Treatment of Bronchial Carcinoma

Question 1

describe treatment of small cell carcinoma

Answer 1

early metastases - usually spread beyond primary site after presentation, ruling out surgery
more susceptible to cytotoxic chemotherapy - treatment of choice
radiotherapy

Question 2

describe treatment of non-small cell carcinomas

Answer 2

surgical resection (if recognised before metastasising
radical radiotherapy
palliative chemotherapy and new targeted treatment

Question 3

describe treatment options for bronchial carcinomas

Answer 3

surgery - best option (81% chance of survival), pneumonectomy or lobectomy

radiotherapy - radical (curative intent) or palliative (delaying tactic, useful for metastases)

chemotherapy - rarely curative but longer survival (better response in small cell cancer), targets rapidly dividing cells

palliative care - relieving patient of pain

Question 4

describe staging for surgery

Answer 4

bronchoscopy - vocal cord palsy, proximity to carnia, cell type
mediastinoscopy/EBUS - lymph nodes
CT of brain - metastases
CT of thorax - tumour size, lymph nodes, metastases, local invasion
PET scan - metastases

Question 5

describe staging for chemotherapy

Answer 5

choice of drugs determined by cell type
bronchoscopy - small cell or non small cell?
CT - tumour size, local invasion, nodes, metastases
performance status ECOG score - is patient fit enough to cope with stress of chemo

Question 6

describe side effects of chemotherapy

Answer 6

nausea and vomiting 
tiredness
bone marrow suppression - opportunistic infection, anaemia 
hair loss
pulmonary fibrosis

Question 7

describe precautions of radiotherapy

Answer 7

maximum cumulative dose
collateral damage - spinal cord, oesophagus, adjacent lung tissue - only goes where beam is pointed
not good for sub clinical metastases

Question 8

describe stereotactic ablative radiotherapy (SABR)

Answer 8

more beams but each beam is less powerful - less collateral damage
total dose to tumour is high and so more effective

Question 9

describe endobronchial therapy

Answer 9

palliative treatments;
stent insertion for stridor - stretches open narrow trachea
photodynamic therapy
other laser therapy

Question 10

describe how treatment of lung cancer is determined

Answer 10

cell type
extent of disease
co-morbidity - smoking related diseases (COPD, ischaemic heart disease)
patient’s wishes