Treatment of Bronchial Carcinoma Flashcards
Lung cancer treatment?
Giving the diagnosis
Surgery
Radiotherapy (can be given in radical or palliative dose)
Chemotherapy
Supportive care (palliative)
Types of lung cancer?
Small cell
Non-small cell
Characteristics of small cell lung cancer?
Rapidly progressive disease with early metastases; rarely suitable for surgery (at 1st presentation, small cell lung cancer has usually spread beyond primary site)
Good INITIAL response to cytotoxic chemotherapy, due to rapid growth (often backed up with radiotherapy)
Describe non-small cell lung cancer
Includes squamous and adenocarcinomas and accounts for the majority of lung cancers
Curative (radical) options are surgery (if disease is recognised before spread beyond primary site) or radical radiotherapy; this type is less responsive to chemotherapy
Why are some diagnoses unknown?
Sampling techniques are unable to tell the cell type (perhaps, the only thing that can be obtained is necrotic tissue); also, investigations may not be continued due to patient being unwell/other co-morbidities (shorter prognosis)
Types of surgeries available for lung cancer?
Pneumonectomy - lung removal
Lobectomy - lobe removal
Can the cancer be resected, is the disease localised, will the patient survive the operation and what will the residual lung function be?
Benefits and complications with patients suitable for surgery?
Median survival rate does increase with surgery (from 4.8 months without to 42.7 months)
Risk of developing a second primary lung cancer later in life; both lungs were exposed to tobacco smoke
What does staging for surgery involve?
TNM staging - surgeon needs to be certain that the cancer can be completely removeed by an operation so the pre-operative staging amounts to a thorough search for metastases/local invasion:
Bronchoscopy - vocal cord palsy, proximity to carina, cell type?
Mediastinoscopy/EBUS - lymph nodes
CT scan of brain - check for brain metastases
CT scan of thorax - tumour size, lymph nodes,metastases, local invasion?
PET scan - check for metastases
What must the surgeon do after a pneumonectomy?
After removing a lung, the surgeon needs to close up the hole in the bronchial tree
In general, there must be 2 cm of disease free bronchus to close off the hole
So, if the tumour encroaches within 2 cm of the carina, it is impossible to remove it without leaving a hole in the side of the trachea
Describe surgery for lung cancer
Thoracotomy (making an incision into the pleural space in the chest)
Video Assisted Thoracic Surgery (VATS - minimal access) is also used
Scars will be left
Objective - curative
Peri-operative mortality and post-operative morbidity
Determining stage for chemotherapy?
Bronchoscopy/other tissue sampling (small cell/non-small cell)
CT scan: Tumour size, local invasion, nodes, metastases
Performance status - ECOG score (ranges from 0 to 5, from no symptoms to death, and is used to determine who is fit for treatment)
Describe cytotoxic chemotherapy
Whole body treatment that targets rapidly dividing cells
Cannot cross blood-brain barrier so chemo cannot be used for brain cancers /metastases; prophylactic cranial irradiation must be used (radiotherapy)
Rarely curative but does confer longer survival; better response in small cell cancer; there are major side effects
Chemotherapy side effects?
Nausea and vomiting Tiredness Bone marrow suppression (opportunistic infection and anaemia) - can lead to neutropenic sepsis; patients told to watch out for even slightest fever Hair loss Pulmonary fibrosis
Describe radiotherapy
Uses ionising radiation, usually X-rays as an external beam; can be radical (curative)
Disadvantages of radiotherapy?
Maximum cumulative dose has to be given to the tumour but collateral damage does occur to, e.g: spinal cord, oesophagus, adjacent lung tissue
Only goes to where beam is pointed and so is no good for subclinical metastases, except prophyactic cranial irradiation
Common side effects of radiotherapy?
Temporary oesophagitis
Normal lung tissue can undergo post-radiation fibrosis; can be a challenge when patient has precarious lung function, e.g: advanced COPD
Describe endobronchial therapy
Patient receives a photo-sensitising drug a few days beforehand (told to stay out of sun)
Then phototherapy to tumour occurs in the bronchus, with laser light being transmitted down a fibre optic bundle - only works if tumour is in bronchial mucosa
Uses of endobronchial therapy?
Stent insertion for stridor - introducer passed through narrowed section of trachea and stent is deployed into the lumen of the narrow section to open it up (stent will appear on a CT scan)
Photodynamic therapy
Other laser therapy
Radioactive pellets
…all are palliative
How is treatment of lung cancer determined?
Patient’s wishes
Cell type
Extent of disease (TNM staging)
Co-morbidity
Co-morbidity issues in lung cancer?
Other smoking-related disease can be COPD, ischaemic heart disease, peripheral vascular disease, etc
These co-morbidities often restrict the choice of treatment for lung cancer
Aim of palliative care?
To alleviate symptoms, e.g: pain, breathlessness, cough, anxiety and poor mobility
Choices in palliative care?
Palliative radiotherapy
Lung cancer prognosis?
Poor
Half will be dead in 6 months
Causes of lung cancer?
Tobacco smoking - main cause
Asbestos exposure
Radon exposure - gas that is a breakdown product from isotopes found in granite
Prevention is a better option than small chance of cure
