Treatment of Bronchial Carcinoma

Question 1

Small cell lung cancer treatments

Answer 1

Rapidly progressive disease
Early metastases
Rarely suitable for surgery
Good initial response to chemotherapy 
Quite difficult to cure

Question 2

Non-small cell lung cancer treatments

Answer 2

Includes squamous and adeno carcinomas
Curative options are surgery or radical radiotherapy
Palliative chemotherapy and new targeted treatment
Accounts for the majority of lung cancers

Question 3

Treatment options

Answer 3

Surgery
Radiotherapy
Chemotherapy
Palliative care

Question 4

Considerations before surgery

Answer 4

Can we cut it out?
Is the disease localised?
Will the patient survive the operation?
What will the residual lung function be?

Question 5

Tests before surgery

Answer 5

Bronchoscopy
Mediastinoscopy/EBUS
CT scan of brain and thorax
PET scan

Question 6

What is a thoracotomy

Answer 6

A thoracotomy is major surgery involving a long incision around the length of the sixth rib to gain access to the lung in question

Question 7

Staging for chemotherapy

Answer 7

Bronchoscopy/other tissue sampling
CT scan
Performance status ECOG score (score of 0,1 or 2)

Question 8

Cytotoxic chemotherapy

Answer 8

Rarely curative but longer survival
Better response in small cell cancer
Major side effects
IV infusions every 3-4 weeks
Outpatient visits

Whole body treatment
Targets radpidly dividing cells

Question 9

Chemotherapy side effects

Answer 9

Nausea and Vomiting
Tiredness
Bone marrow suppression
Hair loss
Pulmonary fibrosis

Question 10

Radiotherapy

Answer 10

Ionising radiation: They damage dividing cells and have an obvious role in cancer treatment.
Can be used for curative and palliative treatment

Question 11

Radiotherapy - the snags

Answer 11

Maximum cumulative dose
Collateral damage (spinal cord, Oesophagus, adjacent lung tissue)
Only goes where you point the beam (not good for subclinical metastases).

Question 12

SABR

Answer 12

Stereotactic ablative radiotherapy
Many more beams
Each beam is less powerful (Less collateral damage)
Total dose delivered to tumour is higher and so more effective
4D scanning required

Question 13

Endobronchial therapy

Answer 13

Stent insertion for stridor
Photodynamic therapy
Other laser therapy

Question 14

How is treatment for lung cancer determined?

Answer 14

The cell type
The extent of the disease
Co-morbidity (COPD, Ischaemic heart disease)
The patient’s wishes (most important)

Question 15

Causes of lung cancer

Answer 15

Tobacco smoking
Asbestos
Radon