Treatment for Cancer

Question 1

what are the treatments for small cell?

Answer 1

good initial response to chemotherapy. This is often backed up with radiotherapy

they are rarely suitable for surgery

Question 2

why the initial good response to chemo?

Answer 2

it is fast growing

Question 3

what are the treatments for non small cell?

Answer 3

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

Question 4

why are small cell not suitable for surgery in most cases?

Answer 4

this is because at the first presentation, small cell lung cancer has usually spread beyond the primary site.

Question 5

what are the treatment choices?

Answer 5

surgery

radical radiotharapy

chemotherapy

palliative care

Question 6

for which group is chemo used?

Answer 6

SCLC

Question 7

who is given radical radiotherapy ?

Answer 7

patients with early stage NSCLC but adequate lung function, this is ideal if surgery is not possible due to co-morbidities

Question 8

what questions need to be asked for surgery to happen?

Answer 8

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?

Question 9

why is staging important in lung cancer?

Answer 9

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

Question 10

what investigations need to be done to stage the cancer before surgery?

Answer 10

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

Question 11

what does the CT scan show?

Answer 11

tumour size

lymph nodes

metastases

local invasion

Question 12

when can you get surgery?

Answer 12

• if i is relatively small

lymph node involvement is on the same side as the cancer]

Question 13

when can surgery not be performed?

Answer 13

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

Question 14

what surgery can be done?

Answer 14

pneumonectomy or lobectomy

these are major surgeries and it takes weeks to recover

Question 15

why is it important to distinguish cell type?

Answer 15

for deciding drug treatment as the choice of drug is determined by the cell type

Question 16

what are the processes of staging in chemo?

Answer 16

bronchoscopy r other tissue sampling - to determine if it is SC or NSC

CT scan

performance status ECOG score

Question 17

why a CT scan for chemotherapy?

Answer 17

to assess tumour size

local invasion

nodes

metastases

Question 18

why a ECOG for chemotherapy?

Answer 18

it is important to know if the patient is fit enough to cope with the stress of chemotherapy

Question 19

what is cytotoxic chemotherapy?

Answer 19

whole body treatment which targets rapidly dividing cells

It is rarely curative but get longer survival

Question 20

what are some side effects of chemo?

Answer 20

nausea and vomiting 
tiredness 
bone marrow suppression so get opportunistic infection and anaemia
hair loss 
pulmonary fibrosis

Question 21

what is radiotherapy?

Answer 21

Ionising radiation - usually X rays

Question 22

when can radical radiotherapy be given?

Answer 22

if the target is less than 5 cm

Question 23

why is palliative radiotherapy done?

Answer 23

it is a delaying tactic

it is useful for metastases

it is well tolerated

Question 24

early stage NSCLC surgery can be curative. If stage three what is done?

Answer 24

treat with chemotherapy to downstage then surgical resection

Question 25

when is surgery contraindicated?

Answer 25

if the tumour is near the hilum

if there is evidence of metastasis

• FEV1>1.5 L

Vocal cord paralysis

Question 26

what are the snags of radiotherapy ?

Answer 26

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.

Question 27

what is a common side effect post radiotherapy?

Answer 27

temporary oesophagitis

Question 28

for which patients is fibrosis an issure?

Answer 28

this can be important when dealing with a patient with impaired lung function e.g. COPD

Question 29

what is endobronchial therapy and what does it involve?

Answer 29

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

Question 30

what is treatment of a cancer determined by?

Answer 30

• the cell type
• the extent of the disease
• co-morbidity
• the patients wishes

Question 31

which co-morbidities may be important?

Answer 31

smoking related diseases e.g. COPD and ischaemic heart disease