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Respiration > Non-surgical management of lung cancer > Flashcards

Non-surgical management of lung cancer Flashcards

1
Q

What are the types and prevalence of non-small cell lung cancer?

A

85%
Adenocarcinoma 55%
Squamous 30%
Large cell undifferentiated 5%
Not otherwise specified (NOS) 10%

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2
Q

What is the 4 type of lung cancer and its prevalence?

A

Small cell lung cancer 15%

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3
Q

What are the types of pleural mesothelioma?

A

Epithelioma
Sarcomatous
Biphasic

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4
Q

What can a PET scan show/help with?

A

Done to patients with potential for curative treatment.
Picks up lymph node metastasis out with thoracic area.
PET scans often upstage patients.

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5
Q

What sort of things are discussed in and MDT meeting?

A

Discuss each new cancer diagnosis
Discuss therapeutic options

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6
Q

Explain further the discussion about each new patient in an MDT meeting?

A

Resp team = patient wishes, fitness, lung function
Radiologists = discuss imaging
Pathologists = type of tumour, biopsy breakdown

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7
Q

What are therapeutic questions to ask in an MDT meeting?

A

Curative or palliative?
Radiotherapy?
Surgery?
Chemotherapy?
Immunotherapy?
Combination therapy?
Targeted therapy?
Supportive care in community?

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8
Q

What is the performance status measurement?

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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9
Q

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

A

129 days

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10
Q

How is staging done for non-small cell lung cancer?

A

TNM
T = tumour size
N = nodal involvement
M = distant metastasis

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11
Q

When do you offer surgery?

A

Only for curative treatment

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12
Q

What is the survival from surgery dependent on?

A

The stage of the cancer and its location

5-year survival is around 40%

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13
Q

What is necessary to undergo surgery?

A

Good lung function
- FEV1 > 1 for lobectomy
- FEV1 > 2 for pneumonectomy
Lymph node sampling

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14
Q

What are some adjuvant (post op) therapy options and what are their aims?

A

Chemotherapy - increase chance of cure/reduce risk of recurrence
Radiotherapy - Some benefit possible if mediastinal nodes or margins are involved

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15
Q

Explain neoadjuvant therapies (pre-op)?

A

Not used in clinical practice for lung cancer!

Small benefit for stage 3 cancers

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16
Q

What is radical radiotherapy?

A

High does therapy given with the intent to cure

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16
Q

What is radical radiotherapy?

A

High does therapy given with the intent to cure

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17
Q

How is radical radiotherapy given?

A

Highest prescribed dose to the disease as possible and minimum dose to surrounding structures.

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18
Q

What are some acute side effects of radical radiotherapy?

A

Lethargy
Oesophagitis
SOB due to pneumonitis

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19
Q

What are some long term side effects of radical radiotherapy?

A

Pulmonary fibrosis
Oesophageal stricture
Cardiac

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20
Q

What is the survival rate after radical radiotherapy?

A

5-year survival rate = 20%

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21
Q

Why is pulmonary lung function tests essential?

A

Poor lung function (FEV1 < 1 or <50% predicted) precludes radical RT

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22
Q

What is concurrent chemotherapy?

A

Systemic treatment into the blood stream

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23
Q

What are some side effects of chemotherapy?

A

Nausea
Diarrhoea
GI upset
Marrow suppression
Risk of life threatening infection
VTE disease - blood clots, heart attacks, strokes
Neuropathies - numbness in fingers

24
Q

What is the common chemo regiem?

A

Using a combo of 2 drugs
Each cycle is about 21 days

25
Q

When does chemo and radiotherapy commence?

A

Start chemotherapy instantly
Start radiotherapy with cycle 2 or chemo

26
Q

What is the 2-year survival of concurrent chemotherapy?

A

27%

27
Q

What is an example of adjuvant immunotherapy?

A

PACIFIC trial
- only available for stage 3 patients who’ve had chemoradiotherapy.
- Didn’t affect quality of life and improved length of survival.

28
Q

What is SABR?

A

Stereotactic ablative radiotherapy
- Very high dose per fraction
- Has similar outcomes to surgery
- For tumour up to 4cm
- Has to be >2cm from airways and proximal bronchial tree

29
Q

What are the types of biopsy?

A

Bronchoscopy
EBUS
CT guided
US guided

30
Q

How can treatment decisions be influenced?

A

Patient wishes
Co-morbidities (angina, COPD etc.)
- poor patient fitness precludes curative treatment

31
Q

What does a course of chemotherapy look like?

A

Two drugs given as IV infusion every 3 weeks
Most centres give 4 cycles
Regular CT scans to ensure ongoing response

32
Q

What is important to keep in mind throughout chemo/treatement?

A

Quality of life!

33
Q

How does immunotherapy work?

A

If PDL1 score > 50% them give option of first line immunotherapy.
It works by upregulating immune system and “unmasking” cancers

*PDL1 = protein that prevents immune system attacking cells in the body

34
Q

What is tagerted therpy?

A

Tyrosine kinase inhibitor
- Drugs targeted for adenocarcinoma with driver mutation
Suitable for patients unfit for chemo (PS 0-3)

35
Q

What drugs do you use for a EGFR mutation?

A

Erlotinib
Gefitinib
Afatinib

36
Q

What drugs do you use for a ALK translocation?

A

Crizotinib
Ceritinib

37
Q

What drugs do you use for a BRAF mutation?

A

Vemurafenib
Dabrafenib

38
Q

What drug do you use for a ROS alteration?

A

Crizotinib

39
Q

What can palliative radiotherapy be used for?

A

To manage symptoms of:
- Bone metastasis
- Cord compression
- Haemoptysis

40
Q

When do you use higher dose palliative radiotherapy?

A

If disease is too large to encompass radically
Has a survival advantage

41
Q

What is the doubling time of small cell lung cancer?

A

29 days

42
Q

What is small cell lung cancer more associated with?

A

Secretory syndromes:
- SIADH
- Cushing’s

43
Q

When small cell disease is limited what are the curative treatments?

A

Chemoradiotherapy
Eradiate brain prophylactic (PCL)

44
Q

With small call lung cancer what treatments give no advantage?

A

High dose chemo
Alternating chemo
Maintenance chemo
Chemo “on demand”
Maintenance interferon, MMPI, targeted therapies

45
Q

What are the outcomes in treatment of localised small cell lung cancer?

A

Cell divide quickly so respond to treatment quickly (response rate = 90%)
Complete remission = 60%

46
Q

What are the survival rates of small cell lung cancer?

A

Median survival with no treatment = 8 months
Median survival with treatment = 16 months
2-year survival rate = 25%

47
Q

What treatments are done in extensive small cell lung cancer?

A

4 cycles of combo chemo
Consolidation thoracic radiotherapy
PCI recommended
Palliative RT if not fit for chemo

48
Q

What are the survival rates for extensive small cell lung cancer?

A

Median survival with no treatment 8 weeks
Median survival with treatment is 8 months

49
Q

What are the side effects of chemotherapy?

A

Marrow suppression
- Neutropenic sepsis
Nausea, vomiting, GI upset
Mucositis
Fatigue, lethargy
Neuropathy (numbness in fingers)
Hair loss
Nail changes

50
Q

What are the general side effects of radiotherapy?

A

Lethargy
Risk to surrounding organs (oesophagus etc.)

51
Q

What are the acute side effects of radiotherapy?

A

Pneumonitis
Dysphagia

52
Q

What are the late side effects of radiotherapy?

A

Fibrosis
Stricture
Increased risk MI. 2nd malignancies

53
Q

What are the common side effects of immunotherapy

A

Colitis (diarrhoea)
Pneumonitis (breathless)
Dermatitis
Endocrinopathies

54
Q

In immunotherapy what can be given to counteract side effects if bad enough?

A

Steroids

55
Q

Who should be screened by lung cancer screening program?

A

At risk population
e.g. smokers, those in certain jobs

56
Q

What would screening involve?

A

Low dose CT

57
Q

What is the big ethical question about lung cancer screening?

A

Radiation risk to population vs risk of lung cancer cure by catching early?

58
Q

What are some logistical challenges to lung cancer screening?

A

Machine time
Reporting scans
Stress of false positives
Lung nodules needing follow up

Respiration (27 decks)

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