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Respiratory: Patient History, etc > Treatment of Bronchial Carcinoma > Flashcards

Treatment of Bronchial Carcinoma Flashcards

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1
Q

What are some examples of lung cancer treatment?

A
  • Surgery
  • Radiotherapy
  • Chemotherapy
  • Supportive care
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2
Q

What are the steps of giving a diagnosis of lung cancer?

A
  • Prepare the ground
  • Bring a relative
  • Make sure they understand
  • Prepare for obvious questions (what can you do about it? How long have I got?)
  • Tell their GP
  • Arrange follow up
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3
Q

What is the overall prognosis of lung cancer?

“How long have I got?”

A

Very poor overall prognosis

  • Median survival 5.8 months (half of the patients will be dead within 6 months of the diagnosis)
  • 30% 1 year survival
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4
Q

What are the features of small cell carcinoma?

A
  • 12% of lung cancers
  • Early metastases
  • Rapidly progressive disease
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5
Q

What are the treatment options for small cell lung cancer?

A
  • Rarely suitable for surgery (spread beyond primary site)

* Good initial response to chemotherapy (treatment of choice - often backed up by radiotherapy)

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6
Q

What are types of non-small cell lung cancer?

A
  • Squamous and adenocarcinomas
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7
Q

What are the treatment options for non-small cell lung cancer?

A
  • Curative options are surgery or radical radiotherapy

* Palliative options are chemotherapy and new targeted treatment

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8
Q

Is non-small cell lung cancer more common than small cell?

A

Non-small cell lung cancers account for the majority of lung cancers

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9
Q

When can non-small cell lung cancers be treated with surgery?

A

If the disease is recognised before it spreads beyond the primary site

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10
Q

What are the median survival (50% of patients) months of non-small cell, small cell and unknown lung cancers?

A
  • Non-small cell - 7.7 months
  • Small cell - 5.9 months
  • Unknown - 4.9 months
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11
Q

What percentage of patients with non-small cell, small cell and unknown lung cancers survive for a year?

A
  • Non-small cell - 39%
  • Small cell - 24%
  • Unknown - 26%
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12
Q

What is unknown lung cancer?

A

Unknown cell type includes those patients who were too ill to undergo a diagnostic procedure (have a shorter prognosis)

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13
Q

What is key to improved survival of lung cancer?

A

Making the diagnosis early (i.e. stage I, II)

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14
Q

When is surgery a viable treatment option for lung cancer?

A
  • If you can cut the tumour out
  • If the disease is localised
  • If the patient will survive the operation
  • If the residual lung function will be sufficient following surgery
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15
Q

How does surgical resection of cancer improve the chances of survival of patents with lung cancer?

A

Surgical resection

  • Median survival 42.7 months
  • 1 year survival 81 %

No surgery
Median survival 4.8 months
1 year survival 25 %

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16
Q

What is the risk of patients who have undergone surgical resection of lung cancer?

A

Risk of developing a second primary lung cancer later in life

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17
Q

What techniques are used to stage cancer in preparation for surgery?

A
  • Bronchoscopy
  • Mediastinoscopy/EBUS
  • CT scan of brain
  • CT scan of thorax
  • PET scan
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18
Q

How is bronchoscopy used in lung cancer staging?

A

Can identify:-

  • Vocal cord palsy
  • Proximity to carina (if within 2cm of the carina, cannot operate)
  • Cell type
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19
Q

How is mediastinoscopy used in lung cancer staging?

A

Assess the lymph nodes - ensure not to many are involved for surgery

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20
Q

How is CT scan of the brain used in lung cancer staging?

A

To reveal hidden metastases (surgery only if tumour is localised)

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21
Q

How is CT scan of the thorax used in lung cancer staging?

A

Can identify:-

  • Tumour size
  • Lymph nodes
  • Metastases
  • Local invasion
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22
Q

How is a PET scan used in lung cancer staging?

A

Identifies metastases

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23
Q

Why does tumour need to be more than 2cm away from the carina in order to operate?

A
  • Need to have 2cm of disease free bronchus to close off the hole
  • So if the tumour encroaches within 2cm of the carina, it will be impossible to remove it without leaving a hole in the side of the trachea.
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24
Q

What are types of surgery for lung cancer?

A
  • Pneumonectomy
  • Lobectomy
  • Thoracotomy
  • Minimal access VATS
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25
Q

What is a thoracotomy?

A
  • Surgery involving a long incision around the length of the sixth rib to gain access to the lung in question
  • It takes weeks to recover from this operation
  • The patient may be in hospital for ten days before they are fit to return home
26
Q

What is minimal access VATS?

A

Video Assisted Thoracic Surgery is a recent advance using key-hole surgical techniques

  • This is far less traumatic and has the benefit of a much faster recovery
  • Some patients may be in hospital for no more than five days
27
Q

What are the risks associated with surgical resection of lung cancer?

A
  • Peri-operative mortality
  • Post-operative morbidity
  • Only 1 in 20 are suitable for surgery
28
Q

Why may the hemi-diaphragm of the diseased lung be elevated following surgical resection of lung cancer?

A

To compensate for the loss of volume on that side

29
Q

What techniques are used to stage lung cancer for chemotherapy?

A
  • Bronchoscopy or other tissue sampling
  • Ct scan
  • Performance status ECOG score
30
Q

How is bronchoscopy or other tissue sampling used to stage lung cancer for chemotherapy?

A

Identified whether cancer is small cell or non-small cell (small cell responds better to chemotherapy, but non-small cell still responsive)

31
Q

How is CT scan used to stage lung cancer for chemotherapy?

A

Can identify:-

  • Tumour size
  • Local invasion
  • Nodes
  • Metastases
32
Q

What is performance status ECOG score?

A

Assessment of the fitness of the patient to undergo chemotherapy

33
Q

What do new developments in chemotherapy include?

A
  • The use of drugs which tackle epithelial growth factor

* Drug sensitivity testing on the material removed at biopsy

34
Q

What are the advantages of chemotherapy?

A
  • Rarely curative but longer survival

* Whole body treatment so will target rapidly dividing cells

35
Q

What are the disadvantages of chemotherapy?

A

Major side effects

36
Q

What are the side effects of chemotherapy?

A
  • Nausea and vomiting
  • Tiredness
  • Bone marrow suppression (neutropenia) -opportunistic infection, anaemia
  • Hair loss
  • Pulmonary fibrosis
37
Q

What is a potential very dangerous complication of chemotherapy?

A

Neutropenic sepsis

38
Q

What are the new targets of chemotherapy?

A
  • Genetic mutations within the tumour - EFGR, ALK1

* Immune therapy - PD-L1

39
Q

What is radiotherapy?

A

Ionising radiation

  • Usually X-rays
  • External beam
40
Q

What are the possible purposes of radiotherapy?

A
  • Curative intent (intuition to cure)

* Palliative intent (a delaying tactic, used for metastases)

41
Q

What is the advantage of radiotherapy?

A

Usually well-tolerated

42
Q

What are the disadvantages of radiotherapy?

A
  • Maximum cumulative dose required to kill tumour
  • Collateral damage - spinal cord, oesophagus, adjacent lung tissue
  • Only goes where you point the beam
  • Not good for subclinical metastases
43
Q

What is a common side effect of radiotherapy?

A

Temporary oesophagitis

44
Q

What can result from collateral damage to lung tissue following radiotherapy?

A

Normal lung tissue can undergo post radiation fibrosis

45
Q

When is post radiation fibrosis a significant challenge?

A

When dealing with a patient with precarious lung function e.g. advanced COPD

46
Q

What can be done to overcome collateral damage whilst still delivering maximum cumulative dose to tumour?

A

Many beams coming from different angles aimed at the tumour

47
Q

What is SABR?

A

Stereotactic ablative radiotherapy - much higher dose delivered to the tumour delivered through hundreds of small beams rather than 4 or 5

48
Q

What are the advantages of SABR?

A
  • Each beam is less powerful - less collateral damage

* Total dose delivered to tumour is higher and so more effective

49
Q

What are the disadvantages of SABR?

A

4D scanning required

50
Q

What is photodynamic therapy for lung cancer?

A

A type of endobronchial therapy

  • Patient receives a photo-sensitising drug a few days before the bronchoscopy
  • Then receives phototherapy to the tumour in the bronchus with laser light down a fibreoptic bundle
51
Q

What are types of endobronchial therapy?

A
  • Stent insertion for stridor
  • Photodynamic therapy
  • Other laser therapy
52
Q

Is endobronchial therapy curative?

A

All of these treatments are palliative but can make a significant improvement to quality of life

53
Q

What is treatment of lung cancer determined by?

A
  • The cell type
  • The extent of the disease
  • Co-morbidity (can restrict treatment options)
  • The patient’s wishes
54
Q

What are examples of common co-morbities to lung cancer?

A
  • Smoking related diseases: COPD: FEV1 < 1 litre, Ischaemic Heart Disease (IHD), peripheral vascular disease
55
Q

What does palliative care for lung cancer aim to treat?

A
  • Pain
  • Breathlessness
  • Cough
  • Anxiety
  • Poor mobility
56
Q

Why is palliative care significant in lung cancer?

A
  • Less than 10% of lung cancer patients will be cured of their disease
  • The remaining 90% are likely to suffer significant symptoms as a direct result of their cancer
57
Q

What is the prognosis for lung cancer?

A
  • Half will be dead in 6 months

* 1 in 20 survive for 5 years

58
Q

What are the causes of lung cancer?

A
  • Tobacco smoking (the big one)
  • Asbestos
  • Radon
59
Q

What are preventative measures for lung cancer?

A

Many public health measures have been introduced to make tobacco smoking less attractive

  • In the UK, advertising of tobacco has been banned
  • Smoking indoors has also been banned.
  • In Australia, all cigarettes will have to be sold in bland green packs with no logos or other attractions
60
Q

Which 2 cancer treatments are curative?

A
  • Surgery

* Radiotherapy

Respiratory: Patient History, etc (10 decks)

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