Lung Cancer

Question 1

Describe the TNM stage
Tumor -5cm RLL
N - right paratracheal and sub carina
M -0

Answer 1

T2b- 4-5cm (inclusive)
N2- ipsilateral mediastinal or sub carina
M-O

Stage 3A

Question 2

Stage this tumor

T- 4.2cm right LL with destruction of adjacent rib

Answer 2

T3- tumor involving the chest wall, pericardium, phrenic nerve, satellite module in same lobe or >5-7com
n0
M0
Stage 2B

Question 3

Stage this NSCLC
T- 3.7cm RLL tumor with right mainstem bronchus involvement
N -contralateral mediastinum
M0

Answer 3

T2a- involves bronchus but not carina (carina =t4), and T2a =3-4cm
N3- contralateral mediastinal
M-0
Stage 3b

Question 4

What is considered adequate in shuttle walk test

Answer 4

> 25 shuttles

Question 5

In the national lung cancer screening trial (NLST) what was the difference in radiation dose? What was considered a positive screen?

Answer 5

Annual lose dose CT x 3 versus chest X-ray
1.5 mSv used compared to average of 8

Positive screen: non calcified solid nodule > 4mm, new adenopathy or effusion

Question 6

In the national lung cancer screening trial (NLST) what we’re the results of annual screening?

Answer 6

Relative reduction of 20%
NNT = 320
Lots of false positives

Question 7

What is the recommendation for lung cancer screening?

Answer 7

Annual low dose CT scan
Age 55-74
With a 30 pack year hx who smoke or quit <15 yrs ago
3 consecutive years

Question 8

What are the cutoffs for PFT before proceeding to lung cancer surgery?

Answer 8

Post operative Fev1 or DLCO < 60% predicted—> proceed
30-60%—-> shuttle walk (>400m)
<30% cpet —-> >10ml/kg/min

Question 9

List the components of the thoracic RCRI

Answer 9

Pneumonectomy- 1.5
Previous Cad- 1.5
Stroke or tia- 1.5
Gfr< 30 - 1 pt

Score >=2 means cardiac consultation required

Question 10

What are 3 ways to reduce perioperative risk and improve pulmonary disability

Answer 10

1. Smoking cessation
   2 pulmonary rehabilitation
2. Concomitant lung volume reduction surgery

Question 11

What are three tyrosine kinase inhibitors that target the EGFR mutation?

Answer 11

Gefitinibb, erlotinib, afatinib

Question 12

List 5 risk factors for lung cancer aside from smoking

Answer 12

Asbestos
Silicosis
Radon, uranium mining
Genetic
HIV

Question 13

List an adjuvant therapy for EGFR+ lung cancer

Answer 13

Osimertinib

Question 14

List two examples of immunotherapy directed at PDL-1

Answer 14

Durvalumab

Pembrolizumab