surgical lung cancer management

Question 1

which NSCLC is most associated with smoking

Answer 1

suqamous cell carcinoma

Question 2

3 signs of regional lung cancer spread

Answer 2

hilar lymph node involvement; mediastinal invasion; pleural effusion

Question 3

what further investigations are done to stage the disease if there is nodal involvement (3)

Answer 3

EBUS with transbronchial biopsy; thoracoscopy (if bronchoscopy/biopsy inconlusive); mediastinotomy (biopsy of mediastinal nodes/masses)

Question 4

NSCLC treatments for different stages

Answer 4

curative:
stage I + II - surgical resection + adjuvant chemotherapy (not RT unless resection margins are not tumour free) or RT +polychemotherapy if not suitable for surgery;
stage IIIa - polychemotherapy + radiation therapy, surgery considered if tumour size decreases significantly;
Pancoast tumour <stage IIIb - neoadjuvant radiation therapy + polychemotherapy, surgery;

palliative: stages IIIb + IV - polychemotherapy, sypmtom-orientated palliative support, radiation therapy for metastases

Question 5

SCLC treatments

Answer 5

limited disease: curative - polychemotherapy + radiation therapy, usually unresectable, prophylactic cranial irradiation in pts who respond to chemo
extensive disease: palliative - polychemotherapy; RT + prophylactic cranial irradiation if pt responds to chemo

Question 6

what stages is surgery usually indicated for

Answer 6

I and II (occasionally III if low N stage and depending on tumour position)

Question 7

what is resectability

Answer 7

the ability to completely excise the tumour at surgery

Question 8

what are 7 surgical complications that might occur (lung cancer)

Answer 8

1. displacement of the heart towards the operated side
2. bronchial stump insufficiency
3. pneumothorax
4. postoperative haemorrhage
5. chylothorax (damage to thoracic duct)
6. atelectasis
7. pneumonia

Question 9

how does radiation cause cell damage (3)

Answer 9

damages DNA + cell structure; preventing cell replication; inducing cell death

Question 10

4 indications for RT in lung cancer

Answer 10

1. curative intervention (radical) - stage I/II unfit for surgery or III in combinatino w chemo
2. neo-adjuvant - to down stage IIIa disease
3. adjuvant - hilar/mediastinal nodes
4. palliative - symptom relief

Question 11

4 acute effects of radiotherapy

Answer 11

oesophagitis; pneumonia; nausea/vomiting; bone marrow suppression

Question 12

4 long term affects of radiotherapy

Answer 12

pneumonitis/pulmonary fibrosis; rib fractures; cardiac fibrosis/dysfunciton; hypothyroidism

Question 13

5 cell funcitons targeted by chemo

Answer 13

1. DNA replication/repair
2. cytoskeleton
   3.neucleotide synthesis
3. hormone
4. specific receptors

Question 14

is chemotherapy curative for lung cancer

Answer 14

no

Question 15

3 indications for chemo in lung cancer

Answer 15

first line for stage IIIb/IV disease (palliative); neoadjuvant therapy to downstage IIIa; adjuvant for unexpected advanced disease on path staging

Question 16

what behviour do SCLCs exhibit

Answer 16

aggressive behaviour associated with paraneoplastic syndromes

Question 17

SCLC chemo management

Answer 17

limited : platinum based chemotherapy with thoracic radiotherapy
extensive: chemo alone (possibly with prophylactic cranial irradiation)

Question 18

What nerve roots are affected by pancoast tumours

Answer 18

C8; T1

Question 19

What sign is typical of pancoast tumour

Answer 19

Arm and small hand muscle wastage

Question 20

4 symptoms of Horner’s syndrome

Answer 20

Miosis; enophthalmos; partial ptosis; an/hypohydrosis