Reduces risk of recurrence

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15
Q

What is neoadjuvant therapy ?

A

Neoadjuvant chemotherapy is delivered before surgery with the goal of shrinking a tumour or stopping the spread of cancer to make surgery less invasive and more effective.

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16
Q

What is radical radiotherapy ?

A

potentially curative treatment in NSCLC

Delivered in conventional 2-Gy fractions, hypo-fractionated and ablative stereotactic courses

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17
Q

What is the side effects of Radical radiotherapy ?

A

Acute- lethargy, oesophagitis, SOB due to pneumonitis

Long term- pulmonary fibrosis, oesphageal stricture, cardiac

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18
Q

What is the 5 year survival rate after radical radiotherapy ?

A

20%

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19
Q

What treatment is a systemic treatment ?

A

Chemotherapy

20
Q

What is concurrent chemoradiotherapy ?

A

Highly efficacious locoregional treatment option for solid tumours
Better than with RT alone
no standard regime

21
Q

What does the addition of chemo increase ?

A

Toxicity

22
Q

What is the 2 year survival rate of concurrent chemoradiotherapy ?

A

27%

23
Q

What percent of Non small cell lung cancer patients have advanced disease ?

A

80%

24
Q

What is stage III ?

A

Very locally advanced disease

25
Q

What are the palliation options ?

A 
Chemo
Immunotherapy 
TKI
Palliative Radiotherapy 
Combination of all
26
Q

What is palliative chemotherapy ?

A

Given as a doublet regime

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

27
Q

What is palliative immunotherapy ?

A

PDL1- prevents immune system attacking cells in the body
Cancers are good at masking themselves from immune system via PDL1 expression
Can be used 1st line if PDL1 score >50%

28
Q

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

A

Painful bone metastases - radiotherapy

Brain metastases - resection

29
Q

What is pemetrexed used for ?

A

Maintenance chemotherapy

30
Q

What is palliative TKIs ?

A

Targeted drugs for adenocarcinoma with driver mutations
Available for patients unfit for chemo (PS 0-3)
2nd line treatment options at progression
Understanding mechanisms of resistance- REBIOPSY

31
Q

What are examples of Driver mutations for NSCLC ?

A

EGFR mutation
ALK translocation
BRAF mutation
ROS alteration

32
Q

What is the concept for Tyrosine Kinase Inhibitors ?

A

Blocks Tyrosine Kinase which is a membrane receptor protein - This stops the formation of a protein causing the tumour to grow

33
Q

What drugs are Tyrosine Kinase Inhibitors ?

A

Erlotinib
Gefitinib
Afatinib

34
Q

What is palliative radiotherapy used for ?

A

Management of symptoms:

  - bone metastasis
  - cord compression
  - haemoptysis
35
Q

What is SABR ?

A

Stereotactic ablative RT
Can have similar outcomes to surgery
Tumours up to 4cm
>2cm away from airways and proximal bronchial tree

36
Q

What % of patients have SCLC ?

A

15%

37
Q

What is the doubling time for SCLC ?

A

29 days

38
Q

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

A

Limited Disease - Staged to one hemithorax

Extensive disease - more advanced disease

39
Q

How do you treat SCLC of limited disease ?

A

Chemotherapy
Combination of drugs including cisplatin and etoposide
Early thoracic radiotherapy is better
Prophylactic cranial radiation

40
Q

In SCLC is there any benefit from any of the following?

High Dose chemo?

Alternating Chemo?

Maintenance Chemo?

Chemo ‘on demand’?

Maintenance interferon?

A

NO

41
Q

What is median survival of limited disease SCLC with and without treatment ?

A

With - 8 months

Without - 16 months

42
Q

What is the rate of two year survival with SCLC in limited disease ?

A

25%

43
Q

What are the side effects to chemotherapy ?

A

Marrow suppression ( + risk of threatening infection)
Nausea, vomiting GI upset, mucositis, fatigue, lethargy
Neuropathy, increased risk of MI/ stroke, renal impairement
Hair loss, nail chnages

44
Q

What are the side effects of radiotherapy ?

A

Lethargy, risk to surrounding organs
Acute: pneumonitis, dysphagia
Late: fibrosis, stricture, increased risk MI

45
Q

What are the side effects of immunotherapy ?

A

Colitis, pneumonitis, dermatitis, endocrinopathies

Respiratory block (38 decks)

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