Treatment for Cancer Flashcards
what are the treatments for small cell?
good initial response to chemotherapy. This is often backed up with radiotherapy
they are rarely suitable for surgery
why the initial good response to chemo?
it is fast growing
what are the treatments for non small cell?
the curative options are surgery or radical radiotherapy
they are less responsive to chemotherapy- though they do
respond
this accounts for the majority of lung cancers
why are small cell not suitable for surgery in most cases?
this is because at the first presentation, small cell lung cancer has usually spread beyond the primary site.
what are the treatment choices?
surgery
radical radiotharapy
chemotherapy
palliative care
for which group is chemo used?
SCLC
who is given radical radiotherapy ?
patients with early stage NSCLC but adequate lung function, this is ideal if surgery is not possible due to co-morbidities
what questions need to be asked for surgery to happen?
can it be cut out? - if 2cm away it can be resected
is the disease localised?
will the patient survive the operation? and if so how long will they need to recover
what will the residual lung function be like?
why is staging important in lung cancer?
surgeon needs to know and be certain that the cancer can be completely removed by an operation so the preoperative staging amounts to a thorough search for evidence of metastasis or local invasion
what investigations need to be done to stage the cancer before surgery?
bronchoscopy - the purpose is to determine the cell type
mediastinoscopy/EBUS : looking for lymph node involvement
CT scan of the brain - for metastases
CT scan of the thorax
PET scan - metastases
what does the CT scan show?
tumour size
lymph nodes
metastases
local invasion
when can you get surgery?
- if i is relatively small
lymph node involvement is on the same side as the cancer]
when can surgery not be performed?
if lymph nodes on opposite sides
with metastatic disese
if have local invasion as it is going to be hard to get a clear resection
what surgery can be done?
pneumonectomy or lobectomy
these are major surgeries and it takes weeks to recover
why is it important to distinguish cell type?
for deciding drug treatment as the choice of drug is determined by the cell type
what are the processes of staging in chemo?
bronchoscopy r other tissue sampling - to determine if it is SC or NSC
CT scan
performance status ECOG score
why a CT scan for chemotherapy?
to assess tumour size
local invasion
nodes
metastases
why a ECOG for chemotherapy?
it is important to know if the patient is fit enough to cope with the stress of chemotherapy
what is cytotoxic chemotherapy?
whole body treatment which targets rapidly dividing cells
It is rarely curative but get longer survival
what are some side effects of chemo?
nausea and vomiting tiredness bone marrow suppression so get opportunistic infection and anaemia hair loss pulmonary fibrosis
what is radiotherapy?
Ionising radiation - usually X rays
when can radical radiotherapy be given?
if the target is less than 5 cm
why is palliative radiotherapy done?
it is a delaying tactic
it is useful for metastases
it is well tolerated
early stage NSCLC surgery can be curative. If stage three what is done?
treat with chemotherapy to downstage then surgical resection
when is surgery contraindicated?
if the tumour is near the hilum
if there is evidence of metastasis
- FEV1>1.5 L
Vocal cord paralysis
what are the snags of radiotherapy ?
maximum cumulative dose
there may be collateral damage e.g. to spinal cord, oesophagus and adjacent lung tissue
It only goes where you point the beam so it is not useful for subclinical metastases
Normal lung tissue can undergo post radiation fibrosis.
what is a common side effect post radiotherapy?
temporary oesophagitis
for which patients is fibrosis an issure?
this can be important when dealing with a patient with impaired lung function e.g. COPD
what is endobronchial therapy and what does it involve?
It is a palliative therapy but can make a significant improvement to life
what does it involve?
stent insertion for stridor
photodynamic therapy
radioactive pellets
what is treatment of a cancer determined by?
- the cell type
- the extent of the disease
- co-morbidity
- the patients wishes
which co-morbidities may be important?
smoking related diseases e.g. COPD and ischaemic heart disease
