Non-Surgical Management of Cancer

Question 1

What are the two main subtypes for types of lung cancer?

Answer 1

Small cell lung cancer
Non-small cell lung cancer

Question 2

Which type of lung cancer is more prevalent?

Answer 2

Non-small cell lung cancer

Question 3

What are the main two types of non-small cell lung cancer?

Answer 3

Adenocarcinoma
Squamous

Question 4

When discussing a new lung cancer diagnosis, what must be considered?

Answer 4

Staging
Tumour type
Patient history and wishes
Patient fitness (including ECOG performance status and pulmonary function tests)

Question 5

What is the staging of lung cancer based on?

Answer 5

CT/PET

Question 6

What is the tumour type confirmation based on?

Answer 6

Biopsy

Question 7

List some of the therapeutic options for those with lung cancer?

Answer 7

Radiotherapy
Surgery
Chemotherapy
Immunotherapy
Targeted therapies

Question 8

What are the two subdivisions when it comes to deciding which treatment is best for the patient?

Answer 8

Curative or palliative

Question 9

What does a MDT meeting discuss?

Answer 9

Each new cancer diagnosis
Therapeutic options

Question 10

What test is used to measure patient performance status?

Answer 10

ECOG

Question 11

What does a 0 in the ECOG scale suggest?

Answer 11

Asymptomatic; well

Question 12

What does a 1 in the ECOG scale suggest?

Answer 12

Symptomatic; able to do light work

Question 13

What does a 2 in the ECOG scale suggest?

Answer 13

Has to rest but for <50% of the day

Question 14

What does a 3 in the ECOG scale suggest?

Answer 14

Has to rest for >50% of the day

Question 15

What does a 4 in the ECOG scale suggest?

Answer 15

Bedbound

Question 16

What does a 5 in the ECOG scale suggest?

Answer 16

Dead

Question 17

What is meant by doubling time?

Answer 17

The time taken for a cell to divide/double.

Question 18

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

Answer 18

129 days

Question 19

What is used to stage non-small cell lung cancer?

Answer 19

TNM

Question 20

What can be used after surgery to reduce chances of reoccurence?

Answer 20

Chemotherapy

Question 21

Is adjuvant therapy pre or post operation?

Answer 21

Post

Question 22

Is neoadjuvant therapy pre or post operation?

Answer 22

Pre

Question 23

How long does the planning process for radical radiotherapy take?

Answer 23

Around two weeks

Question 24

What are some of the acute side effects of radical radiotherapy?

Answer 24

Lethargy, oesophagitis, SOB due to pneumonitis

Question 25

What are some of the long term side effects of radical radiotherapy?

Answer 25

Pulmonary fibrosis, oesophageal stricture, cardiac problems

Question 26

What is the % of survival five years after radical radiotherapy?

Answer 26

Approx. 20%

Question 27

Discuss the benefits vs disadvantages of combining radiotherapy and chemotherapy.

Answer 27

Benefits- increased chances of survival Disadvantages- addition of chemo means toxicity increases

Question 28

Name the therapy used for patients are that are not fit for surgery but still has similar outcomes to surgery.

Answer 28

SABR

Question 29

What are some of the options for palliative treatment?

Answer 29

Chemo Immunotherapy TKI Palliative radiotherapy Palliative immunotherapy

Question 30

What is PDL1?

Answer 30

Programmed death ligand

Question 31

What does PDL1 do?

Answer 31

Protein that prevents immune system attacking cells in the body

Question 32

When can palliative immunotherapy be used as a first line treatment?

Answer 32

If PDL1 score >50%

Question 33

What are palliative TKIs?

Answer 33

Targeted drugs for adenocarcinoma with driver mutation

Question 34

What are some of the side effects of chemotherapy?

Answer 34

Nausea GI upset Marrow suppression and risk of life threatening infection VTE disease Neuropathies Hair loss Nail changes

Question 35

Name some of the symptoms that palliative radiology can help with.

Answer 35

Bone metastasis Cord compression Haemoptysis

Question 36

Name an advantage of palliative radiotherapy.

Answer 36

Can be given if disease too large to encompass radically Has a survival advantage

Question 37

What % of patients have small cell lung cancer?

Answer 37

15%

Question 38

What is the doubling time for small cell lung cancer?

Answer 38

29 days

Question 39

Describe the decline of patients with small cell lung cancer

Answer 39

Become ill more quickly due to quicker doubling time.

Question 40

What are the drugs in the combinations of drugs used to treat small cell lung cancer?

Answer 40

Cisplatin+ etoposide

Question 41

What is the treatment for small cell lung cancer if it is curative?

Answer 41

Chemo Drug combo

Question 42

What is the response rate like for those with localised disease?

Answer 42

High (approx. 60% make full remission).

Question 43

In extensive disease, what treatment is usually given?

Answer 43

Combination chemo

Question 44

In those with localised disease, how long an they live with no treatment?

Answer 44

8 months

Question 45

In those with extensive disease, how long can they be expected to live for without treatment?

Answer 45

8 weeks

Question 46

In those with localised disease, how long can they be expected to live for with treatment?

Answer 46

16 months

Question 47

In those with extensive disease, how long can they be expected to live for with treatment?

Answer 47

8 months

Question 48

What are some of the side effects of immunchemotherapy?

Answer 48

Colitis Pneumonitis Dermatitis Endocrinopathies

Question 49

Who would attend a MDT meeting?

Answer 49

Respiratory consultants Pathologist Radiologist Clinical and medical oncologist Cancer nurse specialist Cardiothoracic surgeons

Question 50

List some of the symptoms associated with advanced lung cancer.

Answer 50

Pain- Depression Constipation Breathlessness Nausea & vomiting Anorexia

Question 51

What are the anticipatory medications that are commonly prescribed to relieve palliative patients of distress?

Answer 51

Morphine- pain & breathlessness Midazolam- agitation Levomepromazine- nausea Hyoscine butylbromide- secretions