early detection and management

Question 1

lung cancer prognosis

Answer 1

80% of suffers die within 12 months of diagnosis

Question 2

what are the different stagings of cancer (I-IV)

Answer 2

I - all T1/2 tumors without proximal lymph node disease
II - all T1/2 tumors with involved ipsilateral hilar nodes
IIIa - ipsilatera (resectable) mediastinal nodes
IIIb - ipsilateral (nonresectable) mediastinal nodes
IV - distant mets

Question 3

what are 5 treatment options for lung cancers

Answer 3

surgery (if possible);
radiotherapy (if localised but cannot be resected);
chemotherapy (improves results of radio);
biological alternatives;
palliative care

Question 4

what determines whether a cancer is suitable for surgery (4)

Answer 4

disease features: histology (usually NSCLC), stage (I/II/IIIa only);
patient features: PMH (comorbidities), pulmonary function

Question 5

5 contra-indications to cancer surgery

Answer 5

malignant pleural effusion;
superior vena cava obstruction;
Horner’s syndrome;
vocal cord paralysis;
phrenic nerve paralysis (diaphragm becomes elevated)

Question 6

4 types of surgical resection procedures

Answer 6

wedge excision; segmentectomy; lobectomy (chest wall excision); pnuemonectomy;

Question 7

what stage (early, late etc.) is each type of treatment used for - cancer (4)

Answer 7

surgery - early disease;
radiotherapy - locally advanced disease;
chemotherapy - advanced metastatic disease;
biological agents - advanced metastatic disease;

Question 8

timecourse for radical vs palliative radiotherapy treatment

Answer 8

radical: 4-6 weeks (apart from stereotactic)
palliative: 2-3 weeks (aim to relieve symptoms not cure)

Question 9

what is stereotactic radiotherapy

Answer 9

where radiotherapy is given from many different angles around the body - the tumour receives a high dose of radiation and the tissues around it receive a much lower dose, lowering the risk of side effects

Question 10

when is post-operative radiotherapy given

Answer 10

when the tumour is known to extend to the surgical margins

Question 11

when is endobronchial radiotherapy used and how is it done

Answer 11

used for effective palliative symptom relief; achieved by using a bronchoscope to place a radioactive isotope in the bronchus

Question 12

what kind of tumours would be suitable or stereotactic radiotherapy (location etc.)

Answer 12

peripheral tumours - no nodal disease; away from blood vessels and airways

Question 13

what is respiratory gaiting and what is its use in radiotherapy

Answer 13

a system that tracks a patient’s normal respiratory cycle with an infrared camera and chest/abdomen marker;
The system is coordinated to only deliver radiation when the tumor is in the treatment field

Question 14

examples of chemotherapies for lung cancer

Answer 14

cisplatin; carboplatin; gemcitabine, placlitaxel

Question 15

when is chemotherapy used in lung cancer (3)

Answer 15

1. adjuvant chemotherapy after surgery for NSCLC;
2. radical chemo-RT for potentially curable tumours which are locally extensive;
3. palliative chemotherapy in advanced disease

Question 16

examples of biological agents

Answer 16

erlontinib (tarveca), gefitinib (iressa) - EGFR tyrosine kinase inhibitors