Treatment of Lung Cancer (DISEASE MECHANISMS)

Question 1

What is treatment of choice for small cell lung cancer?

Answer 1

Cytotoxic chemotherapy, often back with radiotherapy

Question 2

Why is SCLC suitable for chemotherapy?

Answer 2

Very rapid cell growth makes it susceptible

Question 3

Why is surgery rarely an option for SCLC?

Answer 3

Early metastases

Question 4

What are the curative treatment options for NSCLC?

Answer 4

Surgery or radical radiotherapy

Question 5

What does “radical” mean in terms of cancer treatment?

Answer 5

With the intent to cure

Question 6

What are the different treatment options for bronchial carcinoma?

Answer 6

Surgery
Radiotherapy
Chemotherapy
Palliative care

Question 7

Surgery significantly ______ the median survival rates

Answer 7

increases

Question 8

What tools are used to stage for surgery?

Answer 8

Bronchoscopy
Mediastinoscopy
CT scan of brain/thorax
PET scan

Question 9

How far from the carina must the tumour be to be operable?

Answer 9

> 2 cm

Question 10

What is a pneumonectomy?

Answer 10

Surgical removal of a lung / part of a lung

Question 11

What is a lung lobectomy?

Answer 11

Surgical removal of a lung lobe

Question 12

Which surgical methods can be used to remove lung cancer?

Answer 12

Thoracotomy (very invasive)

Minimal access VATS (Video-assisted thoracic surgery)

Question 13

What must be considered when debating surgery as a treatment option?

Answer 13

Peri-operative mortality and post-operative morbidity

Question 14

What methods can be used to stage for chemotherapy?

Answer 14

Bronchoscopy / Tissue sampling
CT scan (size/local invasion/nodes/metastases)
Performance status ECOG score

Question 15

What do the different ECOG scores represent?

Answer 15

0 = no symptoms
1 = some symptoms but no affect on daily life 
2 = >50% out of bed/chair
3 = <50% out of bed/chair
4 = housebound

Question 16

Where is chemotherapy most responsive?

Answer 16

Small cell lung cancer

Question 17

What side effects are associated with chemotherapy?

Answer 17

Nausea and Vomiting 
Tiredness
Bone marrow suppression (possibility of neutropenic sepsis) 
Hair loss 
Pulmonary fibrosis

Question 18

Radiotherapy is usually _______ treatment

Answer 18

palliative

Question 19

What are the issues with radiotherapy as a treatment option?

Answer 19

Maximum cumulative dose
Collateral damage (spinal cord / oesophagus / adjacent ling tissue)
Only has local effects (doesn't work for subclinical metastases except cranial irradiation)

Question 20

What are the different options for endobronchial therapy?

Answer 20

Stent insertion for stridor
Photodynamic therapy
Outer-laser therapy
Radioactive pellets

Question 21

What does photodynamic therapy involve?

Answer 21

Photo-sensitising drug –> exposure of tumour to certain light frequency –> tumour attacked by photo-sensitive drugs

Question 22

Endobronchial therapies are ______ treatment

Answer 22

palliative

Question 23

What determined the treatment of lung cancer?

Answer 23

Cell type
Extent of disease
Co-morbitidy
Patient’s wishes

Question 24

What is meant by co-morbidity in terms of lung cancer treatment?

Answer 24

Other smoking related diseases such as COPD or IHD

Question 25

Palliative care addresses (5)

Answer 25

Pain
Breathlessness
Cough
Anxiety 
Poor mobility