Non operative management of Lung cancer

Question 1

What is combined with surgery treatment of lung cancer

Answer 1

adjuvant/neoadjuvant therapy

Question 2

What is the aim of adjuvant treatment

Answer 2

Increase chance of cure, applied after surgical treatment to make sure all tumour cells are removed

Question 3

What is neo- adjuvant treatment in Lung cancer

Answer 3

Pre -operative chemotherapy

Question 4

What is the main effects of radiotherapy

Answer 4

Inflammation and fibrosis

Question 5

What do you need to check with the patient before starting radiotherapy and how do you check this

Answer 5

Patient can withstand the toxics effects of radiotherapy

Pulmonary function tests

Question 6

What is the best systemic treatment

Answer 6

Chemoradiotherapy

Question 7

What is the treatment plan based for in the diagnosis of stage 4 lung cancer

Answer 7

palliative care with radiotherapy and chemotherapy

Question 8

How much can you reduce symptoms in stage 4 Lung cancer with radiotherapy

Answer 8

Up to 70%

Question 9

What does radiotherapy aid in stage 4 lung cancer

Answer 9

Help breathlessness if the lung has collapsed,
eases pain
Gets ride of heamoptysis

Question 10

What is given as palliative treatment to bone metasisis

Answer 10

radiotherapy

Question 11

What is the new treatment for adenocarcinomas if patient has EGFR mutation

Answer 11

Tryosine kinase inhibitors

Question 12

What is the different adenocarcincoma biomarkers

Answer 12

EGFR - mutation
ALK - translocation
BRAF - mutation
ROS - alteration

Question 13

Why is it important to figure out the molecular biology of the patients tumour

Answer 13

To figure out what targeted drug therapy is needed to that a potential mutation

Question 14

If you cant figure out the molecular biology of the patients tumour what is the treatment plan

Answer 14

Chemotherapy

Immunotherapy treatments

Question 15

What is the problem of small cell lung cancer

Answer 15

practically untreatable

Question 16

What is the treatment plan for small cell lung cancer

Answer 16

a combination of drugs – this is a palliative form of care rather than curative

Question 17

How much does chemotherapy prolong survival in small cell lung cancer

Answer 17

8 weeks till 8 months

Question 18

What is the two histological subtypes of lung cancers

Answer 18

small cell lung cancer - 15%

Non small cell lung cancer - 85%

Question 19

What cancers fall are classed as non small cancer

Answer 19

adenocarcinoma

squamous

Question 20

What is the different therapeutic options for Lung cancer

Answer 20

¡ Surgery
¡ Radiotherapy - curative (radical) or palliative ¡ Chemotherapy
¡ Combination of above
¡ Targeted therapies

Question 21

What does therapeutic optics depend upon

Answer 21

Tumour type; 
stage; 
ECOG performance status; 
patient wishes and options; 
aims of therapy (curative or palliative)
Co- morbidity status

Question 22

What stage is adjuvant therapy most important

Answer 22

stage I and II;

Question 23

What is the characteristics of stage 3 and stage 4 in non small cell lung cancer

Answer 23

metastases

Question 24

what is the treatment plan for stage 3 non small cell lung cancer

Answer 24

Combine radiotherapy and chemotherapy, with an increased toxicity

Question 25

What are the two advancing symptoms of stage 3- 4 lung cancer that can affect your quality of life

Answer 25

Painful bone metastases | Brain metastases

Question 26

How is brain metastases managed in lung cancer

Answer 26

resection, Radiotherapy steroids

Question 27

What is the characteristic of bone metastasis

Answer 27

``` affects any site worse at night Bad pain radiating down front of the leg sore to pee constipation cord compression leads to paraplegia ```

Question 28

What is the chemotherapy drug for adenocarcinoma

Answer 28

Pemetrexed + Cisplatin

Question 29

What is an example of a immunotherapy drug and its mechanism

Answer 29

Nivolumab BMS - check point inhibitor | blocks PDL1 the signal that prevent T cells attacking cancer cells, therefore allowing T cell activation to clear cancer

Question 30

How long does its take small cell Lung cancer to double

Answer 30

29 days

Question 31

What is the difference in the treatment plan for small cell lung cancer - as more advanced disease

Answer 31

Chemotherapy - essential and best choice Need a combination of drugs Need early thoracic radiotherapy Prophylactic cranial radiation - prevent brain metastases

Question 32

What is he combination of chemotherapy drug used in the treatment of small cell lung cancer

Answer 32

cisplatin+ etoposide

Question 33

What has no effect or advantage on the treatment of small cell lung cancer

Answer 33

— High dose chemo/— Alternating chemo/— Maintenance chemo/— Chemo ‘on demand’ These literally have no clinical advantage, better to use a more efficient dose as will have the same outcome without causing all the unneeded side effects