Treatment of lung cancer Flashcards
What the basic outline of lung cancer treatment?
Giving the diagnosis Surgery Radiotherapy Chemo Supportive care
How do you give a diagnosis of lung cancer?
Prepare the ground Bring a relative Make sure they understnad Prepare for obvious questions - what can you do? How long do I have? Tell their GP Arrange a follow up
What are the characteristics of small cell cancer?
12% of lung cancer cases
Rapidly progressive disease
Early metastases
Rerely suitable for surgery due to at the time of presentation is have usually spread beyond the primary site
Good initial response to chemo due to the rapid growth of the tumor
What are the characteristics of non small cell lung cancers?
Squamous, adeno carcinoma and large cell
Can be cured by surgery or radical radiotherapy
Palliative chemo - will not cure but will prolong life
What are the treatment choices for cancer?
Surgery
Radiotherapy
Chemotherapy
Palliative care
What are some considerations before surgery is performed?
Can it be cut out?
Is it localised or has the cancer metastasized?
Will the patient survive the operation or are they too frail
What will be the lung function after surgery - if a whole lobe is cut out of a patient with COPD that has a lung cancer, their prognosis post-op will be bad and they will have very little resp function
How is cancer staged prior to surgery?
Bronchoscopy - vocal chord palsy, proximity to carina (must be at least 2cm away from carina), cell type
EBUS - lymph nodes
CT scan of brain - look for metastases
CT scan of thorax - tumour size, lymph nodes, metastases, local invasion
PET scan - Metastases
What is the surgery that can be performed for lung cancer?
Peumonectomy (whole lung removed)
Lobectomy (lobe and associated lymph nodes removed)
Only 1/20 are suitable for surgery
How is lung cancer staged prior to chemotherapy?
Bronchoscopy to determine cell type - small cell or non small cell - needed to allow for specific chemo to be given for maximal treatment
CT scan - tumour size, local invasion, nodes, metastases
Performance status on ECOG score - patient needs to be fit to cope iwth the stress of chemo. EGOC score goes from 1 (very fit) to 4 (bed bound)
How is cytotoxic chemo work?
It is a whole body treatment that targets rapidly dividing cells. It can pass thorough the blood brain barrier allowing treatment of brain tumour but can cause prophylactic cranial irridation
What are some side effects of chemo?
Nausea and vomiting Tiredness Bone marrow suppression - opportunistic infection, anaemia Hair loss Pulmonary fibrosis
What are some new treatments?
Treatments that target genetic mutations such as EGFR and ALK1 and treatements that target the immune system such as PD-L1 - programmed death ligand 1
What can radiotherapy be used for?
Ionising radition that can be radical (curative treatment)
Can also be used in a palliative setting as a delaying tactic. Usually well tolerated
What are the down sides to radiotherapy?
Maximum cumulative dose
Collateral damage - spinal chord, oesophagus, adjacent lung tissue
Only goes to where you point the beam and so is not useful for subclinical metastases
What is SABR?
Seterotactctic albative radiotherapy
Many more beams than simple X-rays
Each beam is less powerful and so there is less collateral damage but there are more beams to more radiation is exposed to the tumour
4D scanning is required
