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Respiratory Medicine > Non-Surgical Management of Lung Cancer > Flashcards

Non-Surgical Management of Lung Cancer Flashcards

1
Q

What % of patients are diagnosed with lung cancer at a stage that is too late to cure?

A

80%

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2
Q

Explain the basic process of a lung cancer diagnosis

A
  1. CXR
  2. CT scan
  3. Tissue biopsy (bronchoscopy, EBUS, CT guided/ Ultrasound guided)
  4. Classify the cancer histologically
  5. PET (if the patient is for curative treatment)
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3
Q

Explain what each point on the eastern cooperative group (ECOG) performance status means

A 
0- asymptomatic and well
1= symptomatic but 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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4
Q

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

A

129 days

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5
Q

How is lung cancer staged?

A

TNM staging system

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6
Q

What does TNM stand for?

A

T= tumour size & mediastinal/structural involvement

N= nodal involvement

M= Presence of distant metastases

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7
Q

In which case would surgery be offered to a patient with non-small cell lung cancer?

A

If it could be surgically cured

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8
Q

What is the 5 year survival of surgical non-small cell lung cancer patients?

A

40%

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9
Q

If FEV>1, what kind of surgery could be offered to a non-small cell lung cancer patient?

A

Lobectomy

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10
Q

If FEV>2, what kind of surgery could be offered to a non-small cell lung cancer patient?

A

Pneumectomy

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11
Q

What tissue must be taken prior to surgery in order to accurately stage cancer?

A

Lymph nodes

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12
Q

What is adjacent therapy?

A

Therapy that is given after the primary or initial therapy to maximize its effectiveness

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13
Q

What are the two usual adjacent therapies given to surgical cancer patients?

A

chemotherapy or radiotherapy

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14
Q

What are neoadjuvant treatments?

A

Therapy delivered before the main treatment, to help reduce the size of a tumour or kill cancer cells that have spread.

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15
Q

What scan must cancer patients have before they can undergo radical radiotherapy?

A

A planning CT scan

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16
Q

What is the aim of radical radiotherapy?

A

To cure the cancer

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17
Q

What is the typical treatment regime for radical radiotherapy?

A

55Gy of radiotherapy in 20 fractions (1x daily, Monday-Friday for 4 weeks)

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18
Q

What is the 5 year survival of patients after radical radiotherapy?

A

20%

19
Q

List three long term side effects of radiotherapy

A
  • pulmonary fibrosis
  • Oesophageal stricture
  • Cardiac effects
20
Q

What test is vital to carry out before lung cancer radiotherapy?

A

Pulmonary function testing

21
Q

What pulmonary function result precludes radiotherapy?

A

FEV1 < 1 or <50% pred

22
Q

How long does a cycle of concurrent chemoradiotherapy last?

A

21 days

23
Q

How long must patients wait in between their CT planning scan and the beginning of radiotherapy?

A

2 weeks (while the doctors come up with the radiotherapy treatment plan)

24
Q

What is the 2 year survival rate of patients who have undergone concurrent chemoradiotherapy?

A

27%

25
Q

What is stereotactic ablative radiotherapy?

A

54Gy of radiotherapy is administered in 3 fractions over the course of 1 week (Monday, Wednesday & Thursday). It is a high dose

26
Q

What is the advantage of stereotactic ablative radiotherapy?

A

Ablative radiotherapy can have similar outcomes to surgery and therefore is useful in patients who are not fit for surgical treatment

27
Q

What is the maximum diameter of a tumour that can be treated with stereotactic ablative radiotherapy?

A

4cm

28
Q

How far away from the airway and bronchial tree must a tumour be in order to be treated with stereotactic ablative radiotherapy?

A

> 2cm away

29
Q

List the 4 palliative treatment options available for lung cancer patients

A
  1. Chemotherapy
  2. Immunotherapy
  3. Tyrosine kinase inhibitors
  4. Palliative radiotherapy
30
Q

What is the name of the palliative immunotherapy drug?

A

Nivolumab

31
Q

How does nivolumab work?

A

prevents PD1 on cancer cells from binding to PDL1 (programmed death ligand) on immune cells and inactivating them. This causes an upregulation of the immune system and an ‘unmasking’ of cancers

32
Q

What kind of patients tend to be good candidates for a tyrosine kinase inhibitors?

A

patients that have an adenocarcinoma driven by a targetable mutation. Patients tend to be younger non-smokers.

33
Q

What is the most common mutation causing adenocarcinoma?

A

EGRF (15%)

34
Q

Which are more common; small cell lung cancers or non-small cell lung cancers?

A

Non-small cell lung cancer (85% of lung cancers compared to just 15% of lung cancers being small cell)

35
Q

What is the doubling time of small cell lung cancer?

A

29 days

36
Q

Why is small cell lung cancer more responsive to treatment than non-small cell lung cancer?

A

It grows much faster

37
Q

What syndromes are associated with small cell lung cancer?

A

secretory syndromes (such as cushings)

38
Q

How is small cell lung cancer usually curatively treated?

A

Not usually surgically (unless detected very very early)

Treatment includes chemoradiotherapy with a combination of drugs and prophylactic irradiation of the brain (in SCLC, the cancer cells are small enough to cross the blood brain barrier so mets in the brain are common)

39
Q

What is the;

  1. response too treatment rate
  2. the complete remission rate
  3. Mean survival time with no treatment
  4. Mean survival time with treatment

in localised small cell lung cancer patients?

A
  1. response to treatment rate = 90%
  2. Complete remission rate = 60%
  3. Median survival with no treatment= 8 months
  4. Median survival with treatment= 16 months
40
Q

How is extensive small cell lung cancer treated?

A
  • Treat with 4 cycles only of 2 drug combination chemotherapy
  • Thoracic radiotherapy can sometimes be used alongside chemotherapy to treat the original disease site
  • Prophylactic cranial irradiation recommended in patients who are relatively well
  • If brain metastases are present, treat with radiotherapy and steroids
  • Consider radiotherapy to palliate symptoms if the patient is not fit for chemo
41
Q

What is the;

  1. response too treatment rate
  2. the complete remission rate
  3. Mean survival time with no treatment
  4. Mean survival time with treatment

in extensive small cell lung cancer patients

A
  • Response to treatment rate = 80%
  • Complete recovery rate= 30%
  • Median survival with no treatment= 8 weeks
  • Median survival with treatment = 8 months
42
Q

List the top 3 chemotherapy side effects

A
  1. Marrow suppression (can lead to neutropenic sepsis)
  2. Nausea
  3. Vomiting
43
Q

List 2 general side effects, 2 acute side effects and 2 late side effects of radiotherapy

A

General;
lethargy
risk to surrounding organs

Acute;
Pneumonitis
Dysphagia

Late
Fibrosis
Increased risk of Mi

44
Q

What are the 4 common side effects of immunotherapy?

A

Anything “itis”

  • Colitis
  • Pneumonitis
  • Dermatitis
  • Endocrinopathies

Respiratory Medicine (27 decks)

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