Non-Surgical Management of Cancer Flashcards
What are the two main subtypes for types of lung cancer?
Small cell lung cancer
Non-small cell lung cancer
Which type of lung cancer is more prevalent?
Non-small cell lung cancer
What are the main two types of non-small cell lung cancer?
Adenocarcinoma
Squamous
When discussing a new lung cancer diagnosis, what must be considered?
Staging
Tumour type
Patient history and wishes
Patient fitness (including ECOG performance status and pulmonary function tests)
What is the staging of lung cancer based on?
CT/PET
What is the tumour type confirmation based on?
Biopsy
List some of the therapeutic options for those with lung cancer?
Radiotherapy
Surgery
Chemotherapy
Immunotherapy
Targeted therapies
What are the two subdivisions when it comes to deciding which treatment is best for the patient?
Curative or palliative
What does a MDT meeting discuss?
Each new cancer diagnosis
Therapeutic options
What test is used to measure patient performance status?
ECOG
What does a 0 in the ECOG scale suggest?
Asymptomatic; well
What does a 1 in the ECOG scale suggest?
Symptomatic; able to do light work
What does a 2 in the ECOG scale suggest?
Has to rest but for <50% of the day
What does a 3 in the ECOG scale suggest?
Has to rest for >50% of the day
What does a 4 in the ECOG scale suggest?
Bedbound
What does a 5 in the ECOG scale suggest?
Dead
What is meant by doubling time?
The time taken for a cell to divide/double.
What is the doubling time for non-small cell lung cancers?
129 days
What is used to stage non-small cell lung cancer?
TNM
What can be used after surgery to reduce chances of reoccurence?
Chemotherapy
Is adjuvant therapy pre or post operation?
Post
Is neoadjuvant therapy pre or post operation?
Pre
How long does the planning process for radical radiotherapy take?
Around two weeks
What are some of the acute side effects of radical radiotherapy?
Lethargy, oesophagitis, SOB due to pneumonitis
What are some of the long term side effects of radical radiotherapy?
Pulmonary fibrosis, oesophageal stricture, cardiac problems
What is the % of survival five years after radical radiotherapy?
Approx. 20%
Discuss the benefits vs disadvantages of combining radiotherapy and chemotherapy.
Benefits- increased chances of survival
Disadvantages- addition of chemo means toxicity increases
Name the therapy used for patients are that are not fit for surgery but still has similar outcomes to surgery.
SABR
What are some of the options for palliative treatment?
Chemo
Immunotherapy
TKI
Palliative radiotherapy
Palliative immunotherapy
What is PDL1?
Programmed death ligand
What does PDL1 do?
Protein that prevents immune system attacking cells in the body
When can palliative immunotherapy be used as a first line treatment?
If PDL1 score >50%
What are palliative TKIs?
Targeted drugs for adenocarcinoma with driver mutation
What are some of the side effects of chemotherapy?
Nausea
GI upset
Marrow suppression and risk of life threatening infection
VTE disease
Neuropathies
Hair loss
Nail changes
Name some of the symptoms that palliative radiology can help with.
Bone metastasis
Cord compression
Haemoptysis
Name an advantage of palliative radiotherapy.
Can be given if disease too large to encompass radically
Has a survival advantage
What % of patients have small cell lung cancer?
15%
What is the doubling time for small cell lung cancer?
29 days
Describe the decline of patients with small cell lung cancer
Become ill more quickly due to quicker doubling time.
What are the drugs in the combinations of drugs used to treat small cell lung cancer?
Cisplatin+ etoposide
What is the treatment for small cell lung cancer if it is curative?
Chemo
Drug combo
What is the response rate like for those with localised disease?
High (approx. 60% make full remission).
In extensive disease, what treatment is usually given?
Combination chemo
In those with localised disease, how long an they live with no treatment?
8 months
In those with extensive disease, how long can they be expected to live for without treatment?
8 weeks
In those with localised disease, how long can they be expected to live for with treatment?
16 months
In those with extensive disease, how long can they be expected to live for with treatment?
8 months
What are some of the side effects of immunchemotherapy?
Colitis
Pneumonitis
Dermatitis
Endocrinopathies
Who would attend a MDT meeting?
Respiratory consultants
Pathologist
Radiologist
Clinical and medical oncologist
Cancer nurse specialist
Cardiothoracic surgeons
List some of the symptoms associated with advanced lung cancer.
Pain-
Depression
Constipation
Breathlessness
Nausea & vomiting
Anorexia
What are the anticipatory medications that are commonly prescribed to relieve palliative patients of distress?
Morphine- pain & breathlessness
Midazolam- agitation
Levomepromazine- nausea
Hyoscine butylbromide- secretions