Early Stage NSCLC

Question 1

Adenocarcinoma

Answer 1

• Common histology
• 48% of all lung cancers
• Peripheral lesions

Question 2

Squamous cell carcinoma

Answer 2

• Central lesions
• 20% of all lung cancers

Question 3

Common mutation

Answer 3

EGFR (transmembrane tyrosine kinase) mutation

Question 4

EGFR is targetable with
seen in 17% of NSCLC

Answer 4

IO
- Osimertinib
- Erlotinib
- Gefitinib
- Afatinib

Question 5

ROS-1 is targetable with
seen in 1-2% of NSCLC

Answer 5

Ceritinib

Question 6

BRAF
MET
RET
KRAS

Answer 6

BRAF- Vemurafenib
MET- Crizotinib
RET- Cabozatinib
Kras- Sotorasib

Question 7

Screening

Answer 7

50-80 years
>20 pack year smoking history & <15 years since cessation
Low dose CT Chest

Question 8

Clinic presentation

Answer 8

cough
dyspnea
wheeze
stridor
hemoptysis
weight loss
anorexia

Question 9

PTHrp

Answer 9

• Hypercalcemia
• SCC

Question 10

Paraneoplastic syndromes

Answer 10

• PTHrp
• Hypertrophic osteoathropathy

Question 11

PFTs

Answer 11

Tidal volume. This is the amount of air breathed in or out during normal breathing.

Vital capacity. This is the total volume of air that can be breathed out after breathing in as much as you can.

Functional residual capacity. This is the amount of air left in lungs after breathing out normally.

Residual volume. This is the amount of air left in the lungs after breathing out as much as you can.

Total lung capacity. This is the total volume of the lungs when filled with as much air as possible.

Forced vital capacity (FVC). This is the amount of air breathed out forcefully and quickly after breathing in as much as you can.

Forced expiratory volume. This is the amount of air breathed out during the first, second, and third seconds of the FVC test.

Forced expiratory flow. This is the average rate of flow during the middle half of the FVC test.

Peak expiratory flow rate. This is the fastest rate that you can force air out of your lungs.

Question 12

Medically inoperable PFTs

Answer 12

FEV1 <40%
DLCO < 40%
pO2 <70mmHg
pCO2 >50mmHg

Question 13

Work up

Answer 13

H&P
PFT
CBC
CMP
CT Chest W/WO
PET Scan
MRI Brain for stage II or higher
EBUS/ Biopsy

Question 14

Pathological lymph nodes are defined as

Answer 14

> 1.0cm diameter on short axis

Question 15

Bulky LN is defined as

Answer 15

> 3.0 cm diameter on short axis

Question 16

EBUS

Answer 16

2,4,7
8,9,10
- 85% sensitive

Question 17

VATS

Answer 17

5,6

Question 18

Mediastinoscopy

Answer 18

2,4,7
-79% sensitive

Question 19

Poor Prognostic factors

Answer 19

stage
weight loss >5%
KPS<90
age>70
LVSI

Question 20

T Staging

Answer 20

Question 21

N Staging

Answer 21

Question 22

Overall staging

Answer 22

Question 23

Solitary pulmonary nodule

Answer 23

<3cms
>8mm- PET CT

Question 24

Malignant features of the nodule

Answer 24

Faster growth rate
Lack of calcifications
greater size
spiculated margins
solid appearance
contrast enhanced
high SUV

Question 25

Treatment paradigm

Answer 25

Surgery if operable RT if medically not operable

Question 26

Role of chemotherapy

Answer 26

Adjuvant systemic therapy from Stage IIB onwards

Question 27

Adjuvant CRT

Answer 27

Residual disease positive margins

Question 28

Early stage definition

Answer 28

Stage I or II without nodal involvement So staging of mediastinum is important

Question 29

EBUs + Mediastinoscopy

Answer 29

94% Sensitive - Avoided unnecessary thoracotomies

Question 30

Lobectomy or wedge resection

Answer 30

Lobectomy was superior