Treatment of Lung cancer

Question 1

what are the 4 treatment options available to treat lung cancer?

Answer 1

1) surgery
2) chemotherapy
3) radiotherapy
4) palliative care

Question 2

how would you and wouldn’t you treat SMALL CELL lung cancer?

Answer 2

You WOULD;
- treat with chemotherapy
= because of its rapid growth

You WOULDN’t;
- treat with surgery
= because its not localised

Question 3

what are the curative options for NON-SMALL CELL lung cancer?

Answer 3

• radiotherapy
• surgery
  = if its localised

Question 4

what are options are there is its not curable?

Answer 4

= palliative medicine

Question 5

what questions do you want to think about if considering surgery?

Answer 5

1) is the disease localised
2) can you cut it out
3) will the patient survive
4) what will the residual lung function be

Question 6

what 5 things could you do to stage for surgery?

Answer 6

1) bronchoscopy
- vocal cord palsy
- proximity to carina
- cell type

2) mediastinoscopy/EBUS
- lymph nodes

3) CT scan of brain
- metastases

4) CT scan of thorax
- tumour size
- lymph nodes
- metastases
- local invasion

5) PET scan = positron emission tomography
- metastases

Question 7

what are the 2 possible surgery options for lung cancer?

Answer 7

1) lobectomy

2) pneumonectomy

Question 8

what are the 2 ways that these procedures could be done?

Answer 8

1) thoracotomy

2) minimal access VATS

Question 9

what is thoracotomy?

what is its disadvantage?

Answer 9

one long incision is made around the 6th rib to gain access to the lung

It’s disadvantage…

• massive surgery
• weeks to recover

Question 10

Why is minimal access video assisted thoracic surgery good?

Answer 10

• as it used key-hole technique
• far less traumatic
• faster recovery

Question 11

what 3 things allow you to stage for chemotherapy?

Answer 11

1) bronchoscopy or other tissue sampling technique
2) CT scan
- tumour size
- local invasion
- nodes
- metastases
3) performance in ECOG score
- patient needs to be physically fit enough to undergo it

Question 12

what is cytotoxic chemotherapy?

Answer 12

= rarely curative but elongates survival

Question 13

what type of cell has a better response to cytotoxic chemotherapy?

Answer 13

small cell cancer

Question 14

what are the side effects of cytotoxic chemotherapy?

Answer 14

they are massive side effects;

• nausea
• vomiting
• bone marrow suppression
• hair loss
• tiredness

Question 15

what are the 4 types if radiotherapy available?

Answer 15

1) ionising radiation
2) radical
3) palliative
4) well tolerated

Question 16

what are the downsides to radiotherapy?

Answer 16

• maximum cumulative dose
• collateral damage to;
• spinal cord
• oesophagus
• adjacent lung tissue

Question 17

what alternative could be used to minimise the collateral damage caused by radiotherapy?

Answer 17

= SABR

= stereotactic ablation radiotherapy

Question 18

what is is SABR?

Answer 18

• many more beams which are each less powerful
• less collateral damage
• total dose deliver to tumour is higher so more effective but fewer side effects

Question 19

what are the 4 things that determine lung cancer treatment?

Answer 19

1) cell type
2) extent of the disease
3) co-morbidity
5) patient wishes